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Found 588667 cases in entire database

Case Details (Sorted by Age)

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VAERS ID:165420 (history)  Vaccinated:2000-11-15
Age:33.0  Onset:2000-11-15, Days after vaccination: 0
Gender:Female  Submitted:2001-01-17, Days after onset: 63
Location:Pennsylvania  Entered:2001-01-30, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ5928515JAN2001
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4008176 IM 
Administered by: Private     Purchased by: Private
Symptoms: Feeling abnormal, Hypoaesthesia oral, Lymphadenopathy, Pallor, Tongue oedema
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dementia (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: A nurse reported that a 33 year old female received an injection of Flu Shield ''00-''01 on 11/15/00. Immediately, post vax, she developed a painful knot in her neck. She was treated with ibuprofen and it resolved after 3 hours. Later that day, she developed a swollen tongue and numb lips that "felt like pins and needles". She felt strange and became pale. She was treated with oral diphenhydramine. She recovered on 11/16/00. This is 1 of 3 pts from this facility who had an adverse experience following receipt of Flu Shield ''00-''01, lot 4008176.

VAERS ID:165426 (history)  Vaccinated:2000-11-28
Age:33.0  Onset:2000-11-28, Days after vaccination: 0
Gender:Male  Submitted:2000-12-21, Days after onset: 23
Location:Iowa  Entered:2001-01-30, Days after submission: 40
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CellCept, Neoral, Norvasc, Pepcid, Prednisone, Toprol XL
Current Illness: UNK
Preexisting Conditions: Renal transplant
Diagnostic Lab Data: UNK
CDC Split Type: HQ4284430NOV2000
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH  IM 
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  SC 
Administered by: Private     Purchased by: Other
Symptoms: Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: A pharmacist reported that a 33 year old male pt received Flu Shield ''00-''01 and Pneumovax on 11/28/00. On that same date, the pt developed an injection site reaction characterized by a hard knot. The event has since resolved.

VAERS ID:165706 (history)  Vaccinated:2000-07-06
Age:33.0  Onset:2000-07-06, Days after vaccination: 0
Gender:Male  Submitted:2001-01-18, Days after onset: 196
Location:New Jersey  Entered:2001-02-02, 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: Paxil
Current Illness:
Preexisting Conditions: Anxiety disorder
Diagnostic Lab Data: ECG ST Elevations (Normal Range : None) 07/06/2000
CDC Split Type: 20000358461
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM146A90IM 
Administered by: Other     Purchased by: Other
Symptoms: Anxiety, Chest pain, Dyspnoea, Laboratory test abnormal
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypoglycaemia (broad)
Write-up: Less than one hour post vax, the pt experienced dyspnea and chest pain which lasted three hours and then resolved. Lymerix was discontinued. An ECG taken on 07/06/2000 showed ST elevations (NR: none). A cardiac evaluation yielded no cardiac disease. The reporting physician stated that the event could be associated with the pts anxiety disorder. As of 12/12/2000 the outcome of the event is recovered without complications.

VAERS ID:165572 (history)  Vaccinated:2000-10-24
Age:33.0  Onset:2000-10-24, Days after vaccination: 0
Gender:Male  Submitted:2001-02-01, Days after onset: 100
Location:Texas  Entered:2001-02-06, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Open wound
Preexisting Conditions: allergy to PCN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID, ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES472207 IM 
Administered by: Other     Purchased by: Other
Symptoms: Respiratory arrest
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Respiratory failure (narrow)
Write-up: The pt went into respiratory arrest within minutes of receiving a tetanus toxoid injection.

VAERS ID:165604 (history)  Vaccinated:2001-01-09
Age:33.0  Onset:2001-01-09, Days after vaccination: 0
Gender:Female  Submitted:2001-01-17, Days after onset: 8
Location:Virginia  Entered:2001-02-06, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hep C, S/P splenectomy following MVA 9/2000.
Diagnostic Lab Data:
CDC Split Type: VA01005
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4008179 IMLA
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS3376A42IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1070K0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Cellulitis, Injection site erythema, Injection site oedema, Injection site reaction, Injection site warmth, Pancreatitis, Pneumonia
SMQs:, Acute pancreatitis (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Approximately 12 hours post vax area around puncture site became swollen, warm and red. Used warm compresses. Still a problem next morning. Exam done by MD 24 hours post injection. Dx as local reaction to vax. Arm did not improve and patient saw private MD, dx cellulitis placed on Amoxicillin. 1/11/01 Arm improved. Pt incidentally developed pneumonia in both lungs and pancreatitis in the early post vax period.

VAERS ID:165605 (history)  Vaccinated:2001-01-22
Age:33.0  Onset:2001-01-23, Days after vaccination: 1
Gender:Female  Submitted:2001-01-23, Days after onset: 0
Location:North Carolina  Entered:2001-02-06, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: NONE
Preexisting Conditions: allergy to Amoxicillin
Diagnostic Lab Data:
CDC Split Type: NC00008
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0465AA IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0690K0IMLA
Administered by: Public     Purchased by: Other
Symptoms: Groin pain, Hypoaesthesia, Joint range of motion decreased, Oedema, Pain
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Osteonecrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Pt. woke up on 1/23 with pain in left axilla , left arm, and left inguinal groin area. Pt. states left arm feels numb, tingling, swollen. Hard to put through ROM wonders if related to injection on left side yesterday 1/22.

VAERS ID:165611 (history)  Vaccinated:2001-01-23
Age:33.0  Onset:2001-01-23, Days after vaccination: 0
Gender:Female  Submitted:2001-01-29, Days after onset: 6
Location:Kentucky  Entered:2001-02-06, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zyrtec, ibuprofen, Vanconase
Current Illness: spider bite and sinus infection
Preexisting Conditions: allergy to sulfa and Augmentin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESV0012AA6IMLA
Administered by: Public     Purchased by: Private
Symptoms: Erythema, Injection site induration, Skin burning sensation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Peripheral neuropathy (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: On 1/23/01 the pt experienced redness and burning. The pt''s whole arm hurt. The next day, large red whelp and hardness, but was still red. Two days later the whelp is beginning to resolve.

VAERS ID:165623 (history)  Vaccinated:1999-12-22
Age:33.0  Onset:1999-12-22, Days after vaccination: 0
Gender:Male  Submitted:2001-01-25, Days after onset: 400
Location:Minnesota  Entered:2001-02-06, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
IPV: POLIO VIRUS, INACT. (POLIOVAX)CONNAUGHT LTD.P03592   
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME)PFIZER/WYETH4998088   
Administered by: Private     Purchased by: Private
Symptoms: Hyperhidrosis, Malaise, Nausea, Syncope vasovagal
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: The pt experienced vagal symptoms, diaphoretic, syncope. No long term problem. The pt was "ill" and nauseous for 3 days post vax.

VAERS ID:166049 (history)  Vaccinated:2000-07-24
Age:33.0  Onset:0000-00-00
Gender:Female  Submitted:2000-10-03
Location:Ohio  Entered:2001-02-21, Days after submission: 141
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ9805014AUG2000
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTPHIB: DTP + HIB (TETRAMUNE)LEDERLE LABORATORIES  IMLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)
Write-up: A 33 year old female reported that she received an injection of Tetanus Toxoid Adsorbed, on 07/24/00. A few days after vaccine administration, she developed an injection site reaction characterized by redness and pain. She states she was unable to raise her arm above her head. She also experienced generalized weakness. She recovered after 5 to 6 days.

VAERS ID:166138 (history)  Vaccinated:2000-05-26
Age:33.0  Onset:2000-06-07, Days after vaccination: 12
Gender:Female  Submitted:2000-10-03, Days after onset: 118
Location:Florida  Entered:2001-02-22, Days after submission: 142
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: Allergen skin test-positive (reportedly positive for tetanus)
CDC Split Type: HQ9804114AUG2000
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES49883622IM 
Administered by: Public     Purchased by: Public
Symptoms: Hypersensitivity, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: A 33 year old female reported that she received an injection of Tetanus Toxoid Adsorbed, Ultrafined on 5/26/00. On 6/7/00, she developed hives. She was seen by her physician who prescribed Claritin and Benadryl. Allergy testing was reportedly positive for tetanus. The hives persisted and she was treated with prednisone on 7/5/00. On 8/10/00, the physician prescribed Tagamet and an unspecified antihistamine along with the Claritin previously prescribed.

VAERS ID:166188 (history)  Vaccinated:2000-11-21
Age:33.0  Onset:2000-11-23, Days after vaccination: 2
Gender:Female  Submitted:2001-02-20, Days after onset: 89
Location:Kansas  Entered:2001-02-27, 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: Desogen
Current Illness: NONE
Preexisting Conditions: Allergy to Biaxin
Diagnostic Lab Data: Echocardiogram; CAT Scan of chest; Chest X-ray; CBC; Lupus test
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0414BB1IM 
Administered by: Other     Purchased by: Private
Symptoms: Back pain, Chest pain, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Approx. 2 days, post vax, the pt reached down to pick up child and felt a popping sensation. Resulted in pericarditis possibly. Fluid between lung and chest wall (left). Signs and symptoms continued: Hurts when you supine. Placed on steroids and Vioxx. Pain through my rib cage on left side. Amoxicillin on 2/20/01.

VAERS ID:166284 (history)  Vaccinated:2000-12-22
Age:33.0  Onset:2000-12-23, Days after vaccination: 1
Gender:Female  Submitted:2001-02-15, Days after onset: 54
Location:Michigan  Entered:2001-03-01, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Restoril, Cloniper, Diazide, Ultram
Current Illness: NONE
Preexisting Conditions: PCN, Amoxicillin, Zomiq, Imitrex
Diagnostic Lab Data: CBS, Comp.met. panel,ArVA, sed rate, chest x-ray, EKG
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1168K SC 
Administered by: Public     Purchased by: Public
Symptoms: Arthralgia, Chest pain, Dizziness, Dyspnoea, Feeling cold, Headache, Hot flush, Nausea, Visual disturbance
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Arthritis (broad), Hypoglycaemia (broad)
Write-up: Pt reports hot and cold flashes, dizziness, vision,nausea, headache,arthralgia. Developed chest pain and dyspnea. Seen in ER given fluids IV and IV anti emetics.

VAERS ID:166300 (history)  Vaccinated:2001-02-12
Age:33.0  Onset:2001-02-13, Days after vaccination: 1
Gender:Female  Submitted:2001-02-14, Days after onset: 1
Location:New Hampshire  Entered:2001-03-02, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Laceration face
Preexisting Conditions: Penicillin/macrobid
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0365HA IM 
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt reports swelling, edema, pain plus erythema,plus indurate. negative d/c negative paresthesia.

VAERS ID:166364 (history)  Vaccinated:2001-02-20
Age:33.0  Onset:2001-02-21, Days after vaccination: 1
Gender:Male  Submitted:2001-02-21, Days after onset: 0
Location:Florida  Entered:2001-03-02, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM684B61IMLL
Administered by: Public     Purchased by: Other
Symptoms: Headache, Malaise, Musculoskeletal stiffness
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)
Write-up: The pt experienced a headache, neck stiffness, and malaise.

VAERS ID:166407 (history)  Vaccinated:2001-01-24
Age:33.0  Onset:2001-01-24, Days after vaccination: 0
Gender:Male  Submitted:2001-02-15, Days after onset: 22
Location:Connecticut  Entered:2001-03-05, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 20010043221
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM147B90IM 
Administered by: Other     Purchased by: Other
Symptoms: Dizziness, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)
Write-up: The pt received his 1st Lymerix injection on 1/24/01. Immediately, post vax, he became light-headed and dizzy and experienced blurred vision. He recovered "within moments", without treatment. The reporter stated that "it sounded like" the pt "had a problem with needles."

VAERS ID:166436 (history)  Vaccinated:2001-01-12
Age:33.0  Onset:2001-01-14, Days after vaccination: 2
Gender:Female  Submitted:2001-01-24, Days after onset: 10
Location:Arizona  Entered:2001-03-05, Days after submission: 40
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: metformin, Zantac, albuterol, MDI
Current Illness: NONE
Preexisting Conditions: Diabetes; asthma; GERD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)MEDEVA PHARMA, LTD.E71770L0IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0820K SCLA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0362AA1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site inflammation, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Routine TD given in clinic. Returned, 2 days, later with erythemic area 5" X 3", just proximal to elbow. Tenderness, inflammation. No lesions, no drainage.

VAERS ID:166529 (history)  Vaccinated:2000-11-13
Age:33.0  Onset:2000-11-13, Days after vaccination: 0
Gender:Female  Submitted:2000-12-27, Days after onset: 44
Location:California  Entered:2001-03-05, Days after submission: 68
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: HQ4746112DEC2000
Vaccination
Manufacturer
Lot
Dose
Route
Site
TYP: TYPHOID VI POLYSACCHARIDE (ACETONE INACTIVATED DRIED)PFIZER/WYETH4998062 SCLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt reported injection site swelling within hrs developed local swelling on arm the size of a baseball.

VAERS ID:166641 (history)  Vaccinated:1999-08-20
Age:33.0  Onset:2000-08-01, Days after vaccination: 347
Gender:Male  Submitted:2000-09-13, Days after onset: 43
Location:Rhode Island  Entered:2001-03-06, Days after submission: 174
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Pain medicine; Vicodin; Soma
Current Illness: Sinusitis; dizziness
Preexisting Conditions: NONE
Diagnostic Lab Data: Lyme test; CBC; triglycerides, etc
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM 0IM 
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Asthenia, Back pain, Chest pain, Dizziness, Flushing, Hypoaesthesia, Joint swelling, Muscle twitching, Sinusitis
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Severe sinus symptoms without fever; severe flushing; severe back and knee pain; severe joint pain and swelling; twitching of muscles (uncontrollably); severe weakness (has been in bed since); severe dizziness; numbness of face and arm; chest pain with tingling.

VAERS ID:166680 (history)  Vaccinated:2000-11-14
Age:33.0  Onset:2000-11-14, Days after vaccination: 0
Gender:Female  Submitted:2000-12-04, Days after onset: 20
Location:Michigan  Entered:2001-03-07, 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: NONE
Preexisting Conditions: Had pneumococcal pneumonia 05/00.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4630160SCLA
Administered by: Public     Purchased by: Private
Symptoms: Arthralgia, Asthenia, Hypoaesthesia, Injection site hypersensitivity, Injection site oedema, Injection site pain, Joint range of motion decreased, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: This patient had a local reaction, pain, swelling, erythema, large area of upper arm, affected strength and ROM, and numbness persisted over 48 hours. Treatment was Ibuprofen, cold compresses, diphenhydramine HCL; also had systematic reaction, myalgia, and arthralgia.

VAERS ID:166714 (history)  Vaccinated:2001-01-19
Age:33.0  Onset:2001-01-19, Days after vaccination: 0
Gender:Male  Submitted:2001-01-31, Days after onset: 12
Location:Texas  Entered:2001-03-07, Days after submission: 35
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Anti-inflammatory medication.
Current Illness: Sinus infection
Preexisting Conditions: Allergic to Toradol, Codeine, flu shot.
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS3369B60IMLA
Administered by: Other     Purchased by: Public
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: This patient had a rash and itching on his neck and trunk. The patient took Benadryl for 3 days.

VAERS ID:166795 (history)  Vaccinated:0000-00-00
Age:33.0  Onset:0000-00-00
Gender:Female  Submitted:2001-03-02
Location:California  Entered:2001-03-08, 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: UNK
Current Illness:
Preexisting Conditions: Pregnancy (LMP-UNK)
Diagnostic Lab Data:
CDC Split Type: WAES99082119
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Other     Purchased by: Other
Symptoms: Abortion
SMQs:, Termination of pregnancy and risk of abortion (narrow)
Write-up: Information has been received through the pregnancy registry from a physician concerning her sister-in-law, a 33 year old female who was vaccinated with varicella virus vaccine live. Shortly thereafter, the pt was found to have been 2 weeks pregnant at the time of vaccination. Follow-up was received which indicated the pt had a 1st trimester elective abortion. No medical indication was reported; the decision was personal. No further information is available. Follow up on 06/29/2001: "Patient date of birth, adverse event onset date/time, lot # for vaccine 1, vaccine administration date/time is not provided."

VAERS ID:166904 (history)  Vaccinated:2001-02-01
Age:33.0  Onset:2001-02-01, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Massachusetts  Entered:2001-03-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Allergic to some foods- oysters
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS3369A61IMLA
Administered by: Other     Purchased by: Private
Symptoms: Diarrhoea, Malaise, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Vomiting, malaise, diarrhea

VAERS ID:166924 (history)  Vaccinated:2001-01-02
Age:33.0  Onset:2001-01-03, Days after vaccination: 1
Gender:Female  Submitted:2001-02-26, Days after onset: 54
Location:Indiana  Entered:2001-03-12, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Toprol XL
Current Illness: NONE
Preexisting Conditions: High blood pressure
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1064J1IM 
Administered by: Other     Purchased by: Other
Symptoms: Injection site pain, 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 (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Local reaction with soreness, pain or tenderness, itching, swelling and warmth. Doctor prescribed Benadryl and it went away after 3-4 weeks of taking the Benadryl.

VAERS ID:166943 (history)  Vaccinated:2001-02-12
Age:33.0  Onset:2001-02-13, Days after vaccination: 1
Gender:Female  Submitted:2001-02-14, Days after onset: 1
Location:Missouri  Entered:2001-03-12, Days after submission: 26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Carafate, Zantac
Current Illness:
Preexisting Conditions: GI upset "1 week before vaccinations"-began taking Carafate and Zantac.
Diagnostic Lab Data:
CDC Split Type: MO2001008
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0254K1SCRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0298AA1IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0331K1SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Client reports itching, redness, swelling and pain in left upper arm.

VAERS ID:167121 (history)  Vaccinated:2001-02-06
Age:33.0  Onset:2001-02-07, Days after vaccination: 1
Gender:Female  Submitted:2001-02-08, Days after onset: 1
Location:Idaho  Entered:2001-03-14, Days after submission: 34
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: Seasonal allergies
Diagnostic Lab Data: NONE
CDC Split Type: ID01009
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS3369B61IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site haemorrhage, Injection site mass, Injection site warmth, Pruritus
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Had a hard lump, 30 minutes, post vax. It was warm at bedtime and felt a little itchy. Had blood on arm the size of a 50 cent piece and site was king of blue. On 2/7/01 AM, still had bruise (blue). At noon it started severe itching and area got redder and hard spot grew to 1" to 1 1/2" in diameter. By the evening, area was 6" to 8" long and 3" wide (red, hard and hot). She used cool compresses and ibuprofen. The next AM, she went to MD and was prescribed Augmentin.

VAERS ID:167459 (history)  Vaccinated:2000-02-24
Age:33.0  Onset:0000-00-00
Gender:Female  Submitted:2001-03-07
Location:Pennsylvania  Entered:2001-03-15, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Clindamycin, Retin-A
Current Illness:
Preexisting Conditions: acne
Diagnostic Lab Data:
CDC Split Type: WAES00032250
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC. 2  
Administered by: 0     Purchased by: 0
Symptoms: Erythema multiforme
SMQs:, Severe cutaneous adverse reactions (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information rec''d from HCP reports post vaccine the pt experienced a rash that was diagnosed a erythema multiforme. The reporter states that the pt did not experience any adverse reactions to the previous 2 vaccine.

VAERS ID:167216 (history)  Vaccinated:2001-02-02
Age:33.0  Onset:2001-02-02, Days after vaccination: 0
Gender:Female  Submitted:2001-02-10, Days after onset: 8
Location:Unknown  Entered:2001-03-16, Days after submission: 34
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONS 4SCRA
Administered by: Military     Purchased by: Military
Symptoms: Headache, Injection site reaction, Malaise, Nausea, Petechiae
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Pt complained of headache, feeling ill and nausea, onset 1-2 hours, post vax. Had petechial rash at site of vaccine. Atraumatic injection. Treatment with Motrin and Benadryl.

VAERS ID:167679 (history)  Vaccinated:2000-03-14
Age:33.0  Onset:2000-03-14, Days after vaccination: 0
Gender:Female  Submitted:2000-04-26, Days after onset: 42
Location:Pennsylvania  Entered:2001-03-21, Days after submission: 329
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prilosec
Current Illness: UNK
Preexisting Conditions: GERD; Hiatal hernia
Diagnostic Lab Data: UNK
CDC Split Type: HQ1739022MAR2000
Vaccination
Manufacturer
Lot
Dose
Route
Site
DT: DT ADSORBED (NO BRAND NAME)PFIZER/WYETH4988357 IMRA
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: A physician reported that a 33 year old female inadvertently, received an injection of Diphtheria and Tetanus Toxoids Adsorbed Ultrafined, Pediatric on 3/14/00 and experienced an injection site reaction characterized by swelling, redness and pain. The pt also developed a fever. On 3/16/00, she was treated with Augmentin and recovered on 3/23/00. Information received from the vaccine provider on 4/20/00 supplied pt data and stated that the pt recovered.

VAERS ID:167818 (history)  Vaccinated:2001-02-20
Age:33.0  Onset:2001-02-20, Days after vaccination: 0
Gender:Female  Submitted:2001-03-15, Days after onset: 23
Location:West Virginia  Entered:2001-03-26, 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: NONE
Diagnostic Lab Data: Neg Omm
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS3375A40IM 
Administered by: Public     Purchased by: Other
Symptoms: Asthenia, Blood pressure decreased, Dizziness, Dry mouth, Feeling cold, Hyperhidrosis, Hypoventilation, Malaise, Pruritus, Tremor, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: At first pt felt weird, became weak, shaking, cold sweat, threw up, blood pressure bottomed out, shallow breathing, itching, dry mouth, tired and dizzy. Symptoms started approximately 15 minutes post vax, was made to sit in clinic until strong enough to go down the hall and out to ER. There pt was treated with epinephrine and Benadryl. The next day the pt experienced tiredness and dry mouth.

VAERS ID:168018 (history)  Vaccinated:1991-01-29
Age:33.0  Onset:0000-00-00
Gender:Male  Submitted:2001-03-02
Location:Ohio  Entered:2001-04-02, Days after submission: 30
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Nausea, Diarrhea, chest pain, light headed, urinating blood.
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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ANTH: ANTHRAX (NO BRAND NAME)UNKNOWN MANUFACTURER 1SC 
Administered by: Military     Purchased by: Military
Symptoms: Abdominal pain, Back pain, Diarrhoea, Fatigue, Headache, Hypoaesthesia, Muscle spasms, Prostatic disorder, Testicular disorder
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Fertility disorders (narrow), Noninfectious diarrhoea (narrow)
Write-up: After 1st Anthrax, sought treatment on 1/11/91. On 1/21/91, I returned to the Medical Aid Station still complaining of throbbing pain in the lower left back to left testicle. On 1/22/91, I returned again, with lower left back pain and abdominal cramping. During the exam, the prostate felt burning on palpation and was boggy, 2-3cm. I was to return for a follow-up in 7 days. On 1/29/91, I received the Anthrax 2 vaccine. The next day, I returned for a follow-up. Doxycycline (known treatment for the side affects of P. B. pills and the Persian Gulf Syndrome) was still continued for 14 days. When each 1 of these exposures (Anthrax, environmental chemicals, warfare and P. B. pills) are administered individually, the toxicity levels have been reported to be bad enough! Being exposed to these exposures within a 3 week time span (exposure to some for longer periods), can reportedly multiply the toxicity level 25 to 35 times more! Given the known side affects of some exposures and the unknown long term affects of other exposures, combined with a cocktail of all these exposures, I feel it is safe to say that I acquired an unknown illness/Persian Gulf Syndrome! Dx''s given in the past were just actual symptoms of an unknown illness/Persian Gulf Syndrome. The unknown illness/Persian Gulf Syndrome is a probable result of a series of exposures that I was exposed to, that have very little or no data on side affects, thus Undiagnosed Illness. I feel that I should be awarded 100% Service Connection since 4/3/98, when the MD signed a set of severe limitations in which he indicated that I was unable to do 98% of the physical requirements of my job, which eventually led to the termination of my job!. This is my complete statement of what happened to me. I have documentation to uphold this statement! Have been seeking treatment from VA since 10/96 until the present and ongoing treatment. A follow up report received 04/11/2001 adds: (Current symptoms:) Numbness in fingers and toes, muscle cramps and spasms, muscle aches, joint pain and discomfort, back pain with lower back pain dominant, headaches, fatigue, sensitivity to light, abdominal cramps, chronic diarrhea and occasional burning sensation while urinating.

VAERS ID:168544 (history)  Vaccinated:2000-08-16
Age:33.0  Onset:2000-08-20, Days after vaccination: 4
Gender:Male  Submitted:2001-01-15, Days after onset: 148
Location:New York  Entered:2001-04-05, Days after submission: 79
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: U2000006680
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER    
JEV: JAPANESE ENCEPHALITIS (J-VAX)CONNAUGHT LABORATORIES 1  
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Dizziness, Erythema, Face oedema, Fatigue, Nausea, Oedema peripheral, Pruritus, Rash erythematous
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: It was reported that a 33 year old male patient received a JE-VAX and a Hepatitis B vaccination on 08/16/00. Reportedly 4 days after the vaccination 08/20/00, the patient developed itchy, red, and puffy rash over her entire body. She had fatigue, mild dizziness, nausea, swelling of her eyes, lower lips, hands, and joint pain. From additional correspondence received on 10/12/00, it was reported that the patient recovered from this experience. Additional vaccine, patient and responsible physician info was also provided. No further info is expected, this case is closed.

VAERS ID:168371 (history)  Vaccinated:1991-03-01
Age:33.0  Onset:1991-03-01, Days after vaccination: 0
Gender:Male  Submitted:2001-03-31, Days after onset: 3683
Location:Unknown  Entered:2001-04-06, Days after submission: 5
Life Threatening? Yes
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: 1984 diagnosed with Grave''s disease
Diagnostic Lab Data: biopsy
CDC Split Type:
Vaccination
Manufacturer
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ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONS 1SC 
Administered by: Military     Purchased by: Other
Symptoms: Pemphigoid
SMQs:, Severe cutaneous adverse reactions (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: The pt experienced Pemphigus Vulgaris.

VAERS ID:168409 (history)  Vaccinated:2000-04-10
Age:33.0  Onset:0000-00-00
Gender:Male  Submitted:0000-00-00
Location:Pennsylvania  Entered:2001-04-09
Life Threatening? No
Died? No
Permanent Disability? Yes
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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LYME: LYME (LYMERIX)SMITHKLINE BEECHAM  IM 
Administered by: Private     Purchased by: Other
Symptoms: Arthralgia, Hypoaesthesia, Joint stiffness, Neck pain
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: This patient had tingly numbness, joint stiffness, neck pain, and joint pain. Per doc 212646, patient still has joint pain, soreness.

VAERS ID:168630 (history)  Vaccinated:1999-05-10
Age:33.0  Onset:1999-07-01, Days after vaccination: 52
Gender:Female  Submitted:2003-02-14, Days after onset: 1324
Location:Delaware  Entered:2001-04-12, Days after submission: 673
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Allergy medication, Loratadine, Azithromycin, Pseudoephedrine HCl, nasal (unspecified), methylprednisolone, Biaxin
Current Illness:
Preexisting Conditions: She is allergic to penicillin, has seasonal allergies and multiple other allergies (NOS). Concurrent medical conditions included asthma. She has a history of temporomandibular joint disease (onset 4/1/99), recurrent sinusitis (onset 1997), mild infection of right hand due to cat bite (12/17/98), bronchitis, vertigo, nausea, stomach upset, ear pain, chest and ear congestion, depress
Diagnostic Lab Data: Lyme test X 2-neg; Lab test-arthritis; Thyroid test-neg; ANA-Very high; DNA-(+); MRI of brain-nml; AlanineTransminase, Serum: 9IU/L; Anti-DNA, double strand: Negative; Anti-DNA, double strand: Negative; Antinuclear antibody: 1:160positi
CDC Split Type: 2001009075
Vaccination
Manufacturer
Lot
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Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM120F91IM 
Administered by: Private     Purchased by: Private
Symptoms: Antinuclear antibody positive, Arthritis, Carpal tunnel syndrome, Fatigue, Fibromyalgia, Immune system disorder, Inflammation, Joint stiffness, Musculoskeletal stiffness, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Systemic lupus erythematosus (narrow), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Following a Lymerix vaccine the pt subsequently experienced "inflamed joints". She was seed by a physician specializing in Lyme disease. He ran some studies on her and concluded that she did not have Lyme disease but was having an adverse reaction to the vaccine. As of 4/01 the outcome of the event is ongoing. Per F/U, on 5/10/99, the pt received her 2nd dose of Lymerix. She experienced no adverse event for approx. 4 months. In 9/99, the pt experienced fatigue, stiff neck, "inflammed joints" and right arm and right hand joint stiffness. She was seen by her physician in 1/00, who reportedly made a dx of "possible carpal tunnel syndrome and seasonal allergies". She returned to the physician''s office in 5/00, because of increased neck stiffness. In 7/00, the consumer experienced numbness and tingling in her feet with pain. She also experienced "floaters" (NOS). She was treated with doxycycline. Her symptoms continued and she was seen by an infectious disease specialist in 10/00. Doxycycline treatment was continued. In 11/00, she saw a neurologist. He stated the pt "had possible Lyme". In late 1/01, symptoms started to return. She was seen by a rhematologist who dx''d "possible fibromyalgia". In 2/01, the pt''s primary physician dx''d the pt with possible Lyme disease or autoimmune disease (NOS). The pt was subsequently seen by a physician who specialized in "Lyme and related disorders". Unspecified tests for Lyme disease were negative. DNA testing was positive which resulted in a dx of autoimmune arthritis. This physician considered the autoimmune arthritis to be "related to vaccine for Lyme". As of 4/30/01, the outcome of the events was unknown. The follow up states that the concurrent medications included nasal medication, methylprednisolone (Medrol dosepak), pseudo-ephedrine HCl (Sudafed), azithromycin (Z-pak), clarithromycin (Biaxin), gualfenasin/phanylephrine (Exgest LA0, erythromycin, sertraline (Zoloft), fexofenadine HCL (allegra D), allergy shots and loratadine (Claritin). She is allergic to penicillin, has sea

VAERS ID:168739 (history)  Vaccinated:2001-03-15
Age:33.0  Onset:2001-03-16, Days after vaccination: 1
Gender:Female  Submitted:2001-04-09, Days after onset: 23
Location:Michigan  Entered:2001-04-16, 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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0342AA1IMRA
Administered by: Public     Purchased by: Other
Symptoms: Hypokinesia, Injection site pain, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever on 3/17/01 for a few days. Major body aches for 6 days. Severe pain in entire right arm for past 3 1/2 weeks and getting worse. Having difficulty lifting arm and states "feels sore right into the bone".

VAERS ID:168870 (history)  Vaccinated:2001-03-13
Age:33.0  Onset:2001-03-13, Days after vaccination: 0
Gender:Female  Submitted:2001-04-12, Days after onset: 29
Location:Colorado  Entered:2001-04-18, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS3383A41IMLA
Administered by: Public     Purchased by: Public
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: Client complained of pain, swelling, erythema at injection site. Onset on 3/13/01 and lasted until 4/12/01. Treatment: advised client to see PCP for evaluation.

VAERS ID:169089 (history)  Vaccinated:2001-04-10
Age:33.0  Onset:2001-04-10, Days after vaccination: 0
Gender:Female  Submitted:2001-04-16, Days after onset: 6
Location:Pennsylvania  Entered:2001-04-25, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Rash testing-pending
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0004L0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Eye swelling, Pruritus, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Recombivax HB vaccine was administered to left deltoid on 9/10/01 at about 13:00. About 6 hours later, pt developed circumferential maculopapular lesions on erythematous base in left anticubital fossa. Rash was very pruritic. Awoke next morning to similar rash by left temple and erythema and swelling around both eyes. Started on prednisone and Allegra on 4/11/01. On 4/13/01, decreased rash, swelling and itching. No respiratory symptoms. No anaphylaxis. Normal vital signs.

VAERS ID:169096 (history)  Vaccinated:2001-04-06
Age:33.0  Onset:2001-04-06, Days after vaccination: 0
Gender:Female  Submitted:2001-04-06, Days after onset: 0
Location:California  Entered:2001-04-25, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1652K0IMRA
Administered by: Private     Purchased by: Private
Symptoms: Headache, Injection site warmth, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 30 minutes, post vax, noted heat at site, face felt hot, co-worker noted face to be very red and slightly swollen. No SOB, wheezing or oral swelling. No rash. Return to clinic if redness of face, possible puffing around eyes or SOB. Has a slight headache. Rx''d Benadryl liquid and monitored. Stable on release to home with oral Benadryl and instructions.

VAERS ID:169048 (history)  Vaccinated:1999-09-28
Age:33.0  Onset:1999-10-20, Days after vaccination: 22
Gender:Female  Submitted:2001-04-19, Days after onset: 547
Location:New Mexico  Entered:2001-04-26, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Pregnancy (2 days after delivery).
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RUB: RUBELLA (MERUVAX II)MERCK & CO. INC.0839159 SC 
Administered by: Private     Purchased by: Other
Symptoms: Arthralgia, Arthritis, Rash
SMQs:, Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: The pt experienced an extreme rash within one week. Treated with Lidex. The pt also experienced joint pain, started in fingers and feet within 2 weeks. Thereafter diagnosed with seronegative inflammatory arthritis in the active stage.

VAERS ID:169583 (history)  Vaccinated:2001-01-17
Age:33.0  Onset:2001-02-10, Days after vaccination: 24
Gender:Female  Submitted:2001-03-26, Days after onset: 44
Location:New York  Entered:2001-05-08, Days after submission: 42
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Rabies Immune Globulin/R06142/Pasteur Merieux/IM/RA & LA
Current Illness: Hemi-anesthesia
Preexisting Conditions:
Diagnostic Lab Data: Normal labs; MRI; Ssep
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
RAB: RABIES (IMOVAX)PASTEUR MERIEUX INST.R08854IMLA
Administered by: Private     Purchased by: Private
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: Transient hemi-anesthesia A follow up report received 01/22/2003 adds: It was reported that a female pt was given a post exposure series of Imovax Rabies for bat exposure. Pt experienced "flu-like" symptoms after 2nd and 3rd doses. On 02/18/2001 the pt developed numbness in left side of face, ear, arm and calf, no sensory perception in left side, now in right side. Was seen in ER on 02/18/2001, CAT scan done. Referred to neurologist and ENT doctor, MRI done, all reports sent to primary care physician. Unresolved, getting worse. Per Aventis Pasteur Inc. Medical Safety Officer''s conversation with primary care physician on 02/28/2001, it was stated that the neurologist evaluated the pt and made a diagnosis of hemianesthesia. From additional correspondence received on 05/07/2001, additional laboratory data was provided. From follow-up #1 mailed correspondence received on 06/12/2001 stated, "Reviewed, nothing to add at this time. This case is closed.

VAERS ID:169611 (history)  Vaccinated:2001-04-24
Age:33.0  Onset:2001-04-25, Days after vaccination: 1
Gender:Female  Submitted:2001-04-27, Days after onset: 2
Location:California  Entered:2001-05-08, 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: PPD
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: NONE
CDC Split Type: CA010038
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1325J SCRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0377AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: The pt complained of pain and itching at the injection site on the left deltoid. The site was red and warm circle around injection site that was 20mm in width. No complaint of fever, chills and no drainage at site.

VAERS ID:169700 (history)  Vaccinated:0000-00-00
Age:33.0  Onset:0000-00-00
Gender:Male  Submitted:2001-05-06
Location:Unknown  Entered:2001-05-11, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Amyotrophic syndrome, congenital torticollis, hemifacial atrophy, myopathy.
Diagnostic Lab Data: Muscular Biopsy (deltoid) - macrophagic myofascitis.
CDC Split Type: 20010108871
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM    
Administered by: 0     Purchased by: 0
Symptoms: Fasciitis, Muscle disorder
SMQs:, Rhabdomyolysis/myopathy (broad)
Write-up: Report number 2001010887-1 describes the occurrence of macrophagic myofascitis in a 33 year old male patient vaccinated with Engerix-B for hepatitis B prophylaxis. Concomitant medical conditions included congenital myopathy with congenital torticolis, right hemifacial atrophy and amyotrophic syndrome of pelvic girdle and lower limbs. On 12/21/94, in January 1995 and in July 1995, the patient was vaccinated with Engerix B. On 10/25/00, the patient experienced myalgia, deltoid muscular biopsy revealed macrophagic myofascitis. This case was considered as incapacitating. The most recent info received on 05/02/01 reports the outcome of the patient as not yet recovered. Causality assessment was reported by AFSSAPS as dubious for Engerix B.

VAERS ID:169832 (history)  Vaccinated:2001-01-29
Age:33.0  Onset:2001-02-01, Days after vaccination: 3
Gender:Male  Submitted:0000-00-00
Location:Ohio  Entered:2001-05-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HBIG/NABI/3109911/IM/0 previously; Rx OTC Actifed
Current Illness: NONE
Preexisting Conditions: Spring and fall seasonal hay fever
Diagnostic Lab Data: Skin biopsy performed with dx of pityriasis lichenoides on 3/9/01
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1425K0IM 
Administered by: Private     Purchased by: Public
Symptoms: Rash maculo-papular, Skin disorder
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Noted onset of rash beginning on abdomen, 3 days, post vax/HBIG, gradually spread over trunk, proximal extremities, small erythematous non-pruritic papules.

VAERS ID:170167 (history)  Vaccinated:2001-05-08
Age:33.0  Onset:2001-05-09, Days after vaccination: 1
Gender:Female  Submitted:2001-05-14, Days after onset: 5
Location:Alaska  Entered:2001-05-23, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.0240K2IMRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0242AA1IMLA
Administered by: Military     Purchased by: Military
Symptoms: Flushing, Injection site erythema, Injection site warmth, Night sweats, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Received shot on 5/8/01. On 5/9/01, felt flushed, that night my temperature was 101.2F, with hot/cold flashes and night sweats. Fever broke, continued to feel flushed. On 5/11/01, right arm felt hot with red spots to about my elbow. Seen by MD at 18:00 and received antibiotics.

VAERS ID:170221 (history)  Vaccinated:2000-08-21
Age:33.0  Onset:2000-08-23, Days after vaccination: 2
Gender:Male  Submitted:2000-12-15, Days after onset: 114
Location:Ohio  Entered:2001-05-23, Days after submission: 158
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ4663008DEC2000
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)LEDERLE LABORATORIES471038 IM 
Administered by: Other     Purchased by: Other
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: A nurse reported that a 33 year old male received an injection of TD Adsorbed, Purogenated on 8/21/00. On 8/23/00, he developed an injection site reaction characterized by "extreme" pain, soreness, swelling and redness. The pt recovered. This is 1 of 4 patients from this facility who had an adverse experience following receipt of this vaccine, lot 471038.

VAERS ID:170389 (history)  Vaccinated:2001-04-24
Age:33.0  Onset:2001-04-24, Days after vaccination: 0
Gender:Male  Submitted:2001-05-10, Days after onset: 16
Location:Oklahoma  Entered:2001-05-30, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: unspecified;UNCLASSIFIED/UNSPECIFIED VACCINE;;32.00;In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: OK0121
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1516K SC 
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1601K SC 
Administered by: Private     Purchased by: Other
Symptoms: Feeling hot, Hyperhidrosis, Hypotension, Pharyngolaryngeal pain, Pruritus, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Approximately 5-10 minutes after receiving the MMR and varicella vax, the pt complained of feeling hot, flushing, throat burning and intense itching. Decreased blood pressure at 84/50, nausea and vomiting and diaphoresis. Was transported to the ER for monitoring, IV and evaluation.

VAERS ID:170781 (history)  Vaccinated:0000-00-00
Age:33.0  Onset:0000-00-00
Gender:Female  Submitted:2001-05-30
Location:Unknown  Entered:2001-06-01, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: diagnostic laboratory - lack of seroconversion to measles
CDC Split Type: WAES00063195
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 3  
Administered by: Other     Purchased by: Other
Symptoms: Hypokinesia
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Lack of Response - Information has been received from a woman in a physician''s office concerning a 33 year old female who was vaccinated with four doses of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation). Subsequently the patient has not seroconverted to measles

VAERS ID:170837 (history)  Vaccinated:2001-02-01
Age:33.0  Onset:2001-02-07, Days after vaccination: 6
Gender:Male  Submitted:2001-05-15, Days after onset: 96
Location:Unknown  Entered:2001-06-01, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Penicillin allergy
Diagnostic Lab Data:
CDC Split Type: WAES01020848
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0926K SC 
Administered by: 0     Purchased by: 0
Symptoms: Joint swelling, Serum sickness, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a physician concerning a 33 year old male with an allergy to penicillin who on 2/1/01 was vaccinated with the 1 dose of varicella virus vaccine live (lot 636569/0926K). On 2/7/01, the pt experienced hives and not a varicella-like rash. The rash was non-raised. He was seen in the ER. Upon medical review, the hives were determined to be an "Other Medical Review". The pt was treated with a steroid and Benadryl, but did not have much relief. Additionally, on 2/9/01, the pt experienced swelling in his joints and serum sickness-like symptoms. The pt''s hives persisted. The outcome of the pt''s other experiences was not reported. No further information is available.

VAERS ID:170985 (history)  Vaccinated:1999-04-26
Age:33.0  Onset:2000-02-26, Days after vaccination: 306
Gender:Female  Submitted:2001-05-15, Days after onset: 443
Location:Unknown  Entered:2001-06-01, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: Test: serum varicella zoster; Date: 02/28/00, Value: 0.14, Normal Range: -, Comment: less than 0.75 on scale indicates inadequate antibodies, Test: serum varicella zoster; Date: 03/16/00, Value: 0.44, Normal Range: - , Comment: less than 0
CDC Split Type: WAES00032354
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0112J1SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Coma, Infection
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (broad)
Write-up: Lack of Response- Information has been received from a licensed practical nurse concerning a 33 year old female patient who on 01 Mar 2000 (lot # 629140/1835H) and 26 Apr 1999 (lot 629617 /0112J) was vaccinated SC with a first and second dose, respectively, of varicella virus vaccine live. On 25 Feb 2000 the paient had a titer checked and the level was less than 0.14 (less than 0.75 on scale indicates less than adequate). The second titer was checked on 16 Mar 2000 and the results were o.44 which is also less than adequate. Unspecified medical attention was sought. The report expressed a concern with the lot numbers. Additional information has been requested.

VAERS ID:170994 (history)  Vaccinated:2000-02-01
Age:33.0  Onset:0000-00-00
Gender:Female  Submitted:2001-05-15
Location:Unknown  Entered:2001-06-01, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES00032670
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Other     Purchased by: Other
Symptoms: Infection, Skin ulcer
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Skin lesion - Information has been received from a physician concerning a 33 year old female family member who in approximately february, 2000 was vaccinated with one dose of varicella virus vaccine live (site unknown). Approximately two weeks post-vaccination. the patient experieced about 5-10 vesicular lesions diffusely over her body, the patient received unspecified medical attention and the rash subsequently resolved.

VAERS ID:171348 (history)  Vaccinated:1999-10-19
Age:33.0  Onset:2000-05-04, Days after vaccination: 198
Gender:Male  Submitted:2001-05-15, Days after onset: 376
Location:New York  Entered:2001-06-01, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Diabetes mellitus
Diagnostic Lab Data: Immunoglobulin G index - 05/04/00 failed to seroconvert after 2 doses
CDC Split Type: WAES00052313
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0879J1SCLA
Administered by: Private     Purchased by: Other
Symptoms: Laboratory test abnormal, Unevaluable event
SMQs:
Write-up: Information has been received from a physician concerning a 33 year old patient who on 09/21/1999 and 10/19/1999 was vaccinated with a first and second dose, respectively of Varivax. On 05/04/2000, the patient sought unspecified medical attention and had blood tests performed which showed no immunity to varicella. In FOLLOW-UP, the physician reported that the patient received a third dose of Varivax and failed to seroconvert.The physician stated that "the antibody level was 829, far less than the 99 needed".

VAERS ID:171536 (history)  Vaccinated:0000-00-00
Age:33.0  Onset:0000-00-00
Gender:Female  Submitted:2001-05-15
Location:Unknown  Entered:2001-06-01, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES00070590
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  UNUN
Administered by: Other     Purchased by: Other
Symptoms: Herpes zoster, Infection
SMQs:
Write-up: Information has been received from a physician concerning his 33 year old pregnant wife. (LMP 01/24/00) who had chickenpox as a child, and whose son was vaccinated with one dose of varicella vaccine. Subsequently, the pt''s son developed shingles, and approximately 3.5 weeks afterwards in 07/2000 the pregnant wife developed shingles as well. The wife''s shingles were noted to be on the right side of her nose.

VAERS ID:171818 (history)  Vaccinated:0000-00-00
Age:33.0  Onset:2000-10-01
Gender:Female  Submitted:2001-05-15, Days after onset: 226
Location:Unknown  Entered:2001-06-01, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: serum varicella zoster - negative
CDC Split Type: WAES00101065
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Other     Purchased by: Other
Symptoms: Laboratory test abnormal, Unevaluable event
SMQs:
Write-up: Information has been received on a patient who in the fall of 1997 was vaccinated with one dose of varicella virus vaccine live. In approximately October 2000, recent titers indicated that the patient had not seroconverted. The patient sought unspecified medical attention. Additional information has been requested.

VAERS ID:172183 (history)  Vaccinated:2001-01-30
Age:33.0  Onset:2001-02-15, Days after vaccination: 16
Gender:Male  Submitted:2001-05-15, Days after onset: 88
Location:New Jersey  Entered:2001-06-01, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES01021283
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.692614/1687J0SC 
Administered by: Private     Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: on 02/15/2001 the patient developed a generalized rash. The patient sought unspecified medical attention. It was reported that the patient recovered from the rash. Additional information has been requested.

VAERS ID:172202 (history)  Vaccinated:1996-06-21
Age:33.0  Onset:1999-07-07, Days after vaccination: 1111
Gender:Female  Submitted:2001-05-15, Days after onset: 678
Location:Unknown  Entered:2001-06-01, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Therapy (unspecified)
Current Illness:
Preexisting Conditions: Asthma
Diagnostic Lab Data: Serum varicella zoster on 07/07/1999, failed to seroconvert
CDC Split Type: WAES01021946
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SC 
Administered by: Other     Purchased by: Other
Symptoms: Infection protozoal, Laboratory test abnormal, Red blood cell abnormality
SMQs:
Write-up: Information has been received from an RN concerning a patient with asthma and no known allergies who on 06/21/1996 was vaccinated with the first dose of varicella. The RN reported that the patient received the second dose "sometime thereafter". Concomitant therapy included asthma medication as needed. The RN reported that a titer was drawn in 1999 and the "patient failed to seroconvert". Unspecified medical attention was sought. Additional information has been requested.

VAERS ID:172216 (history)  Vaccinated:2000-01-01
Age:33.0  Onset:0000-00-00
Gender:Female  Submitted:2001-05-15
Location:Florida  Entered:2001-06-01, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Drug abuse
Diagnostic Lab Data: Serum varicella zoster: negative prior to vaccine
CDC Split Type: WAES01030119
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Public     Purchased by: Public
Symptoms: Lymphocytic leukaemia
SMQs:, Malignant tumours (narrow)
Write-up: Information has been received from a physician concerning a patient who in approximately 2000 was vaccinated. According to the physician, "a month or two later" she developed acute lymphocytic leukemia. Additional information has been requested.The physician questioned as to if there was a relationship between varicella virus vaccine live and acute lymphocytic leukemia. The physician also believed that the pt''s experience was disabling. Additional info has been requested.

VAERS ID:172218 (history)  Vaccinated:2000-04-01
Age:33.0  Onset:2000-10-01, Days after vaccination: 183
Gender:Female  Submitted:2001-05-15, Days after onset: 226
Location:Minnesota  Entered:2001-06-01, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: irritable bowel syndrome, psoriasis vulgaris
Diagnostic Lab Data: serum varicella zoster - patient did not seroconvert
CDC Split Type: WAES01030255
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain, Injection site pain, Injection site swelling, Insomnia, Nausea
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Information has been received from a patient with mild psoriasis and questionable irritable bowel disease who was vaccinated with two doses of vaccine 4 weeks apart in April 2000. In approximately October 2000, the patient had titers that showed she did not seroconvert. It was reported that the patient received a third dose subcutaneously in the left upper arm on 02/19/2001. Subsequently, the patient experienced an injection site reaction including swelling and pain that began on 02/20/2001 and lasted for 3 days. The pain was so intense she could not sleep on the side of her body that received the injection. The evening of the vaccine administration the patient developed abdominal pain and nausea. The nausea lasted approximately 12 hours and the abdominal pain lasted about 8 hours. Unspecified medical attention was sought. It was reported the patient recovered.

VAERS ID:172273 (history)  Vaccinated:1999-05-26
Age:33.0  Onset:2000-02-19, Days after vaccination: 269
Gender:Female  Submitted:2001-05-15, Days after onset: 450
Location:Michigan  Entered:2001-06-01, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES99061594
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.  SC 
Administered by: Private     Purchased by: 0
Symptoms: Unevaluable event
SMQs:
Write-up: The pt found out she was pregnant following she was vaccinated. At six months ultrasound shows a normal pregnancy.

VAERS ID:171066 (history)  Vaccinated:2001-04-09
Age:33.0  Onset:2001-04-12, Days after vaccination: 3
Gender:Female  Submitted:2001-05-29, Days after onset: 47
Location:Utah  Entered:2001-06-11, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac, Diltiazem, vitamins
Current Illness:
Preexisting Conditions: PSVT scheduled for ablation 5/7/01
Diagnostic Lab Data: CBC wnl except for elevated monocytes. Strep A throat culture negative. Chest xray negative. Pulse 107, respiratory rate 30.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1514K SCLA
Administered by: Other     Purchased by: Private
Symptoms: Arthralgia, Headache, Hyperventilation, Joint stiffness, Laboratory test abnormal, Pain, Pharyngolaryngeal pain, Pyrexia, Rash, Rash papular, Respiratory disorder, Tachycardia
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Three days post immunization patient developed diffuse body aches, headaches, fever and joint stiffness. Four days post vaccine she noticed a rash on her feet, knees and hands. She tried over-the-counter ibuprofen without much significant improvement. She developed a sore throat. Pharynx was erythematous. Skin showed clusters of erythematous papules on the feet, knees and hands. Impression was arthralgias and rash secondary to MMR reaction. Patient was given Demerol and Vistaril in the emergency department. She was prescribed Naprosyn and

VAERS ID:172130 (history)  Vaccinated:2001-02-22
Age:33.0  Onset:2001-03-05, Days after vaccination: 11
Gender:Female  Submitted:2001-05-25, Days after onset: 80
Location:South Carolina  Entered:2001-06-20, Days after submission: 26
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Depo-Provera on 3/5/01, none previously
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
Administered by: Public     Purchased by: Unknown
Symptoms: Hypoaesthesia, Muscular weakness, Neck pain, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Arthritis (broad)
Write-up: Painful, throbbing, aching pains in arms and shoulders. Left arm is numb feeling in my fingers, hand is weak, with burning pain, also in shoulder, arm and on left side of neck, with stinging feeling following. Deep aching pain in my muscles and shoulders.

VAERS ID:172864 (history)  Vaccinated:2001-06-14
Age:33.0  Onset:2001-06-14, Days after vaccination: 0
Gender:Female  Submitted:2001-06-08, Days after onset: 6
Location:Pennsylvania  Entered:2001-07-03, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: egg allergy
Diagnostic Lab Data: NONE
CDC Split Type: PA0150
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0342AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Arthralgia, Headache, Lacrimation increased, Myalgia, Nausea, Pain, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Lacrimal disorders (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: The pt experienced a high fever of 102, chills, muscle aches, joint pain, left arm pain, headache, watery eyes, nausea. The pt was referred to the ER.

VAERS ID:172884 (history)  Vaccinated:2001-05-05
Age:33.0  Onset:2001-05-06, Days after vaccination: 1
Gender:Female  Submitted:2001-06-09, Days after onset: 34
Location:Wyoming  Entered:2001-07-03, Days after submission: 24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: acid reflux
Diagnostic Lab Data: lab tests - nml
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
YF: YELLOW FEVER (YF-VAX)CONNAUGHT LABORATORIESU0330AA1SCLA
Administered by: Military     Purchased by: Military
Symptoms: Diarrhoea, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: The pt experienced extreme diarrhea for 3 weeks plus. Given a prescription to control fever of 102.

VAERS ID:172887 (history)  Vaccinated:2001-06-06
Age:33.0  Onset:2001-06-12, Days after vaccination: 6
Gender:Female  Submitted:2001-06-20, Days after onset: 8
Location:Illinois  Entered:2001-07-03, 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: Albuterol, nebulizer treatments, Accolate, Nasonex, Pulmocort
Current Illness: NONE
Preexisting Conditions: asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.  SC 
Administered by: Other     Purchased by: Other
Symptoms: Arthralgia, Joint stiffness, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: The pt experienced a fever of 101-102, rash to left upper extremity and right wrist, joint pain and stiffness. Saw an MD on 6/19/01.

VAERS ID:173452 (history)  Vaccinated:2001-07-09
Age:33.0  Onset:2001-07-11, Days after vaccination: 2
Gender:Male  Submitted:0000-00-00
Location:Massachusetts  Entered:2001-07-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABTD720IMLA
Administered by: Private     Purchased by: Other
Symptoms: Injury, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Accidents and injuries (narrow), Hostility/aggression (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt developed urticaria and itching on bilateral arms, trunk and legs 2 days post vax. Pt also had a laceration on hand requiring sutures. Pt was treated with Benadryl and prednisone.

VAERS ID:173740 (history)  Vaccinated:1992-04-16
Age:33.0  Onset:1992-04-16, Days after vaccination: 0
Gender:Female  Submitted:2001-07-28, Days after onset: 3390
Location:Michigan  Entered:2001-07-31, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amoxicillin X 24 hours prior
Current Illness:
Preexisting Conditions: History of lidocaine allergy
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER  IMLA
Administered by: Private     Purchased by: Other
Symptoms: Injection site swelling, Swelling face, Throat tightness, Tremor, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Approx. 12 hours, post vax, the pt developed facial tightness, hives behind knees, throat tightness and shakiness. At injection site, she had local reaction with swelling and tightness. VSS, afebrile. She was given 50mg po Benadryl. Recovered uneventfully.

VAERS ID:173864 (history)  Vaccinated:2001-04-25
Age:33.0  Onset:2001-04-26, Days after vaccination: 1
Gender:Male  Submitted:2001-07-16, Days after onset: 81
Location:Unknown  Entered:2001-08-03, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: MRI; CSF-consistent with multiple sclerosis
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0311SCRA
Administered by: Military     Purchased by: Military
Symptoms: Arthropathy, Balance disorder, Multiple sclerosis, Paraesthesia, Sleep disorder, Vision blurred
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Demyelination (narrow), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Arthritis (broad), Hypoglycaemia (broad)
Write-up: One day post vax, the pt developed paresthesia. Four to five months later, he developed joint symptoms. Twelve to thirteen months later, he developed dysequilibrium and a numb sensation. Fourteen to fifteen months later, he developed eye blurring and sleep disturbance. Pt had continued symptoms at evaluation on 7/16/01. Pt recvd first Anthrax vax on 1/5/00, manufacturer Bioport, lot # FAV024, administered in left arm.

VAERS ID:173905 (history)  Vaccinated:1999-04-01
Age:33.0  Onset:1999-07-01, Days after vaccination: 91
Gender:Female  Submitted:0000-00-00
Location:Delaware  Entered:2001-08-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft, allergy meds
Current Illness: NONE
Preexisting Conditions: Allergies, asthma
Diagnostic Lab Data: There are many attached lab tests and reports. Please see attached forms.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM    
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Chills, Dizziness, Ear pain, Fatigue, Headache, Hyperhidrosis, Hypoaesthesia, Musculoskeletal stiffness, Myalgia, Pain, Restlessness, Viral infection, Vitreous floaters
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Akathisia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Retinal disorders (narrow), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)
Write-up: Pt appears to be in second or third stage of Lyme disease, numbness and pain in arm or legs, pt has both. She is having severe headaches and neck creaks and cracks with stiffness. Fatigue has worsened to point she can''t say awake during public meetings, feels drained. Chills and sweats off and on for a year or more. Muscle and joint pains, shooting pains, burning, tingling and numbness and burning in feet. Feeling light headed and woozy by midday to remaining of day. Left eye twitching and bumping into things from feeling disoriented or perception is off. Reported to friend that I was seeing light spots shooting across room (floater), and restlessness, reoccurring ear pain and sensitive to any thing loud. I have been dx with fibromayalgia.

VAERS ID:174232 (history)  Vaccinated:2000-10-03
Age:33.0  Onset:2000-10-30, Days after vaccination: 27
Gender:Male  Submitted:2001-07-30, Days after onset: 272
Location:Unknown  Entered:2001-08-07, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES00121033
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1214J IM 
Administered by: 0     Purchased by: 0
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, Malaise, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received concerning a pt who on the same day of vaccination developed localized significant redness, swelling, and warmth of the third outer aspect of his upper arm. The pt also developed a fever of 103 and experienced malaise. The pt received unspecified over the counter medications for the fever. The pt recovered in 4 to 5 days.

VAERS ID:174234 (history)  Vaccinated:2000-12-11
Age:33.0  Onset:2000-12-12, Days after vaccination: 1
Gender:Female  Submitted:2001-07-30, Days after onset: 229
Location:Unknown  Entered:2001-08-07, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: allergy to animal dander, cat and dog, and asthma
Diagnostic Lab Data:
CDC Split Type: WAES00121254
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  IM 
Administered by: 0     Purchased by: 0
Symptoms: Injection site swelling, Pain, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received concerning a pt who on 1 day post vaccination complained of a swollen arm at the site of injection, welt in the same area which grew to the size of a golf ball. She complains of aches over entire body and fever of 100 F. The pt stated that she reported this to her physician.

VAERS ID:174145 (history)  Vaccinated:0000-00-00
Age:33.0  Onset:2001-07-24
Gender:Female  Submitted:2001-07-27, Days after onset: 3
Location:Unknown  Entered:2001-08-10, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: States she has fibromyalgia.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3382A4 IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:
Write-up:

VAERS ID:174754 (history)  Vaccinated:2001-05-08
Age:33.0  Onset:0000-00-00
Gender:Female  Submitted:2001-05-14
Location:Florida  Entered:2001-08-28, Days after submission: 106
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
DTAP: DTAP (TRIPEDIA)CONNAUGHT LABORATORIESU0371AB IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt developed mild erythema on left shoulder with warmth. Treated with Clindamycin 150mg #28 1 QID.

VAERS ID:174878 (history)  Vaccinated:2001-08-29
Age:33.0  Onset:2001-08-30, Days after vaccination: 1
Gender:Female  Submitted:2001-08-30, Days after onset: 0
Location:Oklahoma  Entered:2001-08-31, 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: Levoxyl, Pepcid, Benadryl.
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: X-ray
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.    
Administered by: Public     Purchased by: Unknown
Symptoms: Balance disorder, Dizziness, Dyspnoea, Headache, Heart rate increased, Lymphadenopathy, Musculoskeletal stiffness, Nausea, Odynophagia, Pharyngeal oedema, Pharyngolaryngeal pain
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: This patient had an injection at 2:00 PM on 08/29/2001. She felt funny all afternoon, off balance. She went back to bed, awoke a 3:00 AM having difficulty breathing. Glands, throat all swollen. Tingly fingers and toes. No fever. Stiff neck, headache, queasy stomach, heart beating fast, sore throat when she swallows (hard to swollow), also feels spacey and dizzy.

VAERS ID:174985 (history)  Vaccinated:2001-04-04
Age:33.0  Onset:2001-04-04, Days after vaccination: 0
Gender:Male  Submitted:2001-06-07, Days after onset: 64
Location:Indiana  Entered:2001-09-05, Days after submission: 90
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: UNK
Diagnostic Lab Data: UNK
CDC Split Type: HQ1777307JUN2001
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.688A21IMRA
PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4694910IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: A nurse reported that a 33 year old male received Pnu-Imune 23 and Hep-A vaccines on 4/4/01. Later that evening, he developed an injection site reaction characterized by a 30mm area of redness and induration and inability to move his arm. He also experienced nausea and vomiting and developed a fever of 101F. The symptoms lasted about 2 days. No further information was available at the date of this report. The reporter indicated that 4 pts experienced these events following receipt of Pnu-Imune 23, lot 469401. (See HQ9560211APR2001, HQ1777407JUN2001 and HQ1777507JUN2001).

VAERS ID:175261 (history)  Vaccinated:2001-07-09
Age:33.0  Onset:2001-07-10, Days after vaccination: 1
Gender:Female  Submitted:2001-08-31, Days after onset: 52
Location:D.C.  Entered:2001-09-11, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0381AA IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Client presented with large erythema and induration on left deltoid, at site of TD injection.

VAERS ID:175266 (history)  Vaccinated:2001-07-16
Age:33.0  Onset:2001-08-01, Days after vaccination: 16
Gender:Female  Submitted:2001-08-27, Days after onset: 26
Location:Unknown  Entered:2001-09-14, Days after submission: 18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Pregnancy (LMP-6/6/01); tetracycline allergy
Diagnostic Lab Data: UNK
CDC Split Type: WAES01071942
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 1SC 
Administered by: Other     Purchased by: Other
Symptoms: Abortion missed
SMQs:, Termination of pregnancy and risk of abortion (narrow)
Write-up: Information has been received concerning a female consumer who on 6/6/01 and 7/16/01 (previously reported as 7/17/01) was vaccinated with the 1st and 2nd doses of varicella virus vaccine live, respectively (sites unknown). There was no concomitant medication. Subsequently, the pt found out she was 6 weeks pregnant on 7/19/01. The pt sought unspecified medical attention. Follow-up information received from the pt, on 8/15/01, indicated that she had a missed abortion. Additional information has been requested. F/U states: an adverse event onset date of ?/8?/01 has been added. This is a corrected report as amended.

VAERS ID:175468 (history)  Vaccinated:2001-09-15
Age:33.0  Onset:2001-09-15, Days after vaccination: 0
Gender:Female  Submitted:2001-09-15, Days after onset: 0
Location:Texas  Entered:2001-09-18, 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: Allergies
Preexisting Conditions: Allergies
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MEN: MENINGOCOCCAL (MENOMUNE-A/C)CONNAUGHT LTD.UA444AA  LA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)CONNAUGHT LABORATORIESR0384  RA
Administered by: Military     Purchased by: Military
Symptoms: Feeling hot
SMQs:
Write-up: Right arm, neck warmness after injection of typhoid vaccine to her right upper arm. Subsided 13:30.

VAERS ID:175813 (history)  Vaccinated:2001-09-13
Age:33.0  Onset:2001-09-13, Days after vaccination: 0
Gender:Female  Submitted:2001-09-27, Days after onset: 14
Location:Vermont  Entered:2001-09-28, 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: Tylenol, Albuterol, Flovent
Current Illness: NONE
Preexisting Conditions: allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.044810IMLA
Administered by: Other     Purchased by: Private
Symptoms: Chest pain, Dyspnoea, Injection site swelling, Paraesthesia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (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), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad)
Write-up: 20 minutes post vax the pt developed swelling at the site, shortness of breath, tingling of arm, hand, fingers, tightness in throat and chest felt heavy. Was immediately brought to ER. Possible medicine reaction.

VAERS ID:176175 (history)  Vaccinated:1999-01-19
Age:33.0  Onset:1999-01-20, Days after vaccination: 1
Gender:Female  Submitted:2001-09-24, Days after onset: 977
Location:California  Entered:2001-10-10, Days after submission: 16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Penicillin and Codeine allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5816A0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Abdominal pain, Anorexia, Headache, Lethargy
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)
Write-up: Headache, no appetite, lethargy and abdominal tenderness.

VAERS ID:176229 (history)  Vaccinated:1999-10-16
Age:33.0  Onset:1999-12-28, Days after vaccination: 73
Gender:Female  Submitted:2001-10-01, Days after onset: 642
Location:Indiana  Entered:2001-10-11, Days after submission: 10
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: Weakness and fatigue~Influenza (Seasonal) (Fluzone)~1~29.00~In Patient
Other Medications: Antihistamines, Advil
Current Illness: NONE
Preexisting Conditions: Allergies-Sinus
Diagnostic Lab Data: CBC; Sed rate; Electrolytes; Antinuclear antibodies serology; CPK; LP; MRI of head and spine; EMG; Thyroid; SGOT; T3, T4, ALT; Copper test; Anti-thyroid Antibodies-all results nml.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)CONNAUGHT LABORATORIESU0108CA1IMLA
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Fatigue, Gait disturbance, Guillain-Barre syndrome, Muscle spasms, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Hypoglycaemia (broad)
Write-up: Within one to two weeks after receiving the Flu shot I started to become easily fatigued and progressively weaker. The I started to experience numbness and tingling to my extremities (hands and feet). By December 1999, I got to a point that I was unable to hold up my own body weight without the assist of another person or a stationary object. I began having muscle spasms that started in my legs and progressed up my entire body including my head. I still continue to experience adverse reactions.

VAERS ID:176550 (history)  Vaccinated:2001-10-02
Age:33.0  Onset:2001-10-02, Days after vaccination: 0
Gender:Female  Submitted:2001-10-05, Days after onset: 3
Location:Pennsylvania  Entered:2001-10-22, Days after submission: 17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Triphasil
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: PA0156
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3369B62IMLA
Administered by: Public     Purchased by: Public
Symptoms: Contusion, Injection site swelling, Injection site warmth
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Post vax the patient''s left upper arm above the elbow is swollen and hot the touch. The area is starting to appear bruised. The patient is being treated with Tequin.

VAERS ID:176968 (history)  Vaccinated:2001-10-06
Age:33.0  Onset:2001-10-07, Days after vaccination: 1
Gender:Male  Submitted:2001-10-17, Days after onset: 10
Location:New York  Entered:2001-10-31, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vasotec
Current Illness: NONE
Preexisting Conditions: High blood pressure
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Public     Purchased by: Other
Symptoms: Cellulitis, Chills, Injection site induration, Injection site inflammation, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mylagia, fever, chills, status post Td booster on 10/06/01 for injury to index finger. PE showed 12 cm area . Inflamation and induration of right deltoid site. On 10/9/01 dx of cellulitis made and treated with Keflex. By 10/16/01 clinically improving. Follow up 12/14/2001: "Contact hospital medical records department."

VAERS ID:177277 (history)  Vaccinated:2001-10-23
Age:33.0  Onset:2001-10-26, Days after vaccination: 3
Gender:Female  Submitted:2001-10-29, Days after onset: 3
Location:Missouri  Entered:2001-11-06, 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: Singulair, Flonase, Vioxx, Albuterol inhaler
Current Illness:
Preexisting Conditions: Asthma
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.1448K IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site inflammation, Injection site pain, Injection site swelling, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Pt has body aches, severe nausea, vomited. Sx 3 days post administration of vaccine. Local swelling and pain, inflammatory at site of vaccine. Pt still has knot today.

VAERS ID:177558 (history)  Vaccinated:2001-01-10
Age:33.0  Onset:2001-01-10, Days after vaccination: 0
Gender:Female  Submitted:2001-02-12, Days after onset: 33
Location:New Jersey  Entered:2001-11-09, Days after submission: 270
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: U200100397
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEUR    
Administered by: Other     Purchased by: Other
Symptoms: Dysgeusia, Nasal discomfort, Oesophageal spasm
SMQs:, Taste and smell disorders (narrow), Dystonia (broad)
Write-up: It was reported that immediately after vaccination the pt could taste the vaccine, had esophageal spasms and a burning and nasal sensation, no respiratory distress or anaphylaxis. These symptoms lasted about 1/2 hour. Pt took Benadryl and was also seen in the emergency room. Further information is requested.

VAERS ID:177676 (history)  Vaccinated:2000-06-28
Age:33.0  Onset:2000-09-01, Days after vaccination: 65
Gender:Male  Submitted:2001-11-09, Days after onset: 434
Location:New Jersey  Entered:2001-11-13, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Aches~Lyme (LYMErix)~2~43~In Patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Blood-(-) nonspecific; tested (+) for Epstein-Barr
CDC Split Type:
Vaccination
Manufacturer
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Dose
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Site
LYME: LYME (LYMERIX)SMITHKLINE BEECHAM144B92IM 
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Fatigue, Hypoaesthesia, Infection, Influenza like illness, Pain, Pharyngolaryngeal pain, Pyrexia, Weight increased
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fatigue, weight gain, pain in feet upon awakening, flu-symptoms, fever and sore throat. The annual follow up received on 7/17/03 states, "since vaccie I have suffered with chronic fatigue and over the years I''ve developed severe joint pain in both feet and now my knees. I have had nerve conduction tests done because my toes are numb. I have never had problems with my feet before the vaccine. Just recently I had MRI''s confirm chronomalacia in my knees. I believe I probably have rheumatoid arthritis but no one has diagnosed that yet. I don''t know why maybe because I''m 36 and RA usually occurs later, don''t know."

VAERS ID:177691 (history)  Vaccinated:2000-08-12
Age:33.0  Onset:2001-01-06, Days after vaccination: 147
Gender:Male  Submitted:2001-11-05, Days after onset: 303
Location:Oklahoma  Entered:2001-11-14, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Cat Scan, EEG, MMR and Spinal tap all WNL.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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Site
ANTH: ANTHRAX (NO BRAND NAME)UNKNOWN MANUFACTURERFAV0244IM 
Administered by: Military     Purchased by: Military
Symptoms: Apnoea, Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (narrow), Hypoglycaemia (broad)
Write-up: Five months after receiving his 5th Anthrax injection, the patient had a seizure during which he stopped breathing and had to be taken to the hospital by paramedics. The patient is currently being followed by MD at the VA and a neurologist.

VAERS ID:177737 (history)  Vaccinated:2001-10-29
Age:33.0  Onset:2001-10-30, Days after vaccination: 1
Gender:Female  Submitted:2001-11-02, Days after onset: 3
Location:Pennsylvania  Entered:2001-11-15, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURUO677AA0IMLA
Administered by: 0     Purchased by: 0
Symptoms: Erythema
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Employee received vaccine around 10 AM. Did not notice anything wrong until following AM when looked at upper arm red 4 inches below injection site and warm. No swelling. Observed area next 4 days and each day reaction decreased until normal on Friday 11/02/2001.

VAERS ID:177742 (history)  Vaccinated:2001-10-31
Age:33.0  Onset:2001-10-31, Days after vaccination: 0
Gender:Male  Submitted:2001-11-05, Days after onset: 5
Location:Illinois  Entered:2001-11-15, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURUO686AB IMRA
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0386AA IMLA
Administered by: Other     Purchased by: Military
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Generalized itching to upper chest, rash present.

VAERS ID:177884 (history)  Vaccinated:2001-10-31
Age:33.0  Onset:2001-11-01, Days after vaccination: 1
Gender:Female  Submitted:2001-11-12, Days after onset: 11
Location:Pennsylvania  Entered:2001-11-16, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: RAD
Preexisting Conditions: Allergy to flu vax.
Diagnostic Lab Data: WBC-24,000; Urine with redness, proteins, urobilinogen and blood.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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PPV: PNEUMO (PNU-IMUNE)LEDERLE LABORATORIES4753910SCLA
Administered by: Private     Purchased by: Other
Symptoms: Bilirubinuria, Blood urine, Chills, Dehydration, Injection site erythema, Injection site induration, Injection site pain, Proteinuria, Vomiting, White blood cell count increased
SMQs:, Acute renal failure (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Biliary system related investigations, signs and symptoms (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Proteinuria (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt developed a 12cm local erythema that was hard and tender. States rigors, nausea and vomiting and dehydration.

VAERS ID:178005 (history)  Vaccinated:2001-11-01
Age:33.0  Onset:2001-11-02, Days after vaccination: 1
Gender:Female  Submitted:2001-11-13, Days after onset: 11
Location:Florida  Entered:2001-11-20, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lotrel, Selexa, Elavil, Noranth, Triliptal, Bus Par, Visceral.
Current Illness:
Preexisting Conditions: Bipolar
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0670AA  LA
Administered by: Private     Purchased by: Private
Symptoms: 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 (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Following AM on waking, noticed reddened, hot, swollen, itchy area approximately 6"x4" upper arm, around site of injection. Took Benadryl with ice to area. Resolved in 3 days.

VAERS ID:178067 (history)  Vaccinated:2001-01-25
Age:33.0  Onset:2001-01-25, Days after vaccination: 0
Gender:Female  Submitted:2001-07-13, Days after onset: 168
Location:Minnesota  Entered:2001-11-21, Days after submission: 131
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: Blood tests and x-ray, results pending.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER    
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1359J   
Administered by: Private     Purchased by: Unknown
Symptoms: Folliculitis, Herpes zoster, Laboratory test abnormal, Thermal burn
SMQs:, Accidents and injuries (narrow)
Write-up: Late January or early February the patient received a chemical burn to her hair. She saw her physician, who gave her a tetanus and varicella vaccine, plus two antibiotics. Four weeks later the patient developed shingles on her scalp. The patient presently has a hair follicle infection and has not recovered.

VAERS ID:178082 (history)  Vaccinated:2001-10-22
Age:33.0  Onset:2001-10-22, Days after vaccination: 0
Gender:Female  Submitted:2001-11-09, Days after onset: 18
Location:Nevada  Entered:2001-11-21, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
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HEPA: HEP A (VAQTA)MERCK & CO. INC.0864L0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dyspnoea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 4 hours, post vax, the pt states she had difficult breathing and a high fever. Spoke with MD that she had Hep-A vaccine and took antihistamine. Within minutes, condition improved. No further problems.

VAERS ID:178505 (history)  Vaccinated:2000-10-20
Age:33.0  Onset:2000-11-01, Days after vaccination: 12
Gender:Male  Submitted:2001-11-28, Days after onset: 392
Location:Unknown  Entered:2001-12-03, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: (see additional page) no page attached
Diagnostic Lab Data:
CDC Split Type: WAES00110171
Vaccination
Manufacturer
Lot
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Site
RUB: RUBELLA (MERUVAX II)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Lymphadenopathy, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been rec''d from a NP concerning a 33 year old male with diabetes Mellitus who on 10/20/00 was vaccinated with rubella virus vaccine live (second generation). On 11/01/00, the pt experienced lymphadenopathy and a rash on his entire body. Medical attention was sought. Additional information has been requested.

VAERS ID:178518 (history)  Vaccinated:2001-08-31
Age:33.0  Onset:2001-09-10, Days after vaccination: 10
Gender:Female  Submitted:2001-11-28, Days after onset: 79
Location:Unknown  Entered:2001-12-03, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Infertility
Diagnostic Lab Data:
CDC Split Type: WAES01091149
Vaccination
Manufacturer
Lot
Dose
Route
Site
RUB: RUBELLA (MERUVAX II)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Lymphadenopathy, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a RN on 10-SEP-2001 concerning a 33 year old female with infertility and no allergies who "approximately 7-10 days ago" was vaccinated with a dose of Meruvax II. On 10-SEP-2001 the pt had swollen glands and a low grade fever. the pt sought unspecified medical attention. Additional information has been requested.

VAERS ID:178560 (history)  Vaccinated:2001-11-20
Age:33.0  Onset:2001-11-20, Days after vaccination: 0
Gender:Male  Submitted:2001-11-26, Days after onset: 6
Location:Indiana  Entered:2001-12-04, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4018032 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Dizziness, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: High temp - 103.3F, dizziness, vomiting, weakness, ten hrs of symptoms.

VAERS ID:178762 (history)  Vaccinated:2001-11-14
Age:33.0  Onset:0000-00-00
Gender:Male  Submitted:2001-11-15
Location:Utah  Entered:2001-12-10, Days after submission: 25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV048B4SCRA
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU0704AA IMLA
Administered by: Military     Purchased by: Military
Symptoms: Unevaluable event
SMQs:
Write-up: Patient accidently received anthrax vaccine 5 months sooner than he was suppose to, no reported adverse effects up to this point 11/15/01.

VAERS ID:178773 (history)  Vaccinated:2001-11-29
Age:33.0  Onset:2001-11-29, Days after vaccination: 0
Gender:Female  Submitted:2001-12-04, Days after onset: 5
Location:Pennsylvania  Entered:2001-12-10, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Aspirin Allergy,Asthma
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURUO213AA0IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.104560IMLA
Administered by: Private     Purchased by: Private
Symptoms: Chest pain, Injection site hypersensitivity, Injection site induration, Injection site pain, Lymphadenopathy, Myalgia, Pruritus
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Severe pain, induration erythema myalgias localized left UE +shoulder +chest pain, mild pruritis. Pain swelling extended from deltoid to pectoral trapezius axillary distrubtion, lymphadenopathy within 24 hours

VAERS ID:178774 (history)  Vaccinated:2001-11-28
Age:33.0  Onset:2001-11-28, Days after vaccination: 0
Gender:Female  Submitted:2001-11-30, Days after onset: 2
Location:South Carolina  Entered:2001-12-10, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BCP
Current Illness: Healthy
Preexisting Conditions:
Diagnostic Lab Data: NONE
CDC Split Type: SC0160
Vaccination
Manufacturer
Lot
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURUO673GA700IMLA
Administered by: Other     Purchased by: Public
Symptoms: Injection site pain, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Soreness injection site, fever 102, 5:30-6 PM took two Goody Powders. Muscle aches up and down arm, joint pain left arm numbness and tingling fingertips developed night of injection and next day. 11/30/2001 symptom free.

VAERS ID:178912 (history)  Vaccinated:2001-12-04
Age:33.0  Onset:2001-12-05, Days after vaccination: 1
Gender:Female  Submitted:2001-12-15, Days after onset: 10
Location:California  Entered:2001-12-12, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0699AA IM 
Administered by: Private     Purchased by: Private
Symptoms: Oedema, Vasodilation procedure
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Red, swollen, warm to touch 45 mm X 35 mm.

VAERS ID:178929 (history)  Vaccinated:2001-11-27
Age:33.0  Onset:2001-11-28, Days after vaccination: 1
Gender:Female  Submitted:2001-11-30, Days after onset: 2
Location:Missouri  Entered:2001-12-12, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Sulfa
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURUO727AA  LA
Administered by: Other     Purchased by: Other
Symptoms: Injection site reaction, Oedema, Pruritus, Vasodilation procedure
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Local reaction in 24 hours: redness, swelling, hot, itchy.

VAERS ID:178940 (history)  Vaccinated:2001-11-23
Age:33.0  Onset:2001-12-03, Days after vaccination: 10
Gender:Male  Submitted:2001-12-08, Days after onset: 5
Location:California  Entered:2001-12-12, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever, examthema 10 days after MMR.

VAERS ID:178959 (history)  Vaccinated:2001-12-04
Age:33.0  Onset:2001-12-05, Days after vaccination: 1
Gender:Unknown  Submitted:0000-00-00
Location:Pennsylvania  Entered:2001-12-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Demulen, Abuterol MPI
Current Illness: NONE
Preexisting Conditions: IVP dye allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1882K1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site reaction
SMQs:
Write-up: Severe local reaction of 10x 7.5 cm area 2 days after Varicella vaccine.

VAERS ID:178978 (history)  Vaccinated:2001-10-22
Age:33.0  Onset:2001-10-22, Days after vaccination: 0
Gender:Female  Submitted:2001-11-15, Days after onset: 24
Location:Texas  Entered:2001-12-13, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
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FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  SC 
Administered by: Other     Purchased by: Private
Symptoms: Hypersensitivity, Pruritus, Vasodilation procedure
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Red, itching, heat.

VAERS ID:179319 (history)  Vaccinated:2001-11-14
Age:33.0  Onset:2001-11-15, Days after vaccination: 1
Gender:Female  Submitted:2001-11-20, Days after onset: 5
Location:Texas  Entered:2001-12-21, Days after submission: 31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: TX01180
Vaccination
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Lot
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0588AA1IM 
TD: TD ADSORBED (NO BRAND NAME)CONNAUGHT LABORATORIESU0147AA IMLA
Administered by: Other     Purchased by: Public
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: The client attended a health clinic at a community center on 11/14/01 where she received a TD booster. She complained of swelling to the left arm, face and neck. She was seen be an RN at the office at 15:30. Her left arm had redness to the deltoid area of approx. 2" in diameter with moderate swelling. No swelling to face, neck or chest, as she had stated. Her arm was warm to touch. Advised her to apply warm and wet soaks.

VAERS ID:179664 (history)  Vaccinated:2001-11-30
Age:33.0  Onset:2001-12-01, Days after vaccination: 1
Gender:Male  Submitted:2001-12-03, Days after onset: 2
Location:Nebraska  Entered:2002-01-03, Days after submission: 31
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Laceration on forth finger of left hand
Preexisting Conditions:
Diagnostic Lab Data: ER nurse did not document on chart lot # or exp. date. When we called them, this is what they gave us.
CDC Split Type:
Vaccination
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TTOX: TETANUS TOXOID (NO BRAND NAME)CONNAUGHT LABORATORIESU0539AA  RA
Administered by: Private     Purchased by: Other
Symptoms: Erythema, Injection site warmth, Lymphadenopathy, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient experienced a baseball sized edema. The area was erythematic and hot to the touch. As of 12/03/2001, the swelling had decreased to the size of a ping pong ball. The lymph nodes in the right axilla were enlarged. Patient feels ok, but has concerns about the reaction. Treatment consisted of ice or heat applied to right deltoid for 10-15 minutes 2-3 X day, 10 mg of Claritin once a day and RTC if site increased in size, redness or drainage.

VAERS ID:179866 (history)  Vaccinated:2001-11-28
Age:33.0  Onset:2001-11-28, Days after vaccination: 0
Gender:Male  Submitted:2001-11-28, Days after onset: 0
Location:Michigan  Entered:2002-01-11, Days after submission: 44
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Patient has a pacemaker
Diagnostic Lab Data: CPK Normal;EKG-ok;CBC-Normal; comprehensive increased Bili 1.5; SGOT increased 95;SGPT increased ; repeat liver enzymes ordered; urine trace (?) blood
CDC Split Type:
Vaccination
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HEPAB: HEP A + HEP B (TWINRIX)GLAXOSMITHKLINE BIOLOGICALS218A61IMLA
IPV: POLIO VIRUS, INACT. (POLIOVAX)AVENTIS PASTEURT1148 SCLA
MEN: MENINGOCOCCAL (MENOMUNE-A/C)CONNAUGHT LTD.UB056AB SCRA
RAB: RABIES (RABAVERT)CHIRON CORPORATION286011 IMRA
Administered by: 0     Purchased by: 0
Symptoms: Chest pain, Hyperhidrosis, Laboratory test abnormal, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: sweats, chills, aches, low grade temp, chest pain

VAERS ID:180263 (history)  Vaccinated:2000-11-14
Age:33.0  Onset:2000-11-14, Days after vaccination: 0
Gender:Female  Submitted:2000-12-12, Days after onset: 28
Location:Wisconsin  Entered:2002-01-22, Days after submission: 406
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: denies taking concomitant meds.
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: 20000356061
Vaccination
Manufacturer
Lot
Dose
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HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3360A42 LA
Administered by: Private     Purchased by: Private
Symptoms: Fatigue, Influenza like illness, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)
Write-up: Report 2000035606-1 describes flu-like symptoms in a 33 year old female who received the hepatitis-b vaccine for prophylaxis of hepatitis B. Reportedly, the vaccinee denies having allergies or medical history. She denies taking concomitant medications In July, 1999, August, 1999 and on 14-NOV-00 (left deltoid), the vaccinee received her first, second and third doses of the hepatitis-b vaccine, respectively. Since receiving her third dose of the hepatitis-b vaccine (starting on 14-NOV-00), the vaccinee experienced flu-like symptoms, fatigue and sore shoulder. As of 11-Dec-00, the outcome of the events is ongoing.

VAERS ID:180294 (history)  Vaccinated:2001-01-02
Age:33.0  Onset:2001-01-02, Days after vaccination: 0
Gender:Female  Submitted:2001-03-13, Days after onset: 70
Location:Massachusetts  Entered:2002-01-22, Days after submission: 315
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergic to oysters
Diagnostic Lab Data:
CDC Split Type: 20010038911
Vaccination
Manufacturer
Lot
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Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS3369A61IM 
Administered by: Other     Purchased by: Private
Symptoms: Diarrhoea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Report 20010038911 described vomiting, diarrhea, and general malaise in a 33 year old female who received hepatitis B vaccine recombinant (Engerix-B) for prophylaxis of hepatitis B. The vaccinee is allergic to oysters. Reportedly she had no medical history and took no concomitant medications. On 01/02/2001, the vaccinee received her second 20 mcg IM dose of Engerix-B. Within twelve hours post-vaccination, the vaccinee experienced vomiting, general malaise, and diarrhea. Symptoms resolved on 01/02/2001. As of 03/13/2001, the outcome of the events is resolved. The reporter has reported these adverse events directly to VAERS.

VAERS ID:180301 (history)  Vaccinated:2001-02-05
Age:33.0  Onset:0000-00-00
Gender:Female  Submitted:2002-01-14
Location:Unknown  Entered:2002-01-23, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: Pregnancy (LMP-UNK)
Diagnostic Lab Data: Beta-human chorionic-positive
CDC Split Type: WAES01041197
Vaccination
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0SC 
Administered by: 0     Purchased by: 0
Symptoms: Abortion spontaneous, Laboratory test abnormal
SMQs:, Termination of pregnancy and risk of abortion (narrow)
Write-up: Information has been received from a RN concerning a 33 year old female who was vaccinated with a first and second dose of varicella virus vaccine live on 05-FEB-2001 and 28-MAR-2001, respectively. The pt informed the RN that she tested positive for pregnancy with a home pregnancy test. Unspecified medical attention was sought. In follow up the RN reported that the pt had an uncomplicated first trimester spontaneous abortion. The RN reported that neither the physician nor the pt thought that there was any relationship between the exposure and the miscarriage. No further information is available.

VAERS ID:180345 (history)  Vaccinated:2002-01-07
Age:33.0  Onset:2002-01-08, Days after vaccination: 1
Gender:Female  Submitted:2002-01-09, Days after onset: 1
Location:Idaho  Entered:2002-01-23, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0372L1 LL
Administered by: Private     Purchased by: 0
Symptoms: Myalgia, Pain, Rash, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Local reaction to MMR. left arm swelling erythema, pain, tenderness & rash. Ice pack applied. taking Advil. Local reaction resolved 1-14-02

VAERS ID:180366 (history)  Vaccinated:2001-02-06
Age:33.0  Onset:2001-02-06, Days after vaccination: 0
Gender:Female  Submitted:2001-03-28, Days after onset: 50
Location:Idaho  Entered:2002-01-24, Days after submission: 302
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: Vaccinee had seasonal allergies and took no concomitant medications. There was no illness at the time of the vaccination.
Diagnostic Lab Data:
CDC Split Type: 2001005414
Vaccination
Manufacturer
Lot
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HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3369B61IMLA
Administered by: Public     Purchased by: Public
Symptoms: Contusion, Feeling hot, Injection site mass, Injection site oedema, Injection site pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: The vaccinee had seasonal allgeries and took no concomitant medications. There was no illness at the time of the vaccination. No adverse events were reported following dose 1 of Engerix-B. On 6 February 2001, the vaccinee received her second IM-left deltoid dose of Engerix-B. 30 minutes later, she developed a hard lump (at the injection site). The lump was warm at bedtime and felt al ittle itchy. The vaccinee had "blood in arm the size of a fifty cent piece and the site was kind of blue." On 7 February 2001, the vaccinee still had a blue bruise. At noon, severe itching began and the area got redder and the "hard spot" grew to 1 to 1.5 inches in diameter. In the evening, the area was 6 to 8 inches long and three inches wide. The area was red, hard and hot. She experienced "swelling/pain in deltoid" (injection site). She treated herself with cool compresses and ibuprofen. On 8 February 2001, she was seen by a physician, who treated her with amoxicillin trihydrate/clavulanic acid (Augmentin). As of 27 March 2001, the outcome of the events was unknown.

VAERS ID:180408 (history)  Vaccinated:2001-04-30
Age:33.0  Onset:2001-05-01, Days after vaccination: 1
Gender:Female  Submitted:2001-06-12, Days after onset: 42
Location:Florida  Entered:2002-01-24, Days after submission: 226
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PB Tine test 04/30/2001
Current Illness: UNK
Preexisting Conditions: allergic to penicillin
Diagnostic Lab Data:
CDC Split Type: 20010141421
Vaccination
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HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM 0IMLA
Administered by: Private     Purchased by: Other
Symptoms: Eye irritation, Eye swelling, Pruritus
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Corneal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Report 20010141421 described swelling and itching (eyes) in a 33 year old female who received hep B vaccine (Engerix-B) for the prophylaxis of hep B. This report was received from the vaccinee and has not been verified by a physician or other health care professional. The vaccinee is allergic to penicillin. Her medical history was not specified. She received the tuberculin tine test on 04/30/2001. On 04/30/2001, the vaccinee received her first left arm dose of Engerix-B. That evening, she experienced itching of the eyes. On 05/01/2001, she woke up with "marked" swelling of the eyes. She "consulted" with the physician and was told to call back if the situation worsened, or alternatively to seek emergency medical attention. On 05/02/2001, the swelling was "the same"; she went to see the physician. The physician consulted with an immunologist who reportedly said that swelling occur as a side effect of the vaccine; he advised that she receive no more immunizations with this vaccine. As of 06/11/2001, the outcome of the events was unknown.

VAERS ID:180432 (history)  Vaccinated:0000-00-00
Age:33.0  Onset:0000-00-00
Gender:Male  Submitted:2001-08-27
Location:Texas  Entered:2002-01-24, Days after submission: 150
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Diagnostic Lab Data: Biltot:elevated-August 2001
CDC Split Type: 20010203732
Vaccination
Manufacturer
Lot
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Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM 0SC 
Administered by: Other     Purchased by: Other
Symptoms: Blood bilirubin increased
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Biliary system related investigations, signs and symptoms (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Report 20010203732 described elevated bilirubin in a 33 year old male who received hep B vaccine (brand unspecified). This report was received from the vaccinee''s wife and has not been verified by a physician or other health care professional. The vaccinee''s allergies, and medical history were not specified. In August 2000, the vaccinee reportedly received an injection of hep b vaccine and a subcutaneous injection of hep a vaccine inactivated. Reportedly, the vaccinee subsequently developed an elevated bilirubin level, which he was currently. The consumer consulted a health care professional regarding the adverse event. Hep B vaccine was discontinued. As of 08/17/2001, the outcome of the adverse event was ongoing.

VAERS ID:180506 (history)  Vaccinated:2001-12-19
Age:33.0  Onset:2001-12-21, Days after vaccination: 2
Gender:Female  Submitted:2002-01-18, Days after onset: 28
Location:Maryland  Entered:2002-01-24, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Route
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.097K1SCLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, 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 (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt called 2 days post vaccination to report redness, swelling, heat and pain at the injection site. Pt states feels systemic itching without rash, no swollen glands.

VAERS ID:180831 (history)  Vaccinated:2000-04-10
Age:33.0  Onset:2000-04-11, Days after vaccination: 1
Gender:Female  Submitted:2000-04-18, Days after onset: 7
Location:Pennsylvania  Entered:2002-02-04, Days after submission: 657
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: U200000276
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0147AA IM 
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site induration, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: It was reported that a pt who rec''d TD adult vaccination on 4/10/00. Reportedly on 4/11/00, the pt developed a local reaction of redness, warmth and induration.

VAERS ID:180832 (history)  Vaccinated:2000-03-20
Age:33.0  Onset:2000-03-24, Days after vaccination: 4
Gender:Female  Submitted:2000-04-18, Days after onset: 24
Location:Pennsylvania  Entered:2002-02-04, Days after submission: 657
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: U200000277
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0147AA IM 
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site induration, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: It was reported that a pt rec''d TD adult vaccination on 3/20/00. Reportedly on 3/24/00, the pt developed a local reaction of redness, warmth, induration.

VAERS ID:181362 (history)  Vaccinated:2002-01-07
Age:33.0  Onset:2002-01-08, Days after vaccination: 1
Gender:Male  Submitted:2002-02-06, Days after onset: 29
Location:Unknown  Entered:2002-02-13, 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:
Current Illness:
Preexisting Conditions: Diabetes Mellitus II
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV063 SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Back pain, Chills, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Pt had chills times 1 day, N&V times 4 days and L extremity pain dorsum post vaccination. Sought medical care 3 days post vax with treatment with LMD with otc analgesic and anti-emesis. All conditions resolved with no further problems noted.

VAERS ID:181600 (history)  Vaccinated:2001-09-18
Age:33.0  Onset:2001-09-18, Days after vaccination: 0
Gender:Female  Submitted:2001-10-16, Days after onset: 28
Location:Ohio  Entered:2002-02-21, Days after submission: 128
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Alesse Birthcontrol pills, Celexa, Advair
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEUR0463AA  LA
Administered by: Private     Purchased by: Private
Symptoms: Hypoaesthesia, Inflammation, Pain
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: Within seconds both arms, hands, fingers went completely numb. After injection had achy severe pain with burning from her shoulder down to her fingers. She have been diagnosed with RSD due to this injury (vaccine) and take nuerontin for nueropathic pain, receive stelute gangalion nerve blocks and now is in physical therapy. Her treatment started early but no one knows it has now almost been 5 month since the vaccine.

VAERS ID:181717 (history)  Vaccinated:2001-12-17
Age:33.0  Onset:2001-12-18, Days after vaccination: 1
Gender:Female  Submitted:2001-12-19, Days after onset: 1
Location:Wyoming  Entered:2002-02-26, Days after submission: 69
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Aspenia
Diagnostic Lab Data: NONE
CDC Split Type: WY0202
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH40180575IMLA
Administered by: Public     Purchased by: Public
Symptoms: Asthenia, Dyspnoea, Feeling hot, Hypersensitivity, Livedo reticularis, Pruritus, Sensation of heaviness, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: On 12/18/01 at 08:00, woke up feeling weak and body felt heavy and felt feverish. At 08:30, began having hot flashes, breathing difficulty and needing to take deep breaths. At 14:00, face and hands turned red and started itching. At 15:30, went to MD''s office and was developing hives, mottling and itching over entire body. On 12/19/01, continued itching but redness resolving. Received Depo-Medrol 40mg, IM. Now am taking Zyrtec 10mg 1 Tab for allergic reaction.

VAERS ID:181935 (history)  Vaccinated:2002-02-01
Age:33.0  Onset:2002-02-07, Days after vaccination: 6
Gender:Female  Submitted:2002-02-13, Days after onset: 6
Location:California  Entered:2002-03-05, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Premarin 1.25, Valium 5 mg
Current Illness: NONE
Preexisting Conditions: hysterectomy
Diagnostic Lab Data: Test for streps-negative
CDC Split Type: CA020015
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0705AA0IM 
Administered by: Public     Purchased by: Public
Symptoms: Malaise, Pain, Pharyngolaryngeal pain, Pyrexia, Rhinitis, Skin exfoliation, Vomiting
SMQs:, Severe cutaneous adverse reactions (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Onset of sore throat, runny nose, body aches, malaise beginning 1 week after flu shot. fever 103 for three days, vomiting. Test for strep -negative. Red bumps on torso, peeling of hands. 10 days later progressed to ear infection. Eymin RX for ear infection.

VAERS ID:182139 (history)  Vaccinated:2002-02-12
Age:33.0  Onset:2002-02-12, Days after vaccination: 0
Gender:Female  Submitted:2002-02-13, Days after onset: 1
Location:Michigan  Entered:2002-03-08, Days after submission: 23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Unspecified reaction;Hep B (Mfr not specified);1;26.00;In Patient
Other Medications: Allegra qd; Albuterol prn; Levbid prn
Current Illness: NONE
Preexisting Conditions: Allergies to penicillin, sulfa, iodine, latex and peanuts
Diagnostic Lab Data: NONE
CDC Split Type: MI2002016
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM704A41IMRA
Administered by: Public     Purchased by: Public
Symptoms: Flushing, Hypotension
SMQs:, Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Hypersensitivity (broad)
Write-up: Client stated she felt "funny/flushed". Client denied nausea, dizziness, weakness or breathing difficulty. At 15:42, client self-administered 50mg Benadryl po. At 16:00, BP was 120/70; pulse 80 and client stated she still felt "funny". At 16:45, client stated she felt "fine", no longer "flushed" or any other symptoms. Client stated the injection site was "sore". Ice pack applied X 30 minutes. At 17:20, BP was 110/70, pulse 80, no further complaints. Client left clinic without assistance. On 2/13/02, client saw PCP and had no further treatment needed, no tests done and she stated injection site still "sore" but no redness, swelling or warmth to the site.

VAERS ID:182210 (history)  Vaccinated:0000-00-00
Age:33.0  Onset:0000-00-00
Gender:Male  Submitted:2001-08-27
Location:Texas  Entered:2002-03-11, Days after submission: 196
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: UNK
Diagnostic Lab Data: biltot-elevated (Aug 2000)_
CDC Split Type: 20010203731
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 0  
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM 0SC 
Administered by: Other     Purchased by: Other
Symptoms: Blood bilirubin increased
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Biliary system related investigations, signs and symptoms (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Report described elevated bilirubin in a 33 year old male who received hep A vaccine. This report was received from the vaccinee''s wife and has not been verified by a physician or other health care professional. The vacinee''s allergies, and medical history were not specified. In August 2000, the vaccinee reportedly received a subcutaneous injection of Havrix and an injection of hep B vaccine. It was not known whether the vaccinee ha dreceived previous doses of Havrix or hep B vaccine. Reportedly, the vaccinee subseuently developd an elevated bilirubin level, which he has currently. The consumer consulted a health care professional regarding the adverse event. Havrix was discontinued. As of 08/17/2001, the outcome of the adverse event was ongoing.

VAERS ID:182277 (history)  Vaccinated:2001-10-30
Age:33.0  Onset:2001-10-31, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:Colorado  Entered:2002-03-13
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: asthmatic
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU0674AA5IMLA
Administered by: Military     Purchased by: Military
Symptoms: Pruritus, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Swollen , hives, itchness all over body. Hives all over. Has retained over 40 lbs of water since shot was given on 30 Oct 01. ER visit 3 Nov 01

VAERS ID:182401 (history)  Vaccinated:2001-07-24
Age:33.0  Onset:2001-07-25, Days after vaccination: 1
Gender:Female  Submitted:2002-03-07, Days after onset: 225
Location:Unknown  Entered:2002-03-13, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES01072676
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.  IM 
Administered by: Other     Purchased by: Other
Symptoms: Hypokinesia, Injection site pain, Pain
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Information has been received from a registered nurse concerning a 33 year old female who on 24 JUL 2001 was vaccinated with Hepatitis B vaccine recombinant (yeast) 1 ml intramuscularly. On 25 JUL 2001 the patient developed soreness at the injection site. The patient stated that she cannot lift the affected arm all the way up and the arm feels heavy. Unspecified medical attention was sought. Additional information has been requested.

VAERS ID:182407 (history)  Vaccinated:2001-08-15
Age:33.0  Onset:2001-08-15, Days after vaccination: 0
Gender:Female  Submitted:2002-03-07, Days after onset: 204
Location:Unknown  Entered:2002-03-13, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Decadron Tablets
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: WAES01082392
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.    
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.    
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Feeling abnormal
SMQs:, Dementia (broad), Guillain-Barre syndrome (broad)
Write-up: Information has been received from a 33 year old female with no past medical history and no known drug allergies who on 15 AUG 2001 was vaccinated with a dose of hepatitis b vaccine recombinant (yeast). Concomitant therapy that day included a dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (second generation) (MSD) and varicella virus vaccine live (site unknown) (MSD). Other concomitant therapy included unspecified steroids (manufacturer unknown). After being vaccinated, the patient began feeling tired and her head was "feeling heavy". It was reported that the patient''s symptoms were "decreasing" since she received the vaccines. The patient sought unspecified medical attention. Additional information has been requested.

VAERS ID:182787 (history)  Vaccinated:2001-11-29
Age:33.0  Onset:2001-12-01, Days after vaccination: 2
Gender:Female  Submitted:2001-12-03, Days after onset: 2
Location:New Mexico  Entered:2002-03-25, Days after submission: 112
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: allergic to pcn and bug bites
Diagnostic Lab Data: NONE
CDC Split Type: NM120101
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEUR0588A0IMRA
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM204A40IMLA
IPV: POLIO VIRUS, INACT. (IPOL)AVENTIS PASTEUR1153 SCLA
Administered by: Other     Purchased by: Other
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt developed intense pruritis/urticaria. Treated with Benadryl then Tagamet.

VAERS ID:182929 (history)  Vaccinated:2002-03-26
Age:33.0  Onset:2002-03-26, Days after vaccination: 0
Gender:Female  Submitted:2002-03-27, Days after onset: 1
Location:Florida  Entered:2002-03-28, 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: Nexium, Ortho-Tryddine
Current Illness: NONE
Preexisting Conditions: Hay Fever
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5262A41 RA
Administered by: Other     Purchased by: Private
Symptoms: Dizziness, Muscle spasms, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Nausea, Cramps, dizzy, vomiting

VAERS ID:183130 (history)  Vaccinated:2002-03-06
Age:33.0  Onset:2002-03-21, Days after vaccination: 15
Gender:Female  Submitted:2002-03-22, Days after onset: 1
Location:Florida  Entered:2002-04-03, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Pcn and environmental allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5250IMRA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0742L SCLA
Administered by: Public     Purchased by: Private
Symptoms: Arthralgia, Arthritis, Pain
SMQs:, Systemic lupus erythematosus (broad), Arthritis (narrow)
Write-up: "Arthritic" type pain in joints of fingers, toes, wrists, neck, lower back, top part of feet, arched of feet, left knee felt crippled (then both knee''s had moderate pain).

VAERS ID:183384 (history)  Vaccinated:2002-02-21
Age:33.0  Onset:2002-02-21, Days after vaccination: 0
Gender:Female  Submitted:2002-02-25, Days after onset: 4
Location:Minnesota  Entered:2002-04-11, Days after submission: 44
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: MN02003
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5231A62IMLA
Administered by: Public     Purchased by: Other
Symptoms: Aphthous stomatitis, Influenza like illness, Sinusitis, Viral infection
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow)
Write-up: The pt went to MD about 1 hour after receiving shot. She had canker sores on left side of tongue that appeared. She received a steroid shot and then was on Prednisone and an antihistamine for 4 days. She didn''t have any difficulty breathing. She ended up back to the MD with flu symptoms, 2 weeks later and then ended up with a sinus infection. The MD suspected that she had a virus in her system on the day she received the vaccine.

VAERS ID:183679 (history)  Vaccinated:2002-03-15
Age:33.0  Onset:2002-03-18, Days after vaccination: 3
Gender:Male  Submitted:2002-05-13, Days after onset: 55
Location:New York  Entered:2002-04-19, Days after submission: 24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Azithromycin; Pentamidine; Fluconazole; Paroxatine hydrochloride; Amprenavir; Ritonavir; menivudine; Acyclovir; Stavudine; Didenosine
Current Illness:
Preexisting Conditions: HIV antibody positive, potitive hep B surface antige. He smoked one-half pack of cigarettes daily; he "rarely" used alcohol.
Diagnostic Lab Data: On 3/1802 ALT serum-667 U/L and AST serum 571 U/L; on 3/2202 ALT serum-217 U/L and AST serum-100 U/L
CDC Split Type: A0364825A
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS 1IM 
Administered by: Private     Purchased by: Other
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Liver related investigations, signs and symptoms (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: The pt was infected with HIV and was Hep-B surface antigen positive. He did not received any concomitant vaccines. Concurrent medications were not specified; however, the physician stated that "nothing had changed with his medication regimen". In approx. 8/01, the pt received his 1st injection of Engerix-B without adverse event. On 3/15/02, the pt received his 2nd injection of Engerix-B. On 3/19/01, he complained of fever and muscle aches. Liver function tests performed on 3/19/01, revealed AST 571 U/L and ALT 667 U/L. Prior to this, the pt''s AST and ALT concentrations were normal. The results of serologic testing for other causes of viral hepatitis were not reported. He did not receive any treatment for the events. He returned to the physician on 3/27/02. At that time, the fever had subsided and the muscle aches had improved. Liver function tests revealed AST 100 U/L and ALT 217 U/L. This report of increased AST and ALT concentrations, is considered "Medically Serious". The follow up states the pt received hep A vaccine (Havrix). It was originally reported that the vaccinee received hep B vaccine (Engerix B); on follow up the vaccine administered was identified as Havrix. He smoked one-half pack of cigarettes daily; he "rarely" used alcohol. Concurrent medications included azithromycin 1200mg weekly beginning 3/27/02, Pentamidine 300mg daily beginning 11/3/00, Fluconazole; Paroxatine hydrochloride; Amprenavir; Ritonavir; menivudine. The physician stated that "nothing" had changed with his medication regimen; however, the physician reported that fluconazole therapy was added on 2/26/02 and discontinued on 3/13/00. On 7/5/01, the vaccinee received his first injection of Havrix without adverse event. On 3/18/01, three days post immunization, he complained of fever, anorexia, and muscle adches. Liver function tests performed on 3/18/01. He returned to the physician on 3/22/02. The fever, anorexia, and muscle aches had resovled. The physician considered the reported events to be possibly related to Havrix administra

VAERS ID:183778 (history)  Vaccinated:2001-11-21
Age:33.0  Onset:2001-11-23, Days after vaccination: 2
Gender:Female  Submitted:2002-03-15, Days after onset: 112
Location:Missouri  Entered:2002-04-23, Days after submission: 38
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: Latex allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Asthenia, Dyspnoea, Lethargy, Pneumonia
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Acute onset of shortness of breath and weakness. No hives or rash. Taken to the medical center. Unstable in ER with weak pulse and lethargic. Admitted to the hospital and was diagnosed pneumonia.

VAERS ID:183858 (history)  Vaccinated:2002-04-16
Age:33.0  Onset:2002-04-18, Days after vaccination: 2
Gender:Female  Submitted:2002-04-18, Days after onset: 0
Location:Ohio  Entered:2002-04-24, 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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0632SCLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site reaction, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Employee received anthrax vaccine on 04/10/2002. On 04/18/2002 at injection site she developed red and indurated (7cm), warm to touch and mild pain.

VAERS ID:183878 (history)  Vaccinated:2002-04-10
Age:33.0  Onset:2002-04-13, Days after vaccination: 3
Gender:Female  Submitted:2002-04-17, Days after onset: 4
Location:New York  Entered:2002-04-24, 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: Serevent, Albuterol
Current Illness: NONE
Preexisting Conditions: Allergic to pcn, codeine, food (strawberries, cashews, etc)
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0520AA IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Injection site reaction, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Pain, swelling, warmth, hardness, tenderness on right deltoid region.

VAERS ID:184268 (history)  Vaccinated:2002-04-09
Age:33.0  Onset:2002-04-09, Days after vaccination: 0
Gender:Male  Submitted:2002-04-09, Days after onset: 0
Location:Michigan  Entered:2002-05-07, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: NONE Known
Diagnostic Lab Data:
CDC Split Type: MI2002030
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)SMITHKLINE BEECHAM710A41IMLA
Administered by: Public     Purchased by: Public
Symptoms: Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Reports swelling above left clavicle post 05/02/2001 vaccine for Hepatitis A. Approximately 30 minutes after Hepatitis A given today (04/09/2002), swelling above left clavicle noted.

VAERS ID:184360 (history)  Vaccinated:2002-04-19
Age:33.0  Onset:2002-04-27, Days after vaccination: 8
Gender:Female  Submitted:2002-05-02, Days after onset: 5
Location:Maryland  Entered:2002-05-09, 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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH40082840SCLA
Administered by: Private     Purchased by: Other
Symptoms: Cellulitis, Injection site hypersensitivity, Injection site oedema, Lymphadenopathy
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 4/29-cellulitis left deltoid with axillary lymph adenopathy 5/2-Revaluation-cellulitis resolved

VAERS ID:184460 (history)  Vaccinated:2002-04-30
Age:33.0  Onset:2002-04-30, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Wisconsin  Entered:2002-05-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: Finger laceration
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)MASS. PUB HLTH BIOL LABTD79 IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Within hours of DT injection was having swelling and erythema at the injection site. 2 days after injection, had 4cm diameter X 1/2cm height area of induration that was warm and tender.

VAERS ID:184519 (history)  Vaccinated:2002-04-29
Age:33.0  Onset:2002-04-29, Days after vaccination: 0
Gender:Male  Submitted:2002-05-10, Days after onset: 11
Location:New York  Entered:2002-05-14, 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:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER  IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad)
Write-up: The pt developed dizziness and blurred vision.

VAERS ID:184664 (history)  Vaccinated:2002-03-07
Age:33.0  Onset:2002-03-14, Days after vaccination: 7
Gender:Female  Submitted:2002-04-04, Days after onset: 21
Location:Kentucky  Entered:2002-05-16, Days after submission: 41
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: OC''s
Current Illness: NONE
Preexisting Conditions: Nerve problems, stomach problems, sleep disturbance
Diagnostic Lab Data: CBC-normal
CDC Split Type: KY2002019
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0342AA IMRA
Administered by: Public     Purchased by: Unknown
Symptoms: Anorexia, Asthenia, Pneumonia, Pyrexia, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: The pt developed generalized weakness, tired, low grade fever off and on (99-99.4 deg. F). These symptoms began one week later. Pt also experienced no appetite and weight loss. On 03/24/2002 the pt was seen in ER with pneumonia and took Zithromax.

VAERS ID:184670 (history)  Vaccinated:2000-01-01
Age:33.0  Onset:2000-09-23, Days after vaccination: 266
Gender:Female  Submitted:2002-05-15, Days after onset: 599
Location:Unknown  Entered:2002-05-16, 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:
Preexisting Conditions: Pregnancy NOS (LMP-2/7/00)
Diagnostic Lab Data:
CDC Split Type: WAES00064391
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.    
TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER    
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Premature labour
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: Information has been received from a physician concerning a 33 year old female who in January 2000 was vaccinated with one dose of varicella vaccine. Concomitant therapy included one dose of tetanus toxoid and one dose of MMR vaccine. It was noted that the pt received these vaccinations "just prior to conceiving." Approximate LMP 02/07/2000. On 06/26/2000, the pt was seen by a physician and an ultrasound was performed. The results indicated "a singleton fetus growing appropriately for gestational age at the 50-75th percentile. Amniotic fluid volume is normal. The placenta is anterior and unremarkable in appearance. No anomalies are identified." The reporting physician noted "would also like to see her follow-up ultrasound evaluation in 6 weeks, specifically to look at fetal limb lengths and to assess the appearance of the lens of the fetal eyes." Follow-up info received from a physician, indicated that on 08/07/2000 the pt had an ultrasound which revealed the following :weight 885 grams, gender: female, no anomalies, limbs, eyes and heart all OK. Follow-up information received from a physician revealed that on 09/23/2000, at 33 weeks, 2 days gestation,t he pt delivered a baby weighing 3lb. 15 oz. The physician''s notes indicated that the baby was healthy and normal. It was also noted that the pt had a previous preterm delivery as well. No further information is available.

VAERS ID:184671 (history)  Vaccinated:2000-07-01
Age:33.0  Onset:0000-00-00
Gender:Female  Submitted:2002-05-15
Location:South Carolina  Entered:2002-05-16, 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: UNK
Current Illness:
Preexisting Conditions: Pregnancy
Diagnostic Lab Data: GBS-positive; heart-slightly tachcardiac
CDC Split Type: WAES00090435
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Guillain-Barre syndrome, Neoplasm malignant, Streptococcus test positive, Tachycardia
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Malignant tumours (narrow)
Write-up: Information has been received from a woman through the Pregnancy Registry concerning her approximately 33 year old female friend who in approximately July 2000 was vaccinated with varicella vaccine. Two days after vaccination, the pt became pregnant. Medical attention was sought. Follow-up information from a physician indicated that the 33 year old female pt, with a past history of bronchitis, a 1998 spontaneous vaginal delivery of an 8 pound infant, gestational diabetes, in 200 a spontaneous abortion, a remote history of abnormal Pap smears, normal since without STD''s, G3, P1, A1 at 34 6/7 weeks was given the EDC of 04/03/2001, by the LMP consistent with a 17 week scan who presented to labor and delivery for induction. Allergies to medications include penicillin, erythromycin and codeine. Current medication includes prenatal vitamins. The pregnancy was complicated with breast cancer with the left modified radical mastectomy performed on 02/01/2001, revealing poorly differentiated invasive dustal carcinoma with 3.5 cm greatest in diameter and positive lymph nodes. The pt needed chemotherapy two weeks postpartum so the decision was made for an early delivery. It was noted that the left mastectomy was healing well. The pt was GBS positive and will be given clindamycin secondary to allergy to penicillin. The pt desired an epidural for pain control. IV pain medications as needed in early induction. Her breast cancer was stable. She was to received chemotherapy two weeks postpartum. The pt was admitted to the labor and delivery. Sterile vaginal exam revealed a cervix that was fingertip, 2 long and high. A Cytotec induction was begun. Three Cytotec inductions had been placed. The pt had good contraction pattern and Pitocin was started. By mid-afternoon, sterile vaginal exam was 3 long and ballotable. Membranes were ruptured at approx. 3:30pm. The pt progressed through labor well and at 17:21 hr, delivered a 5lb. 8.8oz baby. On postpartum day one, the pt was doing well without complaints. She desired discharge to home. The baby would need to stay an additional day. The pt was discharged home on postpartum day two remaining afebrile meeting all goals. It was noted that the baby was given erythromycin 1 g at 17:25 and vitamin K 1 mg IM. Additional info has been requested.

VAERS ID:184705 (history)  Vaccinated:2001-02-09
Age:33.0  Onset:2001-02-21, Days after vaccination: 12
Gender:Female  Submitted:2002-05-15, Days after onset: 447
Location:Ohio  Entered:2002-05-16, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type: WAES01040251
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 0  
Administered by: Other     Purchased by: Other
Symptoms: Rash erythematous, Skin ulcer
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a physician concerning a 33 year old Asian female with no past medical history who on 02/09/2001 at 10:45 was vaccinated with a first dose of Varicella virus vaccine live, There was no concomitant medication or illness at the time of vaccination. On 02/21/2001, the patient was seen by a physician who noted Varicella lesions at the injection site with appeared as a red rash. The patient''s experience was considered to be disabling by the reporter as the patient was unable to work from 02/21/2001- until 02/27/2001 since she is a registered nurse and was not allowed to have patient contact. On 02/27/2002, the patient recovered. No further information is expected.

VAERS ID:184737 (history)  Vaccinated:2001-02-16
Age:33.0  Onset:2001-04-05, Days after vaccination: 48
Gender:Male  Submitted:2002-05-15, Days after onset: 405
Location:New York  Entered:2002-05-16, 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: UNK
Current Illness:
Preexisting Conditions: Tuberculin test postive
Diagnostic Lab Data: Serum varicella zoster-negative
CDC Split Type: WAES01041163
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1614K1SCRA
Administered by: Private     Purchased by: Other
Symptoms: Laboratory test abnormal
SMQs:
Write-up: Information has been received from a registered nurse concerning a 33 year old male with a history of positive 13mm PPD tuberculosis test but who had normal chest films. On 11/11/2000, the pt''s serum varicella zoster virus antibody test was negative. On 01/18/2001, the pt was vaccinated with the first dose of varicella vaccine SC in left deltoid. On 02/16/2001, the pt was vaccinated with the second dose of varicella vaccine SC in the right deltoid. The nurse reported that the pt did not "seroconvert." On 04/05/2001, the pt''s serum varicella zoster virus antibody test was negative after two varicella vaccines.

VAERS ID:184786 (history)  Vaccinated:2001-03-28
Age:33.0  Onset:2001-04-16, Days after vaccination: 19
Gender:Male  Submitted:2002-05-15, Days after onset: 394
Location:New Jersey  Entered:2002-05-17, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: WAES01041953
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0947K0SC 
Administered by: Private     Purchased by: Other
Symptoms: Back pain, Influenza like illness, Pain, Rash
SMQs:, Anaphylactic reaction (broad), Retroperitoneal fibrosis (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a registered nurse concerning a 33 year old male patient with no known allergies and no medical history who on 28 MAR 2001 was vaccinated with his first dose of varicella virus vaccine live, (Lot # 532044/0947K) in the PM subcutaneously in the left arm. There was no concomitant medication or illness at the time of vaccination. On 18 APR 2001 (also reported as 16 APR 2001) the patient developed a rash throughout the body with vesicles. The patient also had flu-like symptoms plys aches, especially in the back. The patient sought medical intervention. It was reported that the patient recovered on 20 May 2001.

VAERS ID:184859 (history)  Vaccinated:0000-00-00
Age:33.0  Onset:0000-00-00
Gender:Female  Submitted:2002-05-15
Location:Unknown  Entered:2002-05-20, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: Diagnostic lab-varicella antibody titer-negative
CDC Split Type: WAES01050414
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 1  
Administered by: Other     Purchased by: Other
Symptoms: Laboratory test abnormal
SMQs:
Write-up: Information has been received from a physician concerning a 88 year old female who was vaccinated with first dose of varicella vaccine on an unspecified date, and second dose as scheduled on an unspecified date. Subsequently, the pt had a varicella antibody titer test which was negative for seroconversion. The pt sought medical attention. Follow-up info has been received from the physician who reported that the pt did not experience an adverse reaction. She just did not develope a positive antibody titer after immunization. No further info is expected.

VAERS ID:185372 (history)  Vaccinated:0000-00-00
Age:33.0  Onset:0000-00-00
Gender:Female  Submitted:2002-05-15
Location:Unknown  Entered:2002-05-24, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: Serum varicella zoster-no seroconversion
CDC Split Type: WAES01081675
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC. 1  
Administered by: Other     Purchased by: Other
Symptoms: Laboratory test abnormal
SMQs:
Write-up: Information has been received from a registered nurse on 08/15/2001 concerning a female with no known drug allergies who "about four years ago" was vaccinated with a second dose of varicella vaccine. There was no concomitant medication. It was reported on 08/15/2001 that recent titers did not show seroconversion. The pt sought unspecified medical attention. Additional info has been requested.

VAERS ID:185695 (history)  Vaccinated:2002-05-18
Age:33.0  Onset:2002-05-19, Days after vaccination: 1
Gender:Male  Submitted:2002-05-21, Days after onset: 2
Location:Pennsylvania  Entered:2002-05-30, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Allergy to Septra
Diagnostic Lab Data: UNK
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TTOX: TETANUS TOXOID (NO BRAND NAME)SANOFI PASTEURU0519AA1IM 
Administered by: Military     Purchased by: Military
Symptoms: Fatigue, Headache, Injection site reaction, Injection site warmth, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: On 5/18/02, member received TD and PPD. On 5/19/02, began to display symptoms of fever with chills. On 5/20/02, member states that he had severe fatigue that was a problem throughout the day with hot sensations around the site area for the TD shot plus a headache. On 5/21/02, member states symptoms still present but are going away.

VAERS ID:186192 (history)  Vaccinated:1999-06-08
Age:33.0  Onset:1999-06-12, Days after vaccination: 4
Gender:Male  Submitted:0000-00-00
Location:Unknown  Entered:2002-06-10
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: LBP/Bilateral Shoulder pain, short term memory loss, right ankle pain, depression with psychotic features
Diagnostic Lab Data: Elevated CPK; Sleep study - normal; Methacholine challenge - normal; EKG - normal; MRI brain - normal; MRI L-spine - mild disc bulges; EMG normal; GTT - WNL
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0332 RA
Administered by: Military     Purchased by: Military
Symptoms: Affect lability, Arthralgia, Blood creatine phosphokinase increased, Depression, Difficulty in walking, Dyskinesia, Dyspnoea, Hypercholesterolaemia, Hypertension, Hypertonia, Insomnia, Muscle spasms, Muscle twitching, Myalgia, Weight increased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Dyslipidaemia (narrow), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Dementia (broad), Dyskinesia (narrow), Dystonia (broad), Parkinson-like events (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Depression (excl suicide and self injury) (narrow), Lipodystrophy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)
Write-up: Debilitating myalgia and spasm. The pt experienced adverse clinical symptoms after each anthrax vaccine dose, then reproducible muscular pain, spasm and weakness began after the 3rd shot. He previously had received the anthrax vaccine during the Gulf war, but there is lack of documentation as to know how many doses and at what intervals. He had been experiencing symptoms of Gulf war illness which included joint pain and short term memory loss at the time he received the repeated series of anthrax doses. On 06/08/1999, 3-4 days after shot, the pt experienced painful cramping in legs and had difficulty walking. Had bilateral burning in the calves, as well as tightness and twitching in the back, neck and chest muscles. Went on sck call 10-15 days in the 6 month period between shot 3 and 4. Was diagnosed with muscle strain and given NSAIDS. Was unable to sleep, experienced fasciculations and muscular pain at night. Symptoms lessened but did not resolve. Muscle spasm, intermittent twitching, occasional muscle jerking in back, arms, hands, neck and legs. Insomnia, depression, hypercholesterolemia, exertional dyspnea, elevated CPK levels. An annual follow up report received 6/26/2003 adds: Continued to have continuous myalgias, paresthesias, arthralgias and muscle spasm. Walks with a cane. Is being medically discharged from the military. Muscle biopsy negative, EMG "bland myopathic process". The follow up received on 12/31/03 states pt continues to have debilitating myalgia, polyarthralgias and peripheral neuropathy. Ambulates with cane. Cannot perform duties within the military setting and is in the process of being medically separated from the service. 12/14/05 3-page correspondence from patient described muscle stiffness of calves. 6-page medical record described crying spells, weight gain, and hypertension.

VAERS ID:186205 (history)  Vaccinated:2002-04-29
Age:33.0  Onset:2002-04-30, Days after vaccination: 1
Gender:Male  Submitted:2002-05-02, Days after onset: 2
Location:Idaho  Entered:2002-06-10, Days after submission: 39
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: ID02023
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.1379L0SCLA
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0386AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1154L0SCRA
Administered by: Public     Purchased by: Private
Symptoms: Injection site erythema, Injection site oedema, Injection site warmth, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever of 103 deg F, 24 hrs after injection. Body aches, redness, swelling, warm to touch, three days following injections.

VAERS ID:186306 (history)  Vaccinated:2002-05-21
Age:33.0  Onset:2002-05-23, Days after vaccination: 2
Gender:Female  Submitted:2002-06-05, Days after onset: 13
Location:South Carolina  Entered:2002-06-11, 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: PPD
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURUO330AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1293L0SCLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Received immunization vaccines, PPD, TD and varicella on 5/21/02. RTC on 05/23/02 for PPD to be read and revealed a red circular area, warm to the touch at the site of the Varicella.

VAERS ID:186506 (history)  Vaccinated:2002-05-18
Age:33.0  Onset:2002-05-27, Days after vaccination: 9
Gender:Female  Submitted:2002-06-06, Days after onset: 10
Location:Texas  Entered:2002-06-14, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Efexor 150 mg; Synthroid 50mg; vitamins-ginkoba
Current Illness: NONE
Preexisting Conditions: Hashiomoto Thyroididis; multi-nodular goider
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5252A21 LA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0023M2SCRA
Administered by: Public     Purchased by: Unknown
Symptoms: Pruritus, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Started with low grade fever and rash on legs (upper right thigh, lower left shin) legs got infected. Everyday noticed new spots until eventually had it all over. Went to doctor 06/05/02 started on Prednisone 50 mg q da x 5 days, Augmentin 500/125 1 tab po twice day x 7 days. Aveno bath as needed fro itching. Improved today. Pt noted three different types of bmps, one looked like chicken pox, one looked like white head that wouldn''t pop bright red very small compact deep blister looking no bump on top deep-clear in color.

VAERS ID:186586 (history)  Vaccinated:2002-05-14
Age:33.0  Onset:2002-05-16, Days after vaccination: 2
Gender:Male  Submitted:0000-00-00
Location:Ohio  Entered:2002-06-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Xarnax
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1301L0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Erythema, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever, rash and red spots 16 hrs after vaccination then resolved. Then a rash 4 week later with fever with rash.

VAERS ID:186937 (history)  Vaccinated:2002-06-07
Age:33.0  Onset:2002-06-09, Days after vaccination: 2
Gender:Female  Submitted:2002-06-18, Days after onset: 9
Location:Virginia  Entered:2002-06-25, 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: Clonazapan; Paxil; Trazadone
Current Illness: Ruptured eardrum
Preexisting Conditions: Neurological problems (unspecified)
Diagnostic Lab Data: Blood work; MRI-scheduled
CDC Split Type:
Vaccination
Manufacturer
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Dose
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Site
DT: DT ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Other
Symptoms: Dyspnoea, Loss of consciousness, Oedema, Pain
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: Unable to breath, swollen, pain on whole right side (extremities), needed oxygen, was in and out of consciousness, excruciating pain.

VAERS ID:187828 (history)  Vaccinated:2002-07-13
Age:33.0  Onset:2002-07-13, Days after vaccination: 0
Gender:Female  Submitted:2002-07-15, Days after onset: 2
Location:Pennsylvania  Entered:2002-07-22, 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: Latex gloves, Celebrex, Percocet, Pyridium
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM5292A21IMLA
Administered by: Public     Purchased by: Private
Symptoms: Chills, Headache, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 1/2 hour after receiving Hep B vaccine #2, had onset of headache over Right eye with body chills. Next day, complained of soreness at injection site. On 7/15/02 still complained of not feeling well with body aches.

VAERS ID:187923 (history)  Vaccinated:1995-01-01
Age:33.0  Onset:1998-12-01, Days after vaccination: 1430
Gender:Female  Submitted:2002-05-30, Days after onset: 1275
Location:Unknown  Entered:2002-07-23, Days after submission: 54
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data: 12/98 diagnostic lab-measles titer was neg; 8/99 diagnostic lab-measles titer revealed lack of sero-conversion
CDC Split Type: WAES01112190
Vaccination
Manufacturer
Lot
Dose
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Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC. 2SC 
Administered by: Other     Purchased by: Other
Symptoms: Laboratory test abnormal
SMQs:
Write-up: Information has been received on 11/15/01 from a physician concerning a 33 year old Hispanic female who "since 1995" was vaccinated with a 1st, 2nd and 3rd dose of MMRII. The pt received the 1st 2 doses from her physician "around 1995". A measles titer was done in 12/98 and was found to be negative. It was reported that another immunization was given on 2/1/99. A titer was drawn in 8/99 which again revealed lack of sero-conversion. It was noted that the pt did sero-convert on mumps and rubella. The pt sought unspecified medical attention. It was reported that the reporting physician opted not to give the pt a 4th dose. No further information is expected.

VAERS ID:188419 (history)  Vaccinated:2002-07-18
Age:33.0  Onset:2002-07-18, Days after vaccination: 0
Gender:Female  Submitted:2002-07-22, Days after onset: 4
Location:Indiana  Entered:2002-08-05, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Paxil
Current Illness: NONE
Preexisting Conditions: PCN, ASA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0340M0SCLA
Administered by: Private     Purchased by: Other
Symptoms: Pain in jaw, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Osteonecrosis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Onset of low grade fever, afternoon 07/18/02and 07/19/02 and continues today - Onset swelling jaw 07/21/02, Denies difficulty swollen and breathing.

VAERS ID:188827 (history)  Vaccinated:2002-08-04
Age:33.0  Onset:2002-08-04, Days after vaccination: 0
Gender:Female  Submitted:2002-08-04, Days after onset: 0
Location:South Carolina  Entered:2002-08-13, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Allergic to sulfonamides
Diagnostic Lab Data: BP, P- 09:15 108/98/60P 09:30 118/76/76P 09:20 100/70/76P
CDC Split Type:
Vaccination
Manufacturer
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Site
MEN: MENINGOCOCCAL (MENOMUNE)SANOFI PASTEURUB185AB0SC 
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU0382AA0IM 
Administered by: Military     Purchased by: Military
Symptoms: 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), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: Pt passed out approx 5 min post vaccine administration of Tetanus-Diphtheria and Menomune.

VAERS ID:189110 (history)  Vaccinated:2002-08-15
Age:33.0  Onset:2002-08-15, Days after vaccination: 0
Gender:Female  Submitted:2002-08-15, Days after onset: 0
Location:Alabama  Entered:2002-08-20, 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: Asthma, Mold, Grass, IVP dye per health history.
Diagnostic Lab Data: No labs done in ER.
CDC Split Type:
Vaccination
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MEA: MEASLES (ATTENUVAX)MERCK & CO. INC.0531L SCRA
Administered by: Public     Purchased by: Private
Symptoms: Heart rate increased, 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: Received Attenuvax Booster vaccine. 30-40 minutes after administered complained of nausea, vomiting and pulse rate was elevated to 140. To ER; treated by ER physician epi and Benadryl.

VAERS ID:189188 (history)  Vaccinated:1999-03-17
Age:33.0  Onset:1999-03-29, Days after vaccination: 12
Gender:Male  Submitted:2002-08-05, Days after onset: 1224
Location:Unknown  Entered:2002-08-22, Days after submission: 17
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: Head CT-normal; multiple neurological examinations-all normal
CDC Split Type:
Vaccination
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ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0364  
Administered by: Military     Purchased by: Military
Symptoms: Drug administration error, Headache
SMQs:, Medication errors (narrow)
Write-up: Within 2 weeks of administered expired vaccine, severe headache onset. Frequent headaches since. No severe headaches prior to vaccine.

VAERS ID:189347 (history)  Vaccinated:2002-02-13
Age:33.0  Onset:2002-02-13, Days after vaccination: 0
Gender:Female  Submitted:2002-08-14, Days after onset: 181
Location:Virginia  Entered:2002-08-26, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: NONE
Diagnostic Lab Data: TSH and CBC-nml
CDC Split Type:
Vaccination
Manufacturer
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Dose
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Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS711A6 IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: Pt developed numbness in fingers and toes shortly after receiving Hep-A vaccine. Symptoms have persisted to this date.

VAERS ID:189431 (history)  Vaccinated:2002-06-11
Age:33.0  Onset:2002-06-17, Days after vaccination: 6
Gender:Female  Submitted:2002-08-21, Days after onset: 65
Location:Ohio  Entered:2002-08-28, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 14 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: nONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Stool cultures/stool for C Difficue Toxin-neg
CDC Split Type:
Vaccination
Manufacturer
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Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1317L SC 
Administered by: Private     Purchased by: Private
Symptoms: Abdominal pain, Diarrhoea, Gastroenteritis, Gastrointestinal disorder, Leukocytosis, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Diarrhea, fever, nausea and vomiting began 11 days MMR vaccine, 6 days after Varivax vaccine. The discharge summary states abdominal pain. Also states gastroenteritis and Crohn''s disease.

VAERS ID:189567 (history)  Vaccinated:2002-08-08
Age:33.0  Onset:2002-08-15, Days after vaccination: 7
Gender:Female  Submitted:2002-08-20, Days after onset: 5
Location:Michigan  Entered:2002-08-30, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Valtrax, oral birth control, Allegra
Current Illness:
Preexisting Conditions: Hearing loss; harpes (genital); pollen, grass, trees
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0125M0 LA
Administered by: Public     Purchased by: Private
Symptoms: Joint stiffness, Lymphadenopathy, Parotitis, Tenderness
SMQs:, Oropharyngeal infections (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Client received 1st MMR on 8/8/02. Symptoms started on 8/15/02 with c/o jaw stiffness, tenderness, (B) ear. Client noticed swollen lymph gland one day later under (R) ear. Symptoms persist today. Has dr''s appoint. today. 8/22/02 saw PMD toda. PMD diagnosed parotitis, severe infection and ordered client not to receive 2nd MMR.

VAERS ID:190975 (history)  Vaccinated:2001-07-30
Age:33.0  Onset:2002-07-30, Days after vaccination: 365
Gender:Male  Submitted:2002-10-03, Days after onset: 65
Location:Unknown  Entered:2002-10-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unk
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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Dose
Route
Site
HEP: HEP B (ENGERIX-B)SMITHKLINE BEECHAM3214A40  
Administered by: Public     Purchased by: Unknown
Symptoms: Erythema, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Became red and itchy all over. Went to walk-in clinic and treated with Benadryl.

VAERS ID:191291 (history)  Vaccinated:2002-09-30
Age:33.0  Onset:2002-10-01, Days after vaccination: 1
Gender:Female  Submitted:2002-10-04, Days after onset: 3
Location:New York  Entered:2002-10-14, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
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Dose
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TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0463AA  LA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Redness, warm at site, below injection site.

VAERS ID:191567 (history)  Vaccinated:2002-10-14
Age:33.0  Onset:2002-10-15, Days after vaccination: 1
Gender:Male  Submitted:2002-10-17, Days after onset: 2
Location:Ohio  Entered:2002-10-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESE34102HA0IMLA
Administered by: Public     Purchased by: Private
Symptoms: Chills, Malaise, Pyrexia, Rash vesicular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: VACCINE ADMINISTERED ON 10/14/02. ON 10/15/02 THE PATIENT DEVELOPED FEVER, MALAISE AND CHILLS. LATE IN THE DAY, THE PATIENT DEVELOPED A VESICULAR RASH. ON 10/16/02, A GENERALIZED VESICULAR RASH WAS NOTED. ON 10/17/02, A RASH, MALAISE, AND CHILLS STILL PRESENT.

VAERS ID:191583 (history)  Vaccinated:2002-09-13
Age:33.0  Onset:2002-09-14, Days after vaccination: 1
Gender:Female  Submitted:2002-09-23, Days after onset: 9
Location:North Dakota  Entered:2002-10-21, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol inhaler prn, Flovent 110mg bid, Triphasil
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type: ND0214
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0527AA IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Injection site pain, Oedema, Vomiting
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Phone call from pt on 9/16/02 states that on 9/14 was vomiting, R arm sore but shoulder and collar bone area red and swollen up to neck.

VAERS ID:191861 (history)  Vaccinated:2001-12-05
Age:33.0  Onset:2001-12-05, Days after vaccination: 0
Gender:Female  Submitted:2001-12-28, Days after onset: 23
Location:Unknown  Entered:2002-10-23, Days after submission: 298
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: U200101234
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0714AA   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site reaction, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: From correspondence received at manufacturer on 12/5/01 it was reported that a 33 year old female patient received a Fluzone SV 2001-2002 vaccination administered on 12/5/01. Patient developed a local reaction 2 hours after vaccination--3.5cm red swollen area.

VAERS ID:191958 (history)  Vaccinated:2002-10-16
Age:33.0  Onset:2002-10-16, Days after vaccination: 0
Gender:Female  Submitted:2002-10-16, Days after onset: 0
Location:Maryland  Entered:2002-10-25, 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: Depeprovera
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
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Dose
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FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4020024 IMLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site hypersensitivity, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient was given flu shot at 13:58 and instructed to wait 20 minutes in the clinic rest area in case of any reactions. Patient came back at 14:15 with complaints of itching on the face, around the nose and at vaccine site. Vital signs checked: temperature 98.9; pulse 63; respiratory rate 20; BP 109/53. Benadryl 50mg PO given. No respiratory distress. Patient told to wait 30 minutes and was discharged.

VAERS ID:191997 (history)  Vaccinated:2002-10-15
Age:33.0  Onset:2002-10-15, Days after vaccination: 0
Gender:Female  Submitted:2002-10-22, Days after onset: 7
Location:West Virginia  Entered:2002-10-28, 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)AVENTIS PASTEURU0966BA2IM 
Administered by: Other     Purchased by: Private
Symptoms: Blindness transient
SMQs:, Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Glaucoma (broad)
Write-up: On evening of receiving flu immunization developed temporary blindness in right eye. Symptoms resolved after starting medrol pack. No symptoms by evening of 10/16/02. Developed temporary blindness in right eye after vaccine 10/01 with symptoms lasting until 6/02. Connection not linked to vaccine until pt received vaccine this year and developed blindness.

VAERS ID:192085 (history)  Vaccinated:2002-10-21
Age:33.0  Onset:2002-10-21, Days after vaccination: 0
Gender:Female  Submitted:2002-10-24, Days after onset: 3
Location:Michigan  Entered:2002-10-29, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: MVP, Allergy to Nickel; Vitromycin
Diagnostic Lab Data: Negative strept A screen.
CDC Split Type:
Vaccination
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FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER    
TD: TD ADSORBED (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Other     Purchased by: Other
Symptoms: Chest discomfort, Cough, Injection site induration, Pain, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 10/21/02 was at work. Received Td right arm. Received pneumovax and influenza vaccines left arm. 2 hours later felt general unease. By 8 PM was running a fever and left arm swollen, painful and hard to move. 10/22 Fever 103.5, chills, left arm still red, swollen. 10/23 fever 100.5 early morning--lost fever, heavy feeling in chest, slight coughing started 10/24. Feels light-headed, arm still very painful. Seen here; left arm with 3 indurated area left upper arm. Positive erythema of posterior pharynx. Negative strept screen. As per acknowledgement letter: as I wrote on my VAERS form, I did not give any of the vaccines (they were given at work) and therefore have no lot #''s or manufact.

VAERS ID:192466 (history)  Vaccinated:2002-10-27
Age:33.0  Onset:2002-10-31, Days after vaccination: 4
Gender:Female  Submitted:2002-11-01, Days after onset: 1
Location:Utah  Entered:2002-11-04, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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TTOX: TETANUS TOXOID (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Cellulitis, Chills, Injection site oedema, Injection site reaction, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever, body aches, chills, pain, swelling toright arm with cellulitis.

VAERS ID:192676 (history)  Vaccinated:2002-10-30
Age:33.0  Onset:2002-10-30, Days after vaccination: 0
Gender:Female  Submitted:2002-10-31, Days after onset: 1
Location:Missouri  Entered:2002-11-06, 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:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESE37182KA IMLA
Administered by: Other     Purchased by: Private
Symptoms: Dyspnoea, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: One to two hours after receiving injection complained of generalized hives with sl difficulty breathing, took OTC Benadryl. No problems with breathing today 10/31/02 and only a few hives.

VAERS ID:192720 (history)  Vaccinated:2002-10-22
Age:33.0  Onset:2002-10-22, Days after vaccination: 0
Gender:Female  Submitted:2002-10-24, Days after onset: 2
Location:Kansas  Entered:2002-11-06, 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: C/O headahe. Children have colds at home.
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU087AA IMRA
Administered by: Other     Purchased by: Private
Symptoms: Asthenia, Headache, Hot flush, Laryngeal oedema, Nausea, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 8:45am flu vaccination given, reports she had dull headache by 1 hr after injection, c/o weakness, nausea, flush fleeing. By 2 hrs report she had vomiting, increased headache. 10:50 pt describing symptoms, no SOB, hives, swelling of throat. Advised to take po Benadryl. 2:45pm reports feeling flushed. No headache. Did not take Benadryl.

VAERS ID:192798 (history)  Vaccinated:1968-10-28
Age:33.0  Onset:2002-10-29, Days after vaccination: 12419
Gender:Male  Submitted:2002-10-29, Days after onset: 0
Location:Unknown  Entered:2002-11-07, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NKA
Diagnostic Lab Data: Pt to see provider at 1400 today
CDC Split Type:
Vaccination
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ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0630SCLA
Administered by: Military     Purchased by: Military
Symptoms: Back pain, Renal pain
SMQs:, Retroperitoneal fibrosis (broad)
Write-up: On 10/29/02 @ approximately 11:30 hrs, pt awoke with "pain in his entire lower back. At approximately 17:00, the same day (10/24/02), pt states his pain was transferred to left kidney area. Pt states pain has been constant and is still currently there.

VAERS ID:192839 (history)  Vaccinated:2002-02-14
Age:33.0  Onset:2002-02-16, Days after vaccination: 2
Gender:Female  Submitted:2002-04-15, Days after onset: 57
Location:Virginia  Entered:2002-11-07, Days after submission: 206
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: U200200131
Vaccination
Manufacturer
Lot
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HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER    
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)AVENTIS PASTEUR   LA
UNK: VACCINE NOT SPECIFIED (NO BRAND NAME)UNKNOWN MANUFACTURER    
YF: YELLOW FEVER (YF-VAX)AVENTIS PASTEURUB126AB SCLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Feeling hot, Injection site erythema, Injection site induration, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: From telephone contact received at manufacturer on 2/21/02 it was reported that a 33 year old female patient received a YF-Vax dose given on 2/14/02 SQ in left arm. Patient also received Typhim VI also administered in left deltoid, a Hepatitis A vaccination and a Measles vaccination. Reportedly the patient developed a large local reaction 50mmx60mm, red, induration, hard and very warm and painful of the left arm. The local reaction started 2 days after dose was received. Four days after injection the reaction started to subside but then flared up again and is getting larger.

VAERS ID:192841 (history)  Vaccinated:2002-03-14
Age:33.0  Onset:0000-00-00
Gender:Male  Submitted:2002-05-24
Location:Virginia  Entered:2002-11-07, Days after submission: 167
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: U200200239
Vaccination
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YF: YELLOW FEVER (YF-VAX)AVENTIS PASTEUR    
Administered by: Other     Purchased by: Other
Symptoms: Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: From telephone contact received at manufacturer, it was reported that a 33 year old male received Yellow Fever vaccine on 3/14/02. It was reported by a doctor that the patient was experiencing fevers of 102 degrees F and headaches. She states that patient is not immunosuppressed. It was suggested that the patient be seen by an infectious disease doctor.

VAERS ID:192879 (history)  Vaccinated:2002-11-02
Age:33.0  Onset:2002-11-03, Days after vaccination: 1
Gender:Female  Submitted:2002-11-05, Days after onset: 2
Location:Maryland  Entered:2002-11-08, 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: Coumadin, Celexa
Current Illness: None
Preexisting Conditions: Mitral valve replacement, Depression, Obesity
Diagnostic Lab Data: CBC with diff 11/5/02
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0872AB0 LA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.3052L0 LA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Dizziness, Injection site erythema, Injection site pain, Laboratory test abnormal, Malaise
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad)
Write-up: 24 hours after innoculation, chills, malaise, erythema at injection site, dizzy. Left deltoid pain 24 hours post injection on 11/02/2002. 11/03/2002 pain, chilled and miserable. 11/04/2002 site started to get red, slight dizziness. Took tylenol and slept.

VAERS ID:193206 (history)  Vaccinated:2002-11-02
Age:33.0  Onset:2002-11-03, Days after vaccination: 1
Gender:Male  Submitted:2002-11-04, Days after onset: 1
Location:Indiana  Entered:2002-11-13, Days after submission: 9
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
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YF: YELLOW FEVER (YF-VAX)SANOFI PASTEURUB315AA SCRA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Discovered small welt 11/3/02; 11/4/02 small welt spread to reddened area 6x6cm went to med. Rx Benadryl, Tylenol; return to clinic AM 11/5/02 reddened area now 12x12cm, sent to ER. Low grade temp.

VAERS ID:193241 (history)  Vaccinated:2002-10-21
Age:33.0  Onset:2002-10-21, Days after vaccination: 0
Gender:Female  Submitted:2002-10-21, Days after onset: 0
Location:New Mexico  Entered:2002-11-14, Days after submission: 24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Niacin
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0905FA8IM 
Administered by: Private     Purchased by: Private
Symptoms: Hot flush
SMQs:
Write-up: Within 10-15 minutes of injection, patient became hot and flushed all over. Took benadryl 25mg PO and symptoms subsided.

VAERS ID:193388 (history)  Vaccinated:2002-11-04
Age:33.0  Onset:2002-11-06, Days after vaccination: 2
Gender:Male  Submitted:2002-11-07, Days after onset: 1
Location:Unknown  Entered:2002-11-18, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Migraine
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0631SCLA
Administered by: Military     Purchased by: Military
Symptoms: Arthralgia, Erythema, Pruritus, Rash, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient received vaccination on Monday. On Tuesday, rash developed. By Wednesday rash had spread from under arm to elbow. Swelling, redness and tender to touch. Today rash is still spreading down arm. Patient is experiencing joint pain and itching still today. Burning at rash site also.

VAERS ID:193414 (history)  Vaccinated:2002-11-05
Age:33.0  Onset:2002-11-05, Days after vaccination: 0
Gender:Female  Submitted:2002-11-05, Days after onset: 0
Location:Washington  Entered:2002-11-18, 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: Effexor
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETHU0897012 IMRA
Administered by: Other     Purchased by: Private
Symptoms: Dyspnoea, Paraesthesia, Pruritus
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pins and needles back of arm. Itchy skin. Some SOB; no fast or deep breathing. Treatment: Epinephrine right deltoid SC

VAERS ID:193476 (history)  Vaccinated:2002-11-14
Age:33.0  Onset:2002-11-14, Days after vaccination: 0
Gender:Female  Submitted:2002-11-14, Days after onset: 0
Location:Massachusetts  Entered:2002-11-19, 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: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Diagnostic Lab Data: Tuberculin PPD Aventis (L) C0834AB left forearm 11/12/2002
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0953AA EXP 06  LA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Flushing, Hyperhidrosis, Hyperventilation, Hypokinesia, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Pt became weal, pale, diaphoretic, shallow breathing and dizzy- unable to converse, stand, or hold head up. BP 102/58 pulse- unable to feel at first Epinephrine given P58-64. Ambulance called- follow up at hospital.

VAERS ID:193891 (history)  Vaccinated:2002-10-25
Age:33.0  Onset:2002-11-07, Days after vaccination: 13
Gender:Female  Submitted:2002-11-15, Days after onset: 8
Location:Unknown  Entered:2002-11-26, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: Blood work and ultrasound performed to confirm diagnosed of spontaneous abortion.
CDC Split Type:
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ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONS 0SCRA
Administered by: Military     Purchased by: Military
Symptoms: Abortion
SMQs:, Termination of pregnancy and risk of abortion (narrow)
Write-up: Pt received first anthrax vaccine on 10/25/02. Pt did not know she was pregnant at the time of vaccination. Pt had a spontaneous abortion on 11/7/02. Pt had a D&C procedure performed on 11/8/02. Pt was hospitalized for one day on 11/8/02 for D&C procedure.

VAERS ID:193900 (history)  Vaccinated:2002-11-16
Age:33.0  Onset:2002-11-17, Days after vaccination: 1
Gender:Male  Submitted:2002-11-18, Days after onset: 1
Location:D.C.  Entered:2002-11-26, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Seasonal allergies
Diagnostic Lab Data:
CDC Split Type:
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ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0632SCLA
Administered by: Military     Purchased by: Military
Symptoms: Contusion, Pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Accidents and injuries (narrow)
Write-up: Left arm pain from anthrax shot. Has a localized reaction with bruising.

VAERS ID:193907 (history)  Vaccinated:2002-11-07
Age:33.0  Onset:2002-11-07, Days after vaccination: 0
Gender:Female  Submitted:2002-11-12, Days after onset: 5
Location:Tennessee  Entered:2002-11-26, Days after submission: 14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: hyroxapam, glucophage, pulmacort, topomax, albuterol, prozac, triliptol, effexer
Current Illness: NONE
Preexisting Conditions: Diabetes, Asthma, Depression
Diagnostic Lab Data:
CDC Split Type: TN02049
Vaccination
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Lot
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Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH40200292IMLA
HEPA: HEP A (VAQTA)MERCK & CO. INC.0701M0IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.0210M0IMLA
Administered by: Public     Purchased by: Other
Symptoms: Respiratory distress
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Respiratory distress increasing over next several minutes after vaccines. Per MD orderss - Epinphrine 1mg given SQ and 25mg Benadryl given IM. 911 called and oxygen via mask placed at 6L min. EMS takes over at this point. Patient to ER.

VAERS ID:193924 (history)  Vaccinated:2002-11-04
Age:33.0  Onset:2002-11-05, Days after vaccination: 1
Gender:Female  Submitted:2002-11-06, Days after onset: 1
Location:Maryland  Entered:2002-11-26, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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Lot
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FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4020028 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient developed a red/itchy rash within 24 hours that progresed the next day. Patient treated with atanoy and prednisone

VAERS ID:194230 (history)  Vaccinated:2002-10-22
Age:33.0  Onset:2002-11-07, Days after vaccination: 16
Gender:Female  Submitted:2002-11-12, Days after onset: 5
Location:Maine  Entered:2002-12-02, Days after submission: 20
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Environmental allergies: dust but no history of medical testing; hx asthma
Diagnostic Lab Data: Negative varicella titer on 8/2/02.
CDC Split Type:
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0258M SC 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Feeling hot, Injection site erythema, Injection site pain, Pruritus, Pyrexia, Rash maculo-papular, Skin ulcer
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Received Varivax vaccine right upper arm on 10/22/02. On Sunday 11/3/02, injection site became red, sore, itchy, hot. Developed low-grade fever and subsequent sites of macular papular itchy lesions scattered on torso, extremities, one on face. Excluded from work until lesions dried.

VAERS ID:194238 (history)  Vaccinated:2002-10-15
Age:33.0  Onset:2002-10-16, Days after vaccination: 1
Gender:Male  Submitted:2002-10-17, Days after onset: 1
Location:Unknown  Entered:2002-12-02, Days after submission: 46
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:
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ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0642SCLA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Oedema, Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: About 82mm area of erythema, swelling, tenderness. Zyrtec, Motrin .

VAERS ID:194259 (history)  Vaccinated:2002-10-09
Age:33.0  Onset:2002-10-10, Days after vaccination: 1
Gender:Male  Submitted:2002-10-11, Days after onset: 1
Location:Florida  Entered:2002-12-02, Days after submission: 52
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: HTN
Diagnostic Lab Data: BMP - normal
CDC Split Type:
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ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONS    
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Military     Purchased by: Military
Symptoms: Diarrhoea, Nausea, Pain, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Vomiting, diarrhea, nausea, general aches 1 day following flu shot/ anthrax vaccination (possible reaction) IV fluid administered / toradol given improvement.

VAERS ID:194499 (history)  Vaccinated:0000-00-00
Age:33.0  Onset:0000-00-00
Gender:Male  Submitted:0000-00-00
Location:Pennsylvania  Entered:2002-12-03
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
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LYME: LYME (LYMERIX)GLAXOSMITHKLINE BIOLOGICALS    
Administered by: Military     Purchased by: Military
Symptoms: Arthralgia, Arthritis
SMQs:, Systemic lupus erythematosus (broad), Arthritis (narrow)
Write-up: Pain in joints, arthritis.

VAERS ID:194985 (history)  Vaccinated:2002-11-28
Age:33.0  Onset:2002-11-28, Days after vaccination: 0
Gender:Unknown  Submitted:0000-00-00
Location:New Jersey  Entered:2002-12-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Sulfa Drugs
Diagnostic Lab Data: NONE
CDC Split Type:
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ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0661SCRA
Administered by: Military     Purchased by: Military
Symptoms: Injection site reaction, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 20 cm X 13 cm Erythematous rash over right deltoid, Tx: Lidex cream and Claritin, 48 hours later rash completely gone and patient doing well

VAERS ID:195474 (history)  Vaccinated:2002-10-15
Age:33.0  Onset:2002-10-20, Days after vaccination: 5
Gender:Female  Submitted:2002-12-18, Days after onset: 59
Location:Kansas  Entered:2002-12-26, Days after submission: 8
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: All negative
CDC Split Type:
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0918AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: 10/20/02 Generalized tonic/clonic seizure

VAERS ID:195598 (history)  Vaccinated:2002-12-06
Age:33.0  Onset:2002-12-07, Days after vaccination: 1
Gender:Female  Submitted:2003-02-07, Days after onset: 62
Location:Arizona  Entered:2002-12-30, 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: UNK
Current Illness: UNK
Preexisting Conditions: Overweight; smoker; subdural haematoma
Diagnostic Lab Data: UNK
CDC Split Type: HQ5815917DEC2002
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD)PFIZER/WYETH4020006 IM 
Administered by: Private     Purchased by: Other
Symptoms: Abdominal pain, Back pain, Headache, Nervous system disorder
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: A pharmacist reported that a 33 year old female received an injection of Flu Shield on 12/6/02. *On 12/7/02,* she developed severe back pain. She was hospitalized on 12/12/02 because of her complaints of severe back pain, severe abdominal pain, and severe headache. She was worked up for "some sort of neurological problem," but as of 12/16/02, were unable to determine the cause of her severe pain. The reporter noted that the pt had neither a fever, nor any local reactions to the vaccine. *She recovered.* No further info was available as of the date of this report. *F/UP report on 2/12/03: Info received from the reporter indicated that the PT recovered and that the first symptom onset was 12/7/02.*

VAERS ID:195651 (history)  Vaccinated:2002-11-15
Age:33.0  Onset:2002-11-16, Days after vaccination: 1
Gender:Female  Submitted:0000-00-00
Location:Unknown  Entered:2002-12-31
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: Contraceptive pills (unspecified)
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: PJP200200891
Vaccination
Manufacturer
Lot
Dose
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Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)EVANS VACCINESE31902HA IM 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Joint swelling, Pyrexia, Serum sickness, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: A report was received from a health care professional on 12/17/02 concerning a 32 year old female vaccinee who experienced serum sickness one day after receiving Fluvirin on 11/15/02. It was reported that the vaccinee had received an influenza vaccine for the past five years with the date of last vaccination reported as 2001. Concomitant medication reported included unspecified birth control pills. On the 11/16/02 the vaccinee developed hives and was treated with methylpredinisolone for seven days with improvement. After treatment with methylprednisolone was complete on approximately 11/23/02 the hives returned and the vaccinee was treated with prednisone (dose unk). On 12/6/02 the vaccinee began to experience swelling in the ankles, knees and shoulders and experienced a fever (temp unk). On 12/6/02 the vaccinee was hospitalized where the attending physician diagnosed serum sickness. The vaccinee was treated with unspecified IV steroids, methylprednisolone and ciprofloscin for five days. The vaccinee was discharged from hospital on 12/8/02. It was reported that the symptoms had improved but had not resolved. The reporter has assessed the relationship of the vaccine to the event as probable. Follow up on 02/27/2003: "A report was received from a health care professional which stated that the vaccinee had also experienced wrist swelling and had a fever of 101C approximately 2 weeks following vaccination. The vaccinee had recovered at the time of the report."

VAERS ID:195658 (history)  Vaccinated:2002-11-06
Age:33.0  Onset:2002-11-06, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Idaho  Entered:2002-12-31
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: Aspirin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURUO935BA  LA
Administered by: Other     Purchased by: Unknown
Symptoms: Injection site induration, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 1;25 pm left deltoid small amount of swelling noted hardened area around swelling. Bruise noted 3:45 pm, swelling reduced area not as hardened.

VAERS ID:195768 (history)  Vaccinated:2002-12-11
Age:33.0  Onset:2002-12-25, Days after vaccination: 14
Gender:Male  Submitted:2003-01-03, Days after onset: 9
Location:New Jersey  Entered:2003-01-03
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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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1317L0SCLA
Administered by: Private     Purchased by: Private
Symptoms: Chills, Pruritus, Pyrexia, Rash, Skin ulcer
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 12-25-02 CHILLS AND TEMPERATURE 102. 12-26-02 GENERALIZED ITCHING, RED RAISED RASH- FIRST ON BACK, THEN CHEST, FACE AND NECK. FEW ON LOWER EXTREMITIES. FEW VESICLES NOTED ON BACK. LESIONS IMPROVING, DRIED AND FEELING BETTER 12-30-02. TEMP ONLY FOR 2 DAYS.

VAERS ID:195855 (history)  Vaccinated:2001-01-16
Age:33.0  Onset:2001-02-18, Days after vaccination: 33
Gender:Female  Submitted:2001-05-08, Days after onset: 78
Location:New York  Entered:2003-01-07, Days after submission: 609
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Transient hemianesthesia
Preexisting Conditions: NONE
Diagnostic Lab Data: Cat Scan; MRI
CDC Split Type: U200100482
Vaccination
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Lot
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RAB: RABIES (IMOVAX)AVENTIS PASTEUR  IM 
Administered by: Private     Purchased by: Private
Symptoms: Hemiparesis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow)
Write-up: It was reported that a female pt was given a post exposure series of Imovax Rabies for bat exposure. Pt experienced "flu-like" symptoms after the 2nd and 3rd doses. On 2/18/01, the pt developed numbness in left side of face, ear, arm and calf, no sensory perception in left side, now in right side. Was seen in ER on 2/18/01. She was referred to a Neurologist and ENT doctor. All reports were sent to PCP. Unresolved, getting worse. Per the Medical Safety Officer''s conversation with PCP on 2/28/01, it was stated that the neurologist evaluated the pt and made a dx of hemianesthesia. From additional correspondence received on 5/7/01, additional lab data was provided.

VAERS ID:195896 (history)  Vaccinated:2002-12-12
Age:33.0  Onset:2002-12-15, Days after vaccination: 3
Gender:Female  Submitted:2002-12-27, Days after onset: 12
Location:Unknown  Entered:2003-01-08, Days after submission: 12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: EKG was done - Results within normal limits; Normal Syncrhym
CDC Split Type:
Vaccination
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ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTHFAV0650SCLA
Administered by: Military     Purchased by: Military
Symptoms: Chest pain, Injection site mass, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)
Write-up: Stabbing chest pain 3 days after vaccination. Chest felt heav; pain to the left arm, left amr went numb for 2 hours. Patient developed a lump without tenderness that lasted 5 days. No SOB, HA, dizziness, blurred vision, abdominal pain or nausea, vomiting, or diarrhea.

VAERS ID:195909 (history)  Vaccinated:2002-11-19
Age:33.0  Onset:2002-11-19, Days after vaccination: 0
Gender:Female  Submitted:2003-01-02, Days after onset: 44
Location:Pennsylvania  Entered:2003-01-08, 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
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0909AA IMLA
Administered by: Other     Purchased by: Private
Symptoms: Arthralgia, Pain
SMQs:, Arthritis (broad)
Write-up: Patient states the left arm "hurt badly" the evening of 11/19/02. The left arm continued to be painful over the next month. She states the pain is in the joint, so that it hurts to lift her arm over the head, put on clothing. She phoned health dept on 12/19/2002 and was advised to see a physician.

VAERS ID:195984 (history)  Vaccinated:2003-01-03
Age:33.0  Onset:2003-01-03, Days after vaccination: 0
Gender:Female  Submitted:2003-01-06, Days after onset: 3
Location:Virginia  Entered:2003-01-08, 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: Birth control pills
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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MEN: MENINGOCOCCAL (MENOMUNE)AVENTIS PASTEURUB248AA SCLA
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.15056 SCRA
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI)AVENTIS PASTEURV10734  RA
YF: YELLOW FEVER (YF-VAX)AVENTIS PASTEURUB254AA SCLA
Administered by: Public     Purchased by: Public
Symptoms: Feeling hot, Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: The afternoon of the shots felt warm and developed rash from head to chest. Temp 100.6 degrees in PM. Rash was gone by 6 pm. Called clinic and advised to take Benadryl.

VAERS ID:196052 (history)  Vaccinated:2002-12-19
Age:33.0  Onset:2002-12-19, Days after vaccination: 0
Gender:Female  Submitted:2003-01-10, Days after onset: 22
Location:North Carolina  Entered:2003-01-13, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0925AA   
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.    
TTOX: TETANUS TOXOID (NO BRAND NAME)AVENTIS PASTEURU0528AA   
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site mass, Injection site oedema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Arm swelled from flu shot at injection site. Hard lump about the size of a quarter at flu site injection. Still have the lump. Received Pneumovax a second before flu vax. Extremely painful could not sleep on arm for a month.

VAERS ID:196203 (history)  Vaccinated:2002-11-22
Age:33.0  Onset:2002-11-22, Days after vaccination: 0
Gender:Female  Submitted:2002-12-27, Days after onset: 35
Location:Virginia  Entered:2003-01-15, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: No allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0988BA IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Dizziness, Flushing, Hyperhidrosis, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)
Write-up: C/O dizziness, sweating, shakiness apprx. 15 mins after flu shot. Face flushed. No hives, SOB or wheezing. (Only went to ER because another client was also going) ER states was vasovagal Rx IV fluids

VAERS ID:196206 (history)  Vaccinated:2002-10-31
Age:33.0  Onset:2002-10-31, Days after vaccination: 0
Gender:Male  Submitted:2002-12-27, Days after onset: 57
Location:Virginia  Entered:2003-01-15, Days after submission: 19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
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FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0911AA IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)
Write-up: Complained of tingling in fingers of left hand, shoulder and side mouth approximately 1 hour after shot. Neuromus v to hand/arm/mouth wnl; Resolved spontaneously within 5 hours.

VAERS ID:196482 (history)  Vaccinated:2002-11-04
Age:33.0  Onset:2002-11-06, Days after vaccination: 2
Gender:Female  Submitted:2003-01-09, Days after onset: 64
Location:Illinois  Entered:2003-01-17, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: UNK
Preexisting Conditions: The subject had no medical history, concurrent conditions, or concurrent medications.
Diagnostic Lab Data: UNK
CDC Split Type: A0386557A
Vaccination
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Lot
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Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5291A42 LA
Administered by: Private     Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: A nurse described the occurrence of rash in a 33 y.o. female who was vaccinated w/Hep B vaccine recombinant (Engerix-B) for prophylaxis. The subject had no medical history, concurrent conditions, or concurrent medications. The subject received her 1st injection of Engerix-B in 1998. She received her 2nd injection on 10/02/02. "A few days" after the 2nd injection, she developed a "mild" rash that resolved after an unspecified period of time. On 11/4/02, the subject received her 3rd injection of Engerix-B (lot ENG5291A4). Two days later, she developed a rash on both forearms. She was seen by a physician. The reporting nurse considered the rash to be possibly related to Engerix-B administration. As of 12/5/02, the rash had "improved".

VAERS ID:196539 (history)  Vaccinated:2003-01-17
Age:33.0  Onset:2003-01-18, Days after vaccination: 1
Gender:Female  Submitted:2003-01-20, Days after onset: 2
Location:Unknown  Entered:2003-01-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None except local reaction
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
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ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSLAV0653SCLA
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Oedema
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt with 12cm by 16 cm erthematous, edematous swelling of lateral upper arm. This was the same arm that had received the Anthrax immunization 3 days prior.

VAERS ID:196526 (history)  Vaccinated:2003-01-11
Age:33.0  Onset:0000-00-00
Gender:Male  Submitted:0000-00-00
Location:Mississippi  Entered:2003-01-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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JEV: JAPANESE ENCEPHALITIS (JE-VAX)SANOFI PASTEUR  SC 
Administered by: Military     Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:
Write-up:

VAERS ID:196782 (history)  Vaccinated:2001-10-10
Age:33.0  Onset:2001-10-10, Days after vaccination: 0
Gender:Female  Submitted:2003-01-21, Days after onset: 468
Location:Georgia  Entered:2003-01-27, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol; Zithromax, erythromycin, Flonase
Current Illness:
Preexisting Conditions: Pregnancy NOS (LMP=8/30/01); cleft lip and palate
Diagnostic Lab Data: Chest x-ray - pneumonia; Ophthalmoscopy normal; Ultrasound 9 week, normal; Ultrasound normal; Serum alpha-fetoprotein normal; Serum varicella zoster negative
CDC Split Type: WAES01114271
Vaccination
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VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0468L   
Administered by: Other     Purchased by: Other
Symptoms: Cough, Pneumonia, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received from a physician through a pregnancy registry concerning a 33 year old caucasian female with a repaired cleft palate/lip and no previous pregnancies who on 10/1/01 tested negative for varicella antibodies. On 10/10/01, the pt was vaccinated with a dose of varicella virus vaccine live (638902/0468L). Concomitant therapy included azithromycin, erythromycin, albuterol, and fluticasone propionate. The physician reported that the pt was three weeks pregnant at the time of vaccination and did not know. The pt''s date of last menstrual period was reported by the physician to be 8/30/01. The pt''s estimated delivery date was determined to be 6/24/02 according to her 9 week ultrasound on 11/20/01. On 1/9/02, serum alpha-feto protein screening was normal. On 1/22/02, an ultrasound was normal. On an unspecified date the pt had a fever and cough. On 3/12/02, a chest x-ray reveled pneumonia, and the pt was hospitalized for pneumonia. On 6/6/02, 37 weeks from LMP, the pt delivered a normal baby girl weighing 7 lbs. 4oz. Complications during labor and delivery included inadequate pelvis and signs and symptoms of pregnancy induced hypertension. The pt did not have any varicella or herpes zoster symptoms or local reaction post vaccination with varicella vaccine live. The infant had no symptoms of congenital varicella zoster syndrome. Additional info received via medical records indicate that the infant had congenital ptosis. The pt had mild palpebral fissure asymmetry (the right was a bit smaller than the left). The physician did not see any signs of anisocoria or EOM problems to suggest a neuro-ophthalmic lesion. Funduscopic exam was normal. The physician recommended reassurance. A review of the medical records indicated no other adverse symptoms were noted. No additional info is expected.

VAERS ID:196831 (history)  Vaccinated:2003-01-16
Age:33.0  Onset:0000-00-00
Gender:Male  Submitted:2003-01-27
Location:Georgia  Entered:2003-01-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH 0SCLA
Administered by: Military     Purchased by: Military
Symptoms: Lymphadenopathy
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Lymph node in left armpit, "extremely large". Seen at base medical facility. No RX. Is resolving and getting better.

VAERS ID:196919 (history)  Vaccinated:2003-01-04
Age:33.0  Onset:2003-01-04, Days after vaccination: 0
Gender:Male  Submitted:2003-01-19, Days after onset: 15
Location:Florida  Entered:2003-01-29, Days after submission: 10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
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ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONS 0SCLA
Administered by: Other     Purchased by: Military
Symptoms: Arthralgia, Chest pain, Headache
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad)
Write-up: Pronounced joint and chest pain for 1 week after 1st dose. Mild headache for the first 3 days after dose 1. No treatment. Pt has recovered (so far).

VAERS ID:196989 (history)  Vaccinated:2002-02-09
Age:33.0  Onset:2002-02-16, Days after vaccination: 7
Gender:Female  Submitted:2003-02-27, Days after onset: 376
Location:Unknown  Entered:2003-01-30, Days after submission: 28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: propranolol
Current Illness:
Preexisting Conditions: UNK
Diagnostic Lab Data:
CDC Split Type: WAES0202USA01732
Vaccination
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MEA: MEASLES (ATTENUVAX)MERCK & CO. INC.    
Administered by: Other     Purchased by: Other
Symptoms: Headache, Pyrexia, Rash maculo-papular
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Information has been received on 2/18/02 from a physician concerning a 33-year-old female who was vaccinated with a dose of measles virus vaccine live. Concomitant therapy included propranolol, which the patient had been taking "for about 6 months." On 2/16/02 the patient developed a headache, that reportedly on 2/18/02 "seems to be getting better now." On 2/18/02, the patient reported to the physician because she had a papular rash on her face, trunk and arms and also had a fever. The patient was instructed by the physician to discontinue the propranolol. The physician had no explanation for the rash other than the measles virus vaccine live. It was noted on 2/18/02 that "no new medications were introduced recently." Additional information has been requested.

VAERS ID:197054 (history)  Vaccinated:2003-01-29
Age:33.0  Onset:2003-01-29, Days after vaccination: 0
Gender:Female  Submitted:2003-01-29, Days after onset: 0
Location:Kentucky  Entered:2003-01-31, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NKDA Reports she had what she thinks was a migrane H/A.
Diagnostic Lab Data:
CDC Split Type: KY2003010
Vaccination
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HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5312861IMRA
Administered by: Public     Purchased by: Public
Symptoms: Headache, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Pt. reports about 20 min after recieving her 2nd Hep B shout developed a headache involving the top of her head. No visual disturbances. On pain scale of 1-10 with 1=lowest & 10=highest, rate of H/A a 7. Was pale B/P 130/90. She consulted by phone with Hopsital, thought R/T Hep B shot. No more Hep B shots. 2 hrs after took tylonal, H/A gon. Felt fine. C/O Nausea after H/A subsided.

VAERS ID:197060 (history)  Vaccinated:2003-01-19
Age:33.0  Onset:2003-01-29, Days after vaccination: 10
Gender:Male  Submitted:2003-02-01, Days after onset: 3
Location:Unknown  Entered:2003-02-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH40200710SCLA
Administered by: Military     Purchased by: Military
Symptoms: Rash maculo-papular, Rash pruritic, Skin ulcer
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Day 11 after smallpox immunization. Developed generalized maculopapular rash on trunk, upper extremities. Pruritic target lesions. Was seen and treated symptomatically with Atarax, Eucerin Cream.

VAERS ID:197061 (history)  Vaccinated:2003-01-27
Age:33.0  Onset:2003-01-27, Days after vaccination: 0
Gender:Male  Submitted:2003-02-01, Days after onset: 5
Location:Pennsylvania  Entered:2003-02-01
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: Food (sunflower seeds), Downy fabric softner.
Diagnostic Lab Data: Allergic Reaction
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH40200710IDLA
Administered by: Military     Purchased by: Military
Symptoms: Face oedema, Hypersensitivity, Hypoaesthesia oral, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Numbness to Lips. Raised bumps (pinwheel) to head, neck,back and anticubital spaces. Swelling to facial region. Pt given epi 1:1000 1cc IM R deltoid. Pt continued and still continues to have adverse reactions with above symptoms, dispite current treatment of Singular, Allegria, Pepcid and Prednisone.

VAERS ID:197118 (history)  Vaccinated:2003-01-30
Age:33.0  Onset:2003-01-31, Days after vaccination: 1
Gender:Male  Submitted:2003-02-02, Days after onset: 2
Location:Nebraska  Entered:2003-02-02
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
ANTH: ANTHRAX (NO BRAND NAME)MICHIGAN DEPT PUB HLTH    
Administered by: Military     Purchased by: Military
Symptoms: Chills, Headache, Injection site hypersensitivity, Malaise, Nausea, Pain, Pyrexia, Swelling
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Anthrax Vac given. Vac injected into L Shoulder. Burning sensation on injection. Pain and swelling in L shoulder, L upper arm next day. Fever, Chills, Malaise, Nausea, Headaches as well. No hospital or doctor treatment sought for symptoms. Symptoms cleared out after 3 days.

VAERS ID:197313 (history)  Vaccinated:2003-01-22
Age:33.0  Onset:2003-01-23, Days after vaccination: 1
Gender:Female  Submitted:2003-02-05, Days after onset: 13
Location:Indiana  Entered:2003-02-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: NKDA, No medical conditions
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5370A22IMRA
Administered by: Private     Purchased by: Private
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Right upper arm urticaria-like reaction. Patient c/o itching.

VAERS ID:197317 (history)  Vaccinated:2003-01-31
Age:33.0  Onset:2003-02-02, Days after vaccination: 2
Gender:Male  Submitted:2003-02-05, Days after onset: 3
Location:Virginia  Entered:2003-02-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH40200710IDLA
Administered by: Military     Purchased by: Military
Symptoms: Diarrhoea, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Write-up: Developed nausea vomiting and diarrhea on 2 Feb 2003. Evaluated in clinic on 3 Feb 2003 and received 3 liters of IV fluids for dehydration. Returned to work on 4 Feb 2003. Family members were ill with AGE on 1 Feb 2003. BP 140/70, pulse 90

VAERS ID:197487 (history)  Vaccinated:2003-02-01
Age:33.0  Onset:2003-02-09, Days after vaccination: 8
Gender:Female  Submitted:2003-02-10, Days after onset: 1
Location:Unknown  Entered:2003-02-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: CSF NORMAL; WBC NORMAL
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH    
Administered by: Military     Purchased by: Military
Symptoms: Fatigue, Headache, Lymphadenopathy, Pain, Photophobia
SMQs:, Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: HEADACHE, PHOTOPHOBIA, BODY ACHES; FATIGUE; LEFT AXILLARY ADENOPATHY

VAERS ID:197630 (history)  Vaccinated:2002-12-09
Age:33.0  Onset:2002-12-12, Days after vaccination: 3
Gender:Male  Submitted:2002-12-16, Days after onset: 4
Location:Florida  Entered:2003-02-12, Days after submission: 58
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: PCN allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0650SCLA
Administered by: Military     Purchased by: Military
Symptoms: Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)
Write-up: Shortness of breath, started 3 days after the anthrax vaccine. Left arm - no lesions / swelling at time of visit. Lungs CTA = tril? at time of visit.

VAERS ID:197717 (history)  Vaccinated:2003-01-30
Age:33.0  Onset:2003-02-01, Days after vaccination: 2
Gender:Female  Submitted:2003-02-11, Days after onset: 10
Location:Minnesota  Entered:2003-02-13, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: DEPO PROVERA
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data: UNK
CDC Split Type: U200300066
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)AVENTIS PASTEURU0817AA IMLA
Administered by: Private     Purchased by: Other
Symptoms: Cellulitis
SMQs:
Write-up: It was reported that a 33 year old female pt received TD ADS ADULT, lot number U0817AA, given IM in the left deltoid and DEPO PROVERA, given IM in the left deltoid on 1/30/03. The vaccinations were given approximately one inch apart. On 2/1/03, pt went to the hospital ER, where they treated her with IV antibiotics. On 2/2/03, pt went to another ER where she was admitted. It was reported that the pt is still there. Pt is said to have cellulitis. It is unknown if pt recovered. Pt had no illness at the time of vaccination. Reported on 02/20/2003: "From follow-up #1 received on 02/06/2003, it was reported that the patient developed "cellulitis of arm" after the Tetanus and Depo-Provera (lot number JP1204) injection. No additional information was provided. Follow up on 07/07/2003: "From additional information received on 06/25/2003 from the reporter, it was stated that there is no new medical information. The "patient returned to her previous clinic and has not been back since. We did not receive the hospital discharge summary on this patient". No further information is anticipated, this case is considered closed." Follow up on 12/05/03: "From follow up #1 received on 02/06/03, it was reported that the pt developed "cellulitis of arm" after the Tetanus and Depo-Provara (Lot # JF1204) injection. No additional information was provided."

VAERS ID:197814 (history)  Vaccinated:2003-02-09
Age:33.0  Onset:2003-02-10, Days after vaccination: 1
Gender:Male  Submitted:2003-02-14, Days after onset: 4
Location:Virginia  Entered:2003-02-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0736SCRA
Administered by: Military     Purchased by: Unknown
Symptoms: Oedema, Pain, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Right arm swelling, became painful in the elbow, and itchy. Spread to lower forearm and neck. Taken to ER and received fexofenadine (180mg) and Augmentin (875mg)

VAERS ID:197980 (history)  Vaccinated:2002-10-28
Age:33.0  Onset:2002-11-14, Days after vaccination: 17
Gender:Male  Submitted:2002-10-28, Days after onset: 17
Location:Illinois  Entered:2003-02-20, Days after submission: 115
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: Blood work, physical exam, R/O (no spinal tab needed)/ MRI x2
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0872AB0IMLA
Administered by: Other     Purchased by: Other
Symptoms: Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)
Write-up: PT experienced mild case of Guillain Barr, syndrome.

VAERS ID:198019 (history)  Vaccinated:2002-11-18
Age:33.0  Onset:2002-12-01, Days after vaccination: 13
Gender:Female  Submitted:2002-12-04, Days after onset: 3
Location:Washington  Entered:2003-02-20, Days after submission: 78
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: WA021893
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.0774M SCLA
Administered by: Unknown     Purchased by: Private
Symptoms: Oedema, Pain, Vasodilation procedure
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)
Write-up: Received MMR. 14 days later developed pain, swelling and redness in right wrist.

VAERS ID:198059 (history)  Vaccinated:2003-02-11
Age:33.0  Onset:2003-02-17, Days after vaccination: 6
Gender:Female  Submitted:2003-02-20, Days after onset: 3
Location:Tennessee  Entered:2003-02-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: CBC WNL
CDC Split Type: TNSP501
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH40200760  
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Nausea, Pyrexia, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Day 6 post vaccination - nausea/vomiting, low grade fever (100); lt neck-supraclavicular node-tender. Day 8 post vacc - nausea; lt supraclavicular node enlarged; red; very tender; low grade fever. Discussed with CDC CIL.

VAERS ID:198063 (history)  Vaccinated:2003-01-09
Age:33.0  Onset:2003-01-16, Days after vaccination: 7
Gender:Female  Submitted:2003-01-24, Days after onset: 8
Location:Georgia  Entered:2003-02-20, Days after submission: 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: URI; yeast infection
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
ANTH: ANTHRAX (BIOTHRAX)EMERGENT BIOSOLUTIONSFAV0652 RA
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH40200711 LA
Administered by: Military     Purchased by: Military
Symptoms: Fatigue, Headache, Injection site pain, Neck pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)
Write-up: Pt c/o headaches, fatigue and pain in L upper arm later radiating to L neck area. Symptoms started on day 7 and lasted x 2 days. Pt given 24 hrs quarters to rest, given Toradol 60mg IM.

VAERS ID:198064 (history)  Vaccinated:2003-01-30
Age:33.0  Onset:2003-02-08, Days after vaccination: 9
Gender:Male  Submitted:2003-02-20, Days after onset: 12
Location:Virginia  Entered:2003-02-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: Biopsy of lesion showed no organisms,with mixed skin flora. CBC,UA, ESR,CRP,HSV,Varricella, viral culture negative. , immune raji 44.8
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETHUNKNOWN IDLA
Administered by: Military     Purchased by: Military
Symptoms: Myalgia, Rash
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: This re-vaccinee developed scattered, non-pruritic papules and pustules on anterior and posterior shoulders on day 10 after smallpox vaccine. No other symptoms evident except mild , generalized myalgias. Had had axillary LAD on day 5-9 but was resolved at time of rash eruption. All sx resolved without treatment.

VAERS ID:198194 (history)  Vaccinated:2003-02-20
Age:33.0  Onset:2003-02-22, Days after vaccination: 2
Gender:Male  Submitted:2003-02-23, Days after onset: 1
Location:Colorado  Entered:2003-02-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: URI
Preexisting Conditions: NKDA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH    
Administered by: Military     Purchased by: Military
Symptoms: Injection site swelling, Rash erythematous, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 33 y/o male with new onset erythematous rash 3 days s/p smallpox vaccine administration. Rash is erythematous, blanching rash with slightly raised scale on bilateral arms and right cheek. Rash is quite pruritic. Pt is afebrile, and in otherwise good health. NO history of skin disorders other than dry skin in winter.

VAERS ID:198212 (history)  Vaccinated:2003-01-18
Age:33.0  Onset:2003-01-18, Days after vaccination: 0
Gender:Male  Submitted:2003-02-16, Days after onset: 29
Location:Minnesota  Entered:2003-02-24, 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: Just getting over severe cold/virus at time of vaccination
Preexisting Conditions: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TD: TD ADSORBED (NO BRAND NAME)SANOFI PASTEURU0818AA1IMRA
YF: YELLOW FEVER (YF-VAX)SANOFI PASTEURUB135AA1SCLA
Administered by: Military     Purchased by: Military
Symptoms: Fatigue, Influenza like illness, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Flu like symptoms: fatigue, muscle aches, low temp. Duration of attack two wks from time of vaccination.

VAERS ID:198315 (history)  Vaccinated:2003-02-07
Age:33.0  Onset:2003-02-24, Days after vaccination: 17
Gender:Female  Submitted:2003-02-24, Days after onset: 0
Location:Maryland  Entered:2003-02-24
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: dermatitis NOS: evaluated by Dermatology for clearance for vaccine; prev. hx of parapsoriasis
Diagnostic Lab Data: Unknown if recovered, because patient still to be followed clinically. No labs done at this time. COVER/STANDARD PRECAUTIONS; RTC if spread or start to look like vaccine site
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
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SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH40200710IDRA
Administered by: Military     Purchased by: Military
Symptoms: Blister, Injection site erythema, Injection site vesicles, Pruritus
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 7 feb: vaccine given 13 feb: eval for take; + take; small red vessicular area several days later developed large red area of deltoid, upper arm... did not seek care 24 feb seen for multiple small vessicles itching in various areas of neck, arms, legs, abdomen. There were only 1-2 2-3mm red vessicles in each area, with no central necrosis or umbilication, clear vessicular fluid. None looked like the vaccine site

VAERS ID:198374 (history)  Vaccinated:2002-10-30
Age:33.0  Onset:2002-10-30, Days after vaccination: 0
Gender:Female  Submitted:2003-02-19, Days after onset: 112
Location:Michigan  Entered:2003-02-26, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0910AA IMLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site pain, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Had some nausea and vomiting x 1. Arm a little sore. Left arm size of quarter. Tenderness. 10/31/2002 Feeling better. Case closed.

VAERS ID:198381 (history)  Vaccinated:2002-11-11
Age:33.0  Onset:2002-11-11, Days after vaccination: 0
Gender:Female  Submitted:2003-02-19, Days after onset: 100
Location:Michigan  Entered:2003-02-26, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)AVENTIS PASTEURU0910AA IMLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: After receiving IM shot for flu c/o pain going up left side. Tenderness at site. Spoke with pt on 2/5/03 arm fine, no adverse relations. Case closed.

VAERS ID:198472 (history)  Vaccinated:2003-02-20
Age:33.0  Onset:2003-02-26, Days after vaccination: 6
Gender:Male  Submitted:2003-02-27, Days after onset: 1
Location:Colorado  Entered:2003-02-27
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: NKDA
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
SMALL: SMALLPOX (DRYVAX)PFIZER/WYETH    
Administered by: Military     Purchased by: Military
Symptoms: Erythema, Vaccination complication
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Possible self-innoculation to right collarbone. Very limited, single pustule, with bordering erythema.

VAERS ID:198845 (history)  Vaccinated:1997-02-07
Age:33.0  Onset:1997-02-23, Days after vaccination: 16
Gender:Male  Submitted:2003-03-04, Days after onset: 2200
Location:Unknown  Entered:2003-03-05, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS    
Administered by: Unknown     Purchased by: Unknown
Symptoms: Alopecia
SMQs:
Write-up: Full loss of facial hair. Partial progressive loss of pubic hair. Occasional loss of eye lashes.

VAERS ID:198846 (history)  Vaccinated:1997-02-12
Age:33.0  Onset:1997-02-23, Days after vaccination: 11
Gender:Male  Submitted:2003-03-04, Days after onset: 2200
Location:Unknown  Entered:2003-03-05, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: