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VAERS ID: 448163 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Colorado  
Vaccinated:2011-12-01
Onset:2011-12-01
   Days after vaccination:0
Submitted: 2012-01-26
   Days after onset:56
Entered: 2012-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Blood test, Dizziness, Imaging procedure, Injection site mass, Injection site pain, Muscle twitching, Nuclear magnetic resonance imaging brain, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: not prior to the vaccination
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: blood tests, brain/neck MRI, blood pressure tests, facial scans, three doctors appointments (one of which was Urgent Care)
CDC Split Type:

Write-up: I had the first injection on 12/1/2011. That day my arm was very swollen and the injection site was very sore. The swelling and pain lasted ~7 days and then went down. I thought all was well until two weeks later when the swelling and pain came back (lump around injection site). I started to have severe dizziness and neurological twitching. I ended up in the urgent care, and have had just under $3,000 dollars in medical bills trying to figure out what has been going on (brain MRI''s, blood tests, other various tests and images). It has been a true financial struggle. After how much this has cost me (as I have a high deductible), I absolutely refuse to get the second shot. This should be taken off the market.


VAERS ID: 448209 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Illinois  
Vaccinated:2012-01-19
Onset:2012-01-20
   Days after vaccination:1
Submitted: 2012-01-22
   Days after onset:2
Entered: 2012-01-27
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B078AA / UNK LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Dizziness, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: low fever~Td Adsorbed (no brand name)~UN~14.00~Patient|low fever~Tetanus Toxoid (no brand name)~UN~14.00~Patient
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Low grade fever 99-100 degrees F. Some dizziness after injection. Took TYLENOL for fever. Soreness at injection site.


VAERS ID: 448453 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Texas  
Vaccinated:2012-01-12
Onset:2012-01-16
   Days after vaccination:4
Submitted: 2012-01-18
   Days after onset:2
Entered: 2012-01-31
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS X11042 / 1 LA / UN

Administered by: Unknown       Purchased by: Private
Symptoms: Loss of consciousness, Pain, Pyrexia
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), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None mentioned
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt called pharmacy evening 1-17-12 said she passed out 5 days after the shot while at home. Pt said she has been feeling achy and running a fever. Advised pt to see dr if still feeling this way. Could not find anything in pkg insert page. Immediate time of vaccination about passing out or syncope.


VAERS ID: 448897 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Ohio  
Vaccinated:2012-02-02
Onset:2012-02-03
   Days after vaccination:1
Submitted: 2012-02-07
   Days after onset:4
Entered: 2012-02-06
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1706AA / 1 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Laboratory test, 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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: SINGULAIR; PROAIR HFA; Albuterol sulfate; FLOVENT HFA; Fluticasone; AVIANE
Current Illness:
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data: In hospital - tests being done but not available
CDC Split Type:

Write-up: Redness, swelling, pain left arm inj. site. Fever of 103 degrees since 2/3/12 - pt. is still hospitalized.


VAERS ID: 449079 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: California  
Vaccinated:2012-01-31
Onset:2012-01-31
   Days after vaccination:0
Submitted: 2012-02-07
   Days after onset:7
Entered: 2012-02-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Private       Purchased by: Other
Symptoms: Abdominal pain, Asthenia, Fatigue, Laboratory test normal, Nausea, Palpitations
SMQs:, Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Labs from ER normal
CDC Split Type:

Write-up: Nausea, weakness, fatigue paroxysms of racing heart, abdominal pain.


VAERS ID: 449352 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Texas  
Vaccinated:2012-01-23
Onset:2012-02-01
   Days after vaccination:9
Submitted: 2012-02-10
   Days after onset:9
Entered: 2012-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV292 / 1 UN / UN
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR VV04003A / 1 LA / OT
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 UN / UN

Administered by: Military       Purchased by: Military
Symptoms: Cardiac enzymes, Chest pain, Chills, Electrocardiogram, Headache, Myocarditis, Pericarditis, Pyrexia, Troponin
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Cardiac enzymes, troponin level, EKGs
CDC Split Type:

Write-up: Fever, chills, headache, progressive nonradiating chest pain spent 7 days in local hospital with discharge diagnosis of pericarditis/myocarditis.


VAERS ID: 449503 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Maryland  
Vaccinated:2012-01-27
Onset:2012-01-29
   Days after vaccination:2
Submitted: 2012-02-14
   Days after onset:16
Entered: 2012-02-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR E0653 / 2 LA / IM

Administered by: Military       Purchased by: Military
Symptoms: Computerised tomogram, Gait disturbance, Hypoaesthesia, Laboratory test, Lumbar puncture, Muscular weakness, Nuclear magnetic resonance imaging, Paraesthesia
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: MRI; CT scan; labs; LP
CDC Split Type:

Write-up: Pt going overseas, had typhoid inj. 27Jan12, felt fine, 2 days later while standing at sink numbness in face, tingling in fingers, & unsteady, legs went out from underneath him - went to - then to med ctr. Admitted MRI, CT scan, Labs, & LP - sx resolved & D/C from hospital - Pt had typhoid inj. in 2005 without difficulties.


VAERS ID: 449564 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Unknown  
Vaccinated:2011-11-07
Onset:2011-11-14
   Days after vaccination:7
Submitted: 2012-01-31
   Days after onset:78
Entered: 2012-02-14
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Influenza like illness, Vaccine positive rechallenge
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Pt had flu like symptoms after receiving flu shot 4 years in a row.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient with a 5 year history of flu like symptoms after receiving the flu vaccine.


VAERS ID: 449801 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Florida  
Vaccinated:2012-02-17
Onset:2012-02-17
   Days after vaccination:0
Submitted: 2012-02-17
   Days after onset:0
Entered: 2012-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UH273AA / 1 LA / SC

Administered by: Military       Purchased by: Military
Symptoms: Pruritus, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pruritus, rash; better with Benadryl.


VAERS ID: 450167 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Virginia  
Vaccinated:2012-02-20
Onset:2012-02-20
   Days after vaccination:0
Submitted: 2012-02-21
   Days after onset:1
Entered: 2012-02-23
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB515AA / 2 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1305 / UNK LA / SC
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR G1130 / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Periorbital oedema, Sensation of foreign body, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cefdinir; Azithromycin; Ciprofloxacin; Andrographis; Calcium; L-glutamine; Saccharomyces
Current Illness: Previous Dx of Neuro-Lyme DZ.
Preexisting Conditions: Bee sting allergy; Neuro-Lyme''s DZ with seizures - (Dx in 2010?)
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 2 hours after receiving Hepatitis A/Typhoid Vi/ IPV vaccines for travel to foreign country, pt. developed sudden, rapidly enlarging hives in both eyes, expanding to include periorbital area, upper nose & cheeks and a feeling of a lump in her throat. Provider at home thru the emergency service. Pt. did not report swelling to tongue/lips/airway or difficulty with breathing/swallowing when she called the provider on-call (me). She was advised to go to ER & since she called from Pharmacy to my home, I advised her to take BENADRYL 25mg X 2 STAT & have parents drive to ER, (They were with her at time) Pt. ended up not going to ER, but taking the BENADRYL "two or three tablets" and sitting at home with her parents, until symptoms mostly resolved (around 10 pm the same night). Today (2/21) I called pt. for update around 11:45 am. She still has some puffiness around her eyes but otherwise, symptoms have mostly resolved.


VAERS ID: 450363 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Texas  
Vaccinated:2011-02-26
Onset:2012-02-12
   Days after vaccination:351
Submitted: 2012-02-26
   Days after onset:14
Entered: 2012-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR VV04003A / 1 LA / OT

Administered by: Military       Purchased by: Military
Symptoms: Injection site erythema, Nodule, Vaccination site nodule, Vaccination site pustule
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: Physical exam by Dr.
CDC Split Type:

Write-up: Small red pustule like nodules appearing on outer aspect of Left arm near small pox vaccine site. More nodules appeared over the past two weeks and have been noted to be on the Right arm as well.


VAERS ID: 450530 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Virginia  
Vaccinated:2012-01-08
Onset:2012-02-06
   Days after vaccination:29
Submitted: 2012-02-27
   Days after onset:21
Entered: 2012-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR - / 1 LA / ID

Administered by: Military       Purchased by: Military
Symptoms: Blood creatine phosphokinase MB normal, Blood creatine phosphokinase normal, Chest pain, Echocardiogram abnormal, Electrocardiogram PR interval, Electrocardiogram ST segment elevation, Electrocardiogram abnormal, Pericardial effusion, Pericarditis, Pleuritic pain, Troponin I
SMQs:, Systemic lupus erythematosus (broad), Myocardial infarction (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None (to include immunologic disorders, cardiac disease, eczema, or relevant allergies)
Allergies:
Diagnostic Lab Data: See above.
CDC Split Type:

Write-up: Sudden onset of pleuritic chest pain, unaccompanied by dyspnea, orthopnea, edema, or significant limitations in exercise capacity. Normal EKG with the exception of subtle ST elevation (~1mm) and PR depression (~0.5mm) in lead AVF; rhythm was NSR in the low 60s without ectopy or conduction disturbances. Transthoracic echocardiogram showed 1.5 cm pericardial effusion without evidence of RV collapse or tamponade. CK, CK-MB, and troponin I all normal. Final diagnosis made of vaccinia-associated pericarditis; treated with indomethacin with good relief. No admission required.


VAERS ID: 450564 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Virginia  
Vaccinated:2012-02-25
Onset:0000-00-00
Submitted: 2012-02-27
Entered: 2012-02-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR EO442 / 1 RA / IM

Administered by: Military       Purchased by: Military
Symptoms: Vaccination error
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE KNOWN
Current Illness: NONE KNOWN
Preexisting Conditions: NONE KNOWN
Allergies:
Diagnostic Lab Data: NONE KNOWN
CDC Split Type:

Write-up: Patient was erroneously vaccinated with Typhoid. No know adverse reaction has occurred at this time.


VAERS ID: 450714 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Virginia  
Vaccinated:2011-12-05
Onset:2011-12-05
   Days after vaccination:0
Submitted: 2012-02-28
   Days after onset:85
Entered: 2012-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED UT424AA / UNK NS / IN
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1397Z / UNK LA / UN

Administered by: Military       Purchased by: Military
Symptoms: Abdominal pain, Cellulitis, Dizziness, Dysuria, Electrocardiogram ambulatory abnormal, Erythema, Feeling abnormal, Feeling hot, Fibrin D dimer, Full blood count normal, Haematocrit normal, Haemoglobin, Haemoglobin decreased, Hypersensitivity, Injection site erythema, Injection site joint pain, Injection site pain, Injection site reaction, Injection site streaking, Injection site swelling, Joint stiffness, Laboratory test normal, Lymphocyte percentage, Maternal exposure during pregnancy, Metabolic function test normal, Musculoskeletal stiffness, Nausea, Pain, Pain in extremity, Palpitations, Paraesthesia, Pyrexia, Red blood cell count decreased, Sinus tachycardia, Skin discolouration, Tenderness, Urine analysis normal, Vomiting, White blood cell count normal
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Haematopoietic erythropenia (narrow), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PNV
Current Illness: Pregnant; GERD; UC; migraines; asthma; hx SVT
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 12/8/11 labs showed D-dimer, CBC normal with RBC 3.74, HBG 11.3, and HCT and WBC normal. Lymphocytes 20%, BMP and UA were normal. 12/8/11 PVL study of LUE (internal jugular, subclavian, axillary and brachial vein) was negative.
CDC Split Type:

Write-up: AD patient received annual AFLURIA (CSL lot #UT424AA) and PNEUMOCOCCAL vaccine (lot # 1397Z) on 12/5/2011 in the upper left deltoid. At 3 hours later she c/o 3 red slightly raised nonpruritic area''s to mid left lateral upper arm with 5/10 pain which worsened if moved. "Felts as if someone threw something at me or punched me". She denied any trauma, fall, injury, or moving of large items. Later that evening a pinpoint red dot appeared in center of highest red patch with streaking connecting two red patches. Her pain increased to 10/10 and was described as a constant throb. On 12/6-7/2011 (24-48 hours later) she c/o fever 102.6F, nausea, vomiting, left axillary tenderness with increased redness and swelling to lower portion of left upper arm. TYLENOL every 6 hours eased the pain and fevers. Her medical records note afebrile unremarkable exam by cardiology 12/7/2011 for palpitations and lightheadedness (worse since pregnant). She was diagnosed with sinus rhythm/tachycardia via lifeline holter monitor and restarted in INDERAL. On 12/8/2011 (72 hours) she was evaluated by clinic for possible insect bite (she noticed mosquitoes in her home within 24 hours of onset of symptoms) and pain to left arm and fever. Her temperature was 98.5F with heart rate 109. She reported a 3 day history of redness and pain to upper left arm as minor soreness that radiated down to elbow with stiffness and pain, intermittent fevers that respond to TYLENOL and MOTRIN, and nausea, vomiting and abdominal crampy pains. She complained of pain with extension of left arm as if a "rubber band is going to snap:. She was referred to nearby ER with diagnosis of possible tetanus/spider bite for labs and IV antibiotics - her temp was 98.9F, heart rate 105 to 72 bpm (after given IVF bolus). labs showed D-dimer 0.92 (0.1.19), CBC normal with RBC 3.74 (3.8-5.20), HBG 11.3 (11.7-15.5), and HCT , WBC and lymphocytes 20%. BMP an UA were normal. PVL study of LUE (internal jugular, subclavian, axillary and brachial vein) was negative. IV right hand was removed due to complaints of pain from IV site resulting in oral administration of KEFLEX instead of IV. Both providers'' documented 3 x 5 patch of mild erythema and warmth over mid left humeral area dorsal aspect without rash or lymphangitis that was painful to light touch. She resisted flexion-extension of her left elbow or lifting shoulder due to pain, but later was able to extend and flex. Radial pulses were strong equal bilaterally with normal sensation, no bruising or blistering. She was released with contusion instructions and diagnosis of arm pain, dysuria and fever. Follow up with her PCP on 12/9/11 resulted in a second referral to ER for evaluation by infectious disease who gave a diagnosis of cellulitis, pregnancy and pain. She was treated with PERCOCET, prednisone, ZYRTEC and ZANTAC (already on KEFLEX). On 12/14/2011 she advised the redness/swelling were resolving, however her left arm pain persisted and she was referred to clinic by infectious disease provider for further guidance. On 12/19/2011 (day 14-16 after vaccination) continued left arm redness, pain and intermittent tingling down to fingers (following radial nerve from elbow across anterior arm to pain and thumb). Exam - 2 resolving left mid humeral red/brown discoloration s (now 1x1 cm and 1.5x 2 cm) to skin about 4 inches from shoulder and 3 inches below vaccine injection sites. Exam on 12/21/2011: resolution of redness and swelling to left arm (LA circumference was 12 inches on 12/15/11, 11.25 inches on 12/19/2011 and 10.5 inches on 12/21/2011. Skin temperature normal with mild hypersensitivity to touch. She could move her left arm but complained of discomfort to lower bicep/elbow with full extension/flexion and occasional tingling jolt to palm/thumb. Left shoulder exam unremarkable. Speeds and Yergason tests were positive with worst pain along lower anterior bicep region.


VAERS ID: 450717 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: New York  
Vaccinated:2011-12-02
Onset:2011-12-02
   Days after vaccination:0
Submitted: 2012-02-09
   Days after onset:69
Entered: 2012-02-28
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
TTOX: TETANUS TOXOID (NO BRAND NAME) / SANOFI PASTEUR C3984AA / UNK LL / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Mobility decreased, Pain in extremity
SMQs:, Parkinson-like events (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Hand aches and not functional too well
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: No
CDC Split Type:

Write-up: Was given tetanus vaccine on December 02/11 AM. Later that day at home my left arm was sore and aching, couldn''t move arm. It been over 2 months and still hurts. Cannot function arm properly.


VAERS ID: 450721 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2011-11-09
Onset:2011-11-10
   Days after vaccination:1
Submitted: 2012-02-28
   Days after onset:110
Entered: 2012-02-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA652BA / UNK LA / UN

Administered by: Public       Purchased by: Private
Symptoms: Fatigue
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 2/22/12 Patient came back to report that she experienced 72 hours of undue fatigue that began 24 hours after vaccinated. Complete recovery.


VAERS ID: 450809 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2011-10-28
Onset:2011-10-28
   Days after vaccination:0
Submitted: 2012-02-27
   Days after onset:122
Entered: 2012-02-29
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH455AA / 1 RA / UN

Administered by: Public       Purchased by: Private
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed pain (R) shoulder after flu shot - Was seen by PCP & orthopedist for evaluation. Currently getting therapy for shoulder ordered by the orthopedist.


VAERS ID: 450839 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Oregon  
Vaccinated:2012-02-29
Onset:0000-00-00
Submitted: 2012-03-01
Entered: 2012-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Wrong drug administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: medication administration error~Zoster (Zostavax)~~26.17~Patient
Other Medications: Aviane
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Zoster vaccine administered instead of 2nd dose of varicella vaccine. Still watching for potential adverse outcomes.


VAERS ID: 450909 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: New Mexico  
Vaccinated:2012-03-01
Onset:2012-03-01
   Days after vaccination:0
Submitted: 2012-03-01
   Days after onset:0
Entered: 2012-03-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
JEV1: JAPANESE ENCEPHALITIS (IXIARO) / INTERCELL AG JEV10G56F / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4246AA / 2 LA / IM
RAB: RABIES (IMOVAX) / SANOFI PASTEUR E09212 / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4009AA / 1 RA / IM
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR G1124 / 3 RA / IM
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UH271AA / 1 LA / SC

Administered by: Military       Purchased by: Military
Symptoms: Hypersensitivity, Throat irritation, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives, itchy feeling in throat and eyes mild allergic reaction. 50mg Benadryl give via IM injection to right arm.


VAERS ID: 450990 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Michigan  
Vaccinated:2012-03-01
Onset:2012-03-02
   Days after vaccination:1
Submitted: 2012-03-02
   Days after onset:0
Entered: 2012-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C4023AA / 2 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Asthenia, Chills, Headache, Injection site mass, Pain
SMQs:, Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: none to date
CDC Split Type:

Write-up: Large egg-sized mass on R deltoid. Whole body weakness, headache 6/10 sharp and intermittent, body aches and chills. No fever, cough or N/V.


VAERS ID: 451016 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Oregon  
Vaccinated:2012-02-28
Onset:2012-02-28
   Days after vaccination:0
Submitted: 2012-03-02
   Days after onset:3
Entered: 2012-03-03
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UT481AB / UNK LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1138AA / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Abdominal discomfort, Chills, Feeling abnormal, Injection site reaction, Nausea, Pain, Pain in extremity, Pyrexia, Rash macular, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol; omeprazole; FLONASE; cetirizine HCL; ORALONE; Norgestim-Eth
Current Illness: None Routine office visit
Preexisting Conditions: Allergic to penicillin; Asthma; Allergy to Balsam of Peru; GERD; Tinea versicolor
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Achy, sore and radiating pain in arm. Shivering and shakes. She felt like she had a fever, but did not take her temp. Currently no fever. Had blotchy area around injection site. She also developed some nausea - upset stomach. She described the pain as severe. Felt horrible. Improving now. Blotchy area like a rash.


VAERS ID: 451433 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Oregon  
Vaccinated:2009-10-01
Onset:0000-00-00
Submitted: 2012-03-11
Entered: 2012-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / SYR
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 RA / SYR

Administered by: Private       Purchased by: Other
Symptoms: Haemorrhage, Premature labour
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? Yes
Previous Vaccinations:
Other Medications: prenatal pills
Current Illness: Preterm labor/hemorrhage
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Preterm labor/hemorrhage. Went into labor at 28 weeks.


VAERS ID: 451626 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Texas  
Vaccinated:2012-03-12
Onset:2012-03-12
   Days after vaccination:0
Submitted: 2012-03-12
   Days after onset:0
Entered: 2012-03-13
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3486AA / 1 RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Dizziness, Dyspnoea, Feeling hot
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SUBOXONE
Current Illness: No
Preexisting Conditions: No allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shot administered at 3:50, patient said he felt lightheaded then he laid on floor & complained that he was hot then complained of difficulty breathing. Call 911 & gave EPIPEN shot at 3:55. A few minutes later & he said he was breathing OK & had him lay there for awhile then sat up & EMS arrived. He refused to go to ER.


VAERS ID: 451824 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Oklahoma  
Vaccinated:2012-03-14
Onset:0000-00-00
Submitted: 2012-03-14
Entered: 2012-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH455AA / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1023AA / 2 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Maternal exposure during pregnancy, No adverse event, Pregnancy test positive
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Pregnancy test positive
CDC Split Type:

Write-up: Client in for clinic, pregnancy test indicated positive per doctor''s orders. Administration of shot was already given, although client reported not pregnant et last menses 2.18.12. No adverse effect currently present.


VAERS ID: 451856 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: New York  
Vaccinated:2011-11-23
Onset:0000-00-00
Submitted: 2012-03-14
Entered: 2012-03-15
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1397AA / 1 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Abortion induced, Human chorionic gonadotropin positive, Maternal exposure during pregnancy, Ultrasound antenatal screen normal
SMQs:, Tumour markers (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Termination of pregnancy and risk of abortion (narrow), Normal pregnancy conditions and outcomes (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CELEXA 40 mg; KLONOPIN 1 mg; SEROQUEL 150 mg
Current Illness: Pregnancy NOS (LMP = 12/19/2011); Drug hypersensitivity; Anxiety; Bipolar disorder
Preexisting Conditions: Panic disorder
Allergies:
Diagnostic Lab Data: Ultrasound, 02/07/12, Single IUP; urine beta-human
CDC Split Type: WAES1202USA04383

Write-up: Information has been received from a licensed practical nurse, for GARDASIL, a Pregnancy Registry product, concerning a 26 year old female patient with drug hypersensitivity/allergy to aspirin and no pertinent medical history, who on 23-NOV-2011 was vaccinated with a first dose of GARDASIL 0.5 ml, IM (lot number 1397AA, exp 09-APR-2013). On 24-JAN-2012 the patient received the second dose of GARDASIL (dose, route and lot number unspecified). There was no concomitant medication included. The nurse stated that at the time of the report the patient was 10 weeks pregnant. The patient''s last menstrual period was 19-DEC-2011 and estimated delivery date would be 24-SEP-2012. At the time of the report the patient''s outcome was unknown. No treatment was given for an AE. Laboratory diagnostic studies were performed - urine pregnancy test. Follow-up information has been received from health care professional via Pregnancy Questionnaire, for GARDASIL, a Pregnancy Registry product, concerning a 26 year old female patient with panic, anxiety and bipolar, no previous pregnancies, no spontaneous abortions, no deliveries who on 23-NOV-2011 was vaccinated with a first dose of GARDASIL (dose and route not reported) (lot number 668261/1397AA). On 24-JAN-2012 the patient received the second dose of GARDASIL (dose and route not reported) (lot number 1437AA was not valid for GARDASIL and appeared to be 10 weeks pregnant (LMP: 19-DEC-2011, EDD: 25-SEP-2012). Other medications used this pregnancy included: KLONOPIN (1 mg, PRN, indication - anxiety, stopped 07-FEB-2012), SEROQUEL (150 mg, HS, indication - bipolar, stopped 07-FEB-2012) and CELEXA (40 mg, every day, indication - bipolar, stopped 07-FEB-2012). It has been reported that on an unknown date the patient underwent elective termination. At the time of the report the patient''s outcome was unknown. On 07-FEB-2012 laboratory diagnostic ultrasound prenatal test was performed - single and IUP (intrauterine pregnancy. Upon internal review elective termination was considered to be an other important medical event. Additional information has been requested.


VAERS ID: 452301 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: New York  
Vaccinated:2012-03-15
Onset:2012-03-18
   Days after vaccination:3
Submitted: 2012-03-22
   Days after onset:4
Entered: 2012-03-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1144AA / 2 LA / SC

Administered by: Public       Purchased by: Other
Symptoms: Erythema, Injection site erythema, Injection site swelling, Pruritus, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BEYAZ b.s.
Current Illness:
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Called Employee health clinic with redness & swelling at site from varicella #2 vaccine on 3/20/12. Declined to be checked. On 3/22 reported to EHC with several red raised areas that were pruritic. Afebrile 8-10 small red raised areas noted on various parts of body. No blisters noted.


VAERS ID: 452486 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Unknown  
Vaccinated:2012-03-21
Onset:2012-03-22
   Days after vaccination:1
Submitted: 2012-03-26
   Days after onset:4
Entered: 2012-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UH273AA / 1 LA / IM

Administered by: Military       Purchased by: Military
Symptoms: Injection site erythema, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: ''Hives on face, legs & chest. Severe itching in stated areas along with the site where the shot was taken was red & the size of a quarter.


VAERS ID: 452621 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Texas  
Vaccinated:2012-03-21
Onset:2012-03-22
   Days after vaccination:1
Submitted: 2012-03-27
   Days after onset:5
Entered: 2012-03-28
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (IMOVAX) / SANOFI PASTEUR 466011A / 3 UN / IM

Administered by: Military       Purchased by: Military
Symptoms: Oropharyngeal pain, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: "Felt ill" - uncertain~Hep B (no brand name)~UN~0.00~Patient
Other Medications: BUFFERIN as needed; MOTRIN as needed; ZYRTEC; BENADRYL; Prednisone (start 3/25)
Current Illness: None
Preexisting Conditions: Allergy to Penicillin & synthetic material (hives); endometriosis
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 26 y/o F received rabies vaccine 3/21 with hives/sore throat/feverish sensation noted AM of 3/22. Hives progressed, pt sought care in ED 3/25 & given ZYRTEC/BENADRYL/Prednisone with improvement.


VAERS ID: 452656 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Rhode Island  
Vaccinated:2012-03-24
Onset:2012-03-25
   Days after vaccination:1
Submitted: 2012-03-29
   Days after onset:4
Entered: 2012-03-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B078AA / UNK LA / IM

Administered by: Public       Purchased by: Other
Symptoms: Erythema, Headache, Nausea, Neck pain, Oedema peripheral, Pain in extremity, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pain swelling redness left arm neck pain, HA nausea fever treatment seen urgent care put on ZYRTEC 10mg. TYLENOL/ADVIL.


VAERS ID: 453170 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Connecticut  
Vaccinated:2012-03-25
Onset:2012-04-02
   Days after vaccination:8
Submitted: 2012-04-05
   Days after onset:3
Entered: 2012-04-06
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV305 / UNK UN / UN
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR VV04003A / UNK UN / -
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR G11301 / UNK UN / UN

Administered by: Military       Purchased by: Unknown
Symptoms: Injection site cellulitis, Rash generalised
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: NYC1200005

Write-up: On 3/25 received small pox, anthrax typhoid vaccine. On 4/2 developed cellulitis at site of vaccination and non-specific generalized rash which began on the arms and travelled to thorax and legs, sparing hand/feet. Patient was vaccinated through work and seen at ER for the rash on 4/4/12.


VAERS ID: 453183 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Georgia  
Vaccinated:2012-03-06
Onset:2012-03-12
   Days after vaccination:6
Submitted: 2012-04-02
   Days after onset:21
Entered: 2012-04-09
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR 44308BA / 1 LA / UN

Administered by: Private       Purchased by: Private
Symptoms: Blood creatine phosphokinase, Computerised tomogram, Convulsion, Electroencephalogram, Injected limb mobility decreased, Injection site erythema, Injection site swelling, Musculoskeletal pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Generalised convulsive seizures following immunisation (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CT; EEG; CPK drawn
CDC Split Type:

Write-up: Seven days after Tdap patient suffered a seizure. Her arm where shot was given was red & swollen, she also stated her arm and shoulder were hurting badly and having a hard time moving it, she had another seizure as well.


VAERS ID: 453590 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2011-11-03
Onset:2011-11-06
   Days after vaccination:3
Submitted: 2011-12-20
   Days after onset:44
Entered: 2012-04-12
   Days after submission:113
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH462AA / 3 RA / UN

Administered by: Other       Purchased by: Other
Symptoms: Blood creatinine increased, Chills, Headache, Myalgia, Neck pain, Plasmapheresis, Prerenal failure, Pyrexia, Renal failure acute, Urinary tract infection, Urogram, Viral infection
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Arthritis (broad), Tumour lysis syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Unknown - Neg history
Allergies:
Diagnostic Lab Data: See #7
CDC Split Type:

Write-up: 11-6-11 Fever/chills, myalgias, neck pain, H/A went to ED on 11-8-11 for evaluation, UTI, increased creat. prerenal (viral syndrome) 11-10-11 admitted to hospital after returned to the ED with acute renal failure/Flu vaccine stimulus for symptoms was indicated, Rx IVP, plasmapheresis, discharged 11-17-11.


VAERS ID: 453718 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Georgia  
Vaccinated:2012-04-14
Onset:2012-04-14
   Days after vaccination:0
Submitted: 2012-04-14
   Days after onset:0
Entered: 2012-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 LA / SYR
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 RA / SYR

Administered by: Military       Purchased by: Military
Symptoms: Blood test, Dizziness, Electrocardiogram, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Blood test, EKG, vitals.
CDC Split Type:

Write-up: Felt dizzy and passed out. Felt fine afterwards. Clinic required patient to go to emergency room. Released in good condition.


VAERS ID: 453875 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Connecticut  
Vaccinated:2012-03-25
Onset:2012-04-09
   Days after vaccination:15
Submitted: 2012-04-17
   Days after onset:8
Entered: 2012-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV305 / 1 RA / IM
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR VV04003A / 1 LA / ID
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR G1130 / 1 RA / IM

Administered by: Military       Purchased by: Unknown
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Hives = took BENADRYL.


VAERS ID: 453912 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2012-04-03
Onset:2012-04-04
   Days after vaccination:1
Submitted: 2012-04-10
   Days after onset:6
Entered: 2012-04-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4015AA / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Headache, Injection site erythema, Injection site induration, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Laceration to (L) 4th finger
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine given 04/03/12 - seen in office 04/06/12 with (L) arm redness, warmth & pain at inject site. Redness appeared 04/04/12 - continued to increase is size & became more tender & firm - developed mild headache. Treated with cephalexin 500mg TID x 7 days.


VAERS ID: 454027 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2011-11-18
Onset:2011-11-18
   Days after vaccination:0
Submitted: 2012-04-19
   Days after onset:152
Entered: 2012-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA692AA / UNK UN / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB520AA / UNK LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR G10831 / UNK LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1641Z / UNK UN / SC
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD 3002105 / UNK MO / PO

Administered by: Other       Purchased by: Private
Symptoms: Pain, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none known to us
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Havrix vaccine was administered IM in left deltoid (after IPOL vaccine was administered IM in left deltoid). As soon as vaccine was administered, patient reported feeling pain. Her arm remained "very painful" for 2-3 days afterwards and then improved to a "dull soreness" which was not bothersome and sometimes not even noticeable. Patient called us to report this on 4/19/2012 after she had started lifting weights and noticed her left arm was more sensitive and reminiscent of the pain she felt after her Havrix vaccination. We encouraged the patient to see her primary care provider about this and also apply heat/take ibuprofen for the pain. She was mostly concerned there was something wrong with the vaccine itself. We searched for recall notices and none were found concerning that vaccine. She was also slightly concerned that if a nerve was hit during vaccination--how long would that feeling last? I encouraged her to see her primary doctor and we would be happy to share this report with him/her. Overall, she is not experiencing a severe reaction.


VAERS ID: 454289 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Unknown  
Vaccinated:2012-04-21
Onset:2012-04-21
   Days after vaccination:0
Submitted: 2012-04-24
   Days after onset:3
Entered: 2012-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS - / 2 RA / IM

Administered by: Military       Purchased by: Military
Symptoms: Arthralgia, Diarrhoea, Fatigue, Headache, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flonase; Claritin; vitamins
Current Illness: none
Preexisting Conditions: allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache that has not gone away; vomiting; diarrhea; fatigue; soreness of the joints.


VAERS ID: 454282 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Virginia  
Vaccinated:2012-01-23
Onset:2012-02-02
   Days after vaccination:10
Submitted: 2012-04-18
   Days after onset:75
Entered: 2012-04-25
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR - / UNK UN / ID

Administered by: Unknown       Purchased by: Unknown
Symptoms: Echocardiogram abnormal, Electrocardiogram, Nuclear magnetic resonance imaging abnormal, Pericardial disease, Pericarditis, Troponin I increased
SMQs:, Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The subject has no significant medical history.
Allergies:
Diagnostic Lab Data:
CDC Split Type: 201203998

Write-up: This study case was received from the investigator on 13 April 2012. A 26-year-old male subject who had no significant medical history was found to have acute pericarditis, unspecified and unspecified disease of pericardium 10 days after receiving an injection of ACAM2000, lot number, route and site of administration not reported) and anthrax (manufacturer and lot number) on 23 January 2012. On 03 February 2012 the subject had an abnormal troponin I level of 14.80, an abnormal echocardiogram and an abnormal magnetic resonance imaging (MRI) of the heart. The subject had an electrocardiogram performed but the results were not available. The diagnosis of acute pericarditis, unspecified and unspecified disease of pericardium was made on 02 February 2012. The outcome was not reported. Additional information will be requested from the investigator. There is no reporter causality assessment as this is a safety surveillance (data mining, non-interventional) study. Documents held by sender: None.


VAERS ID: 455102 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Texas  
Vaccinated:2012-05-01
Onset:2012-05-01
   Days after vaccination:0
Submitted: 2012-05-07
   Days after onset:6
Entered: 2012-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS M10127B / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Headache, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: N/V, HA.


VAERS ID: 455557 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Virginia  
Vaccinated:2012-04-23
Onset:0000-00-00
Submitted: 2012-04-27
Entered: 2012-05-14
   Days after submission:17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
SMALL: SMALLPOX (NO BRAND NAME) / UNKNOWN MANUFACTURER VV04003A / 1 LA / -

Administered by: Military       Purchased by: Military
Symptoms: Expired drug administered, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Expired Smallpox given with positive reaction, no clinical adverse effect noted.


VAERS ID: 455765 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Nevada  
Vaccinated:2012-05-03
Onset:2012-05-12
   Days after vaccination:9
Submitted: 2012-05-17
   Days after onset:5
Entered: 2012-05-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV305 / 1 UN / IM
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR VV04003A / 1 UN / OT
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B080AA / 1 UN / IM
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR G1124 / 1 UN / IM

Administered by: Military       Purchased by: Military
Symptoms: Erythema, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Developed red, itchy rash to trunk, progressed to patches that coalesced on his arms, thighs and trunk. Starting day 9-10 after vaccine. No fever or other constitutional symptoms. Treated with oral NSAIDS.


VAERS ID: 456220 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Ohio  
Vaccinated:2012-05-23
Onset:2012-05-23
   Days after vaccination:0
Submitted: 2012-05-25
   Days after onset:2
Entered: 2012-05-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U3957CA / 1 RA / IM

Administered by: Unknown       Purchased by: Other
Symptoms: Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ibuprofen and glucosamine
Current Illness: patient was just getting over head cold- there was no temp associated with this
Preexisting Conditions: allergy to shellfish
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt developed fever and body aches the evening the injection was administered. Did not have thermometer to check actually temp.


VAERS ID: 456480 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Hawaii  
Vaccinated:2012-05-29
Onset:2012-05-29
   Days after vaccination:0
Submitted: 2012-05-30
   Days after onset:1
Entered: 2012-05-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1395AA / 2 AR / IM

Administered by: Military       Purchased by: Military
Symptoms: Anaphylactic reaction, Dyspnoea, Endotracheal intubation, Extubation, Intensive care, Pharyngeal oedema
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Oropharyngeal allergic conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: clonazepam, Prozac
Current Illness: No
Preexisting Conditions: -depression/anxiety -Allergy to toradol (rash/itching)
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Anaphylaxis (shortness of breath; sensation of throat swelling) that started approximately 30 minutes after vaccine dose (Gardasil). This was dose #2. Dose #1 was given on 6/8/2011 with no reported adverse effects. Pt was seen in local ER. She was intubated and transferred to ICU on 29 May 2012. She was extubated on 30 May 2012. The plan is to transfer her from the ICU to the regular medicine ward for observation later today if she continues to do well. Currently, this is hospital day #2. No other exposures were thought to be responsible for her signs/symptoms.


VAERS ID: 456646 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Ohio  
Vaccinated:2011-04-03
Onset:2011-04-04
   Days after vaccination:1
Submitted: 2012-05-29
   Days after onset:421
Entered: 2012-06-01
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0034AA / 2 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Erythema, Injection site warmth, Skin induration, Skin mass
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pt. on Allopurinol; XANAX; IMITREX
Current Illness: None
Preexisting Conditions: Gout; Severe migraines; Anxiety
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: After receiving varicella vaccine on 4/3/11 pt states a "red knot, hard, hot and felt like a plate was under the skin." Lasted two weeks and was about 2 inch diameter. No systemic fever; only spot was warm to touch on right upper arm. Took two weeks to go away per pt.


VAERS ID: 456834 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Georgia  
Vaccinated:2012-06-04
Onset:2012-06-05
   Days after vaccination:1
Submitted: 2012-06-05
   Days after onset:0
Entered: 2012-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 3 RA / IM

Administered by: Unknown       Purchased by: Other
Symptoms: Pruritus generalised, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: I went to emergency clinic at 6pm and received 1 shot of steroids in the buttock and a prescription for 20mg prednisone tablet for 4 days.
CDC Split Type:

Write-up: I (patient) woke up to use bathroom and I was itching all over at 2am. I noticed rash on my legs and buttocks. That morning I went to work and throughout the day the rash progressed and more "spots" developed. They are raised and have a clear head to some of them. I did not eat anything different or change detergent. My husband did not have this rash following sleep on 6/04/12. The only change in routine was receiving the 3rd Gardasil vaccine shot. I am itching all over. The welts are on both legs both on the front and backside of my legs, on both buttocks, around the bikini area and I have these "raised spots/rash" on both arms and back also as of 6pm on 6/05/12.


VAERS ID: 456837 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Texas  
Vaccinated:2012-05-15
Onset:2012-05-23
   Days after vaccination:8
Submitted: 2012-06-05
   Days after onset:13
Entered: 2012-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH FAV305 / UNK UN / UN
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR VV04003A / UNK UN / ID
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B076BA / UNK UN / UN
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR G1130 / UNK UN / IM

Administered by: Military       Purchased by: Military
Symptoms: Axillary pain, C-reactive protein normal, Cardiac enzymes normal, Chest discomfort, Chest pain, Electrocardiogram normal, Musculoskeletal chest pain, Pain, Rash, Tenderness
SMQs:, Anaphylactic reaction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CRP; Cardiac enzymes all normal; EKG normal
CDC Split Type:

Write-up: Presented with rash on hands and feet, associated with pain and tenderness with an onset 11 days post vaccination with AVA, Typhoid, and SPV on 15 May. Pt also c/o chest pain, described as a heaviness over left breast area, eased with leaning forward, worsened with laying flat. Onset 8 days post vaccination. No radiation, n/c, no diaphoresis, ? SOB. Pain persisted for 1-2 days. Woke up with pain in chest but did not think much of it as he had a different type pain under his arm and left lateral rib cage area that was tender to touch. Rx steroids (40 mg x 5 then 20 mg x 5) for rash.


VAERS ID: 456898 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Ohio  
Vaccinated:2012-04-17
Onset:2012-04-20
   Days after vaccination:3
Submitted: 2012-05-03
   Days after onset:13
Entered: 2012-06-06
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 RA / UN

Administered by: Private       Purchased by: Military
Symptoms: Diarrhoea, Dizziness, Fatigue, Headache, Insomnia, Lymphadenopathy
SMQs:, Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Lymphedema; (R) leg; (L) arm
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Insomnia, swollen glands in both armpits, diarrhea, tired, headache, dizziness.


VAERS ID: 456901 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Illinois  
Vaccinated:2012-04-17
Onset:2012-04-19
   Days after vaccination:2
Submitted: 2012-06-06
   Days after onset:48
Entered: 2012-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B080AA / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Headache, Pain, Pyrexia, Sensation of pressure
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Patient stated he felt fatigued and very weak, dizzy with the feeling of vertigo at time of vaccination.
Preexisting Conditions: Seasonal allergies, Anxiety/Panic disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt c/o body aches, headache, minor fever, and "pressure all over body."


VAERS ID: 457008 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2012-06-06
Onset:2012-06-07
   Days after vaccination:1
Submitted: 2012-06-07
   Days after onset:0
Entered: 2012-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4021AD / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Dizziness, Headache, Injection site erythema, Injection site pain, Injection site swelling, Pain
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lorazepam; RITALIN
Current Illness: None
Preexisting Conditions: Allergy to PCN; DJD - 2 artificial disks in spine
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache, dizziness, body aches, redness, soreness and swelling of injection site. Pt evaluated by P.A. and was told to ice inj site and take an anti-histamine and call us if streaking/worse.


VAERS ID: 457516 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: California  
Vaccinated:2012-06-06
Onset:2012-06-06
   Days after vaccination:0
Submitted: 2012-06-06
   Days after onset:0
Entered: 2012-06-15
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB225AA / 2 LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0614AA / 1 LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Dizziness, Dyspnoea, Flushing, Tremor, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Allergic to wheat & chocolate; Crohn''s
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After the administration of the vaccines, patient reported feeling dizzy & having difficulty breathing. Patient was advise to sit down & after the administration of the EPI-PEN patient was no longer flushed. Severity of difficulty of breathing decreased. Pt was still shaking. Paramedics arrived & the pt was taken to the hospital. Before leaving pt had an episode of vomiting.


VAERS ID: 457528 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: New York  
Vaccinated:2012-06-06
Onset:2012-06-09
   Days after vaccination:3
Submitted: 2012-06-15
   Days after onset:6
Entered: 2012-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4034AA / 1 LA / UN

Administered by: Other       Purchased by: Other
Symptoms: Body temperature increased, Injection site erythema, Pain in extremity
SMQs:, Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Cut (L) 2nd finger on packing tape teeth
Preexisting Conditions: Denied hx; Allergies; Medications
Allergies:
Diagnostic Lab Data: None. Reported 6/15/12 while in clinic for unrelated concern. Exam & vs WNL
CDC Split Type:

Write-up: Pt reports "Saturday Temp about 102 with arm pain & splotchy red area to (L) upper arm/deltoid area." Denied having evaluation on any further treatment/OTC. States lasted about 2 days then resolved. No symptoms at present time in clinic for unrelated concern.


VAERS ID: 458261 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Michigan  
Vaccinated:2012-06-22
Onset:2012-06-26
   Days after vaccination:4
Submitted: 2012-06-27
   Days after onset:1
Entered: 2012-06-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U4329AA / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Muscle twitching, Pain, Pain in extremity, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Dyskinesia (broad), Dystonia (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Flonase
Current Illness: Numbness on L side of face x2mos. Post-concussion on 2/13/2012.
Preexisting Conditions: None.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Golf ball sized swelling in armpit. Muscle twitching in face. Arm painful and hurts to move it.


VAERS ID: 458577 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Unknown  
Vaccinated:2007-04-30
Onset:2007-09-01
   Days after vaccination:124
Submitted: 2012-07-02
   Days after onset:1766
Entered: 2012-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV102 / 4 UN / UN

Administered by: Military       Purchased by: Military
Symptoms: Albumin urine present, Anti-GAD antibody positive, Anti-islet cell antibody positive, Blood glucose increased, Blood thyroid stimulating hormone decreased, Carbon dioxide normal, Glycosylated haemoglobin increased, Insulin C-peptide increased, Latent autoimmune diabetes in adults, Polydipsia, Polyuria, Type 2 diabetes mellitus, Urine ketone body present, Weight decreased
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Retroperitoneal fibrosis (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Chronic kidney disease (broad), Proteinuria (narrow), Tubulointerstitial diseases (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: NKDA
Allergies:
Diagnostic Lab Data: 10/23/2007, Glucose 413, CO2 28, TSH 1.38, Urine Ketones 1+; 10/26/2007, HgbA1c 10.4, Urine microalbumin 1.2; 12/01/2007, GAD 65, Ab 25.8, Islet Cell Antibody 1:64, C-Peptide 4.2; 3/12/2012, C-Peptide <0.1
CDC Split Type:

Write-up: 25 year old patient presented on 23 OCT 2007 with 4 week history of polyuria and polydipsia. Patient reports weight loss of 20-30 pounds over previous 12 months. His glucose level was 413, his HbgA1c 10.4, his CO2 was 28, and his urine was 1+ for ketones. He was diagnosed with Type 2 DM and started on glipizide along with diet modification, and later Metformin, as well as ACTOS and Insulin. In NOV 2007, patient was referred to a Endocrinologist who, in early DEC 2007, felt patient most likely had Latent Autoimmune Diabetes in Adults (LADA), although his blood sugars were controlled with oral agents. In DEC 2007, he tested antibody positive for GAD65 and Islet Cell antibodies and his C-peptide level was 4.2. Patient denies a history of elevated glucose or blood pressure levels or history of hypertension prior to DM diagnosis. He exercised regularly and had a normal BMI (24) at time of diagnosis. Patient has no first degree family members with a history of diabetes. He denies experiencing any congestion, cough, fever, sinus pain, or diarrhea in weeks-months prior to diagnosis.


VAERS ID: 458611 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Georgia  
Vaccinated:2012-04-19
Onset:2012-04-19
   Days after vaccination:0
Submitted: 2012-04-19
   Days after onset:0
Entered: 2012-07-03
   Days after submission:75
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1542AA / 2 RA / SC
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B076DA / 2 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0830AA / 2 RA / SC

Administered by: Public       Purchased by: Private
Symptoms: Flushing, Hyperhidrosis, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Call came in from wife husband having sweats, red rash skin flushed. No temp had chicken rice at restaurant. Told to go to ER. This was 5pm.


VAERS ID: 458627 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Virginia  
Vaccinated:2011-10-13
Onset:2011-10-13
   Days after vaccination:0
Submitted: 2012-07-03
   Days after onset:264
Entered: 2012-07-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Ear discomfort, Feeling hot, Hypoaesthesia oral, Nausea
SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: tooth infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient presented with complaints of feeling "hot" all day after receiving shot, nauseous, having "ear pressure" and "numb lips".


VAERS ID: 458797 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Minnesota  
Vaccinated:2012-01-07
Onset:2012-02-20
   Days after vaccination:44
Submitted: 2012-07-08
   Days after onset:138
Entered: 2012-07-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 3 LA / ID

Administered by: Private       Purchased by: Private
Symptoms: Blood thyroid stimulating hormone, Hypothyroidism
SMQs:, Hypothyroidism (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Topical meds for psoriasis
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: TSH
CDC Split Type:

Write-up: I was diagnosed with Hypothyroidism, I have NO family history of this disease. I had normal TSH in 2006, no later tests done, however after my 3rd vaccination, I started developing symptoms.


VAERS ID: 458875 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: D.C.  
Vaccinated:2012-05-30
Onset:2012-05-31
   Days after vaccination:1
Submitted: 2012-07-09
   Days after onset:39
Entered: 2012-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0873AA / 3 LA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0869AA / 3 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient states that, 24 hrs. after she had the varicella injection in her right arm, she developed large skin reddening about 70 mm in size with a dime size wheal. The next day it gradually waned and signs & symptoms disappeared on the 3rd day. She experienced no itching and generalized symptoms.


VAERS ID: 459575 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Florida  
Vaccinated:2012-07-09
Onset:2012-07-09
   Days after vaccination:0
Submitted: 2012-07-10
   Days after onset:1
Entered: 2012-07-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0629AE / 1 UN / IM

Administered by: Private       Purchased by: Private
Symptoms: Chest discomfort, Dyspnoea, Electrocardiogram normal, Laboratory test normal
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: RECLIPSEN (oral contraceptive); RETIN A topical gel
Current Illness: None
Preexisting Conditions: Patient with seasonal allergies; No drug allergies; No medical conditions
Allergies:
Diagnostic Lab Data: EKG/lab work by ER -$g all WNL, pt sent home
CDC Split Type:

Write-up: Patient complained of chest tightness and shortness of breath.


VAERS ID: 459660 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Georgia  
Vaccinated:2008-09-26
Onset:2008-09-26
   Days after vaccination:0
Submitted: 2012-07-19
   Days after onset:1392
Entered: 2012-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB132AC / 1 RA / UN
TYP: TYPHOID VI POLYSACCHARIDE (NO BRAND NAME) / UNKNOWN MANUFACTURER 3001391 / UNK UN / UN

Administered by: Private       Purchased by: Private
Symptoms: Abnormal behaviour, Anger, Fatigue, Memory impairment, Neuropathy peripheral, Paraesthesia, Poor quality drug administered, Pyrexia, Thinking abnormal
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Hostility/aggression (narrow), Depression (excl suicide and self injury) (broad), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergy to sulfa drugs
Preexisting Conditions: No concomitant medications.
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: A0984817A

Write-up: This case was reported by a consumer (patient) and described the occurrence neuropathy in a 26-year-old male subject who was vaccinated with TWINRIX (GlaxoSmithKline). A physician or other health care professional has not verified this report. Concurrent medical conditions included allergy to sulfa drugs. Concurrent vaccination included typhoid vaccine (non-gsk);non-GSK manufacturer;unknown;unknown given on 26 September 2008. On 26 September 2008 the subject received 1st dose of TWINRIX (unknown route, route arm) and on unspecified dates the subject received 2nd dose and 3rd dose of TWINRIX (details unknown) and experienced poor quality vaccine administered with the 1st dose. The subject believed that his symptoms might be caused by his vaccine not being refrigerated properly because an internet search turned up a recall for the reported lot number by an agency in his state. On 26 September 2008, about 1 month after vaccination with TWINRIX 1st dose, at an unspecified time after vaccination with TWINRIX 2nd dose and 3rd dose, the subject experienced paresthesia, neuropathy "that felt like his nerves were on fire", memory problem, "irrational" anger/rage, "relapsing fever where he would feel feverish" and exhausted. He explained the fever would go away and recur. While he was hospitalized for these symptoms, but "they did not know the cause". Everyone in his family and at work noticed that "something was wrong because he acted very differently from before the vaccination" (acted as a different person). The subject was seeing a neurologist for these symptoms. The subject reported that the first and second vaccination doses were received at the same office and the third dose was received at a different office, but did not know the exact dates. It could not be determined if the events got worse from subsequent TWINRIX doses or if the problem, was just progressing, thus all doses were considered suspect. The subject was hospitalised. At the time of reporting the paresthesia and "relapsing fever where he would fell feverish" and exhausted were unresolved and the neuropathy "that felt like his nerves were on fire, memory problem and "irrational" anger/rage were worse. The outcome for acted as a different person was unknown. The subject reported an event for his father. See case A0984842A for details.


VAERS ID: 459913 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: California  
Vaccinated:2012-07-12
Onset:2012-07-17
   Days after vaccination:5
Submitted: 2012-07-23
   Days after onset:6
Entered: 2012-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV308 / 1 RA / IM
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR 04003A / 1 LA / OT
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR G11241 / 1 RA / IM

Administered by: Military       Purchased by: Military
Symptoms: Injection site reaction, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: ALLERGY TO PENICILLIN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: ITCHY BUMPS AROUND LOCAL AREA OF THE SITE (LEFT ARM).


VAERS ID: 459916 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Colorado  
Vaccinated:2012-07-20
Onset:0000-00-00
Submitted: 2012-07-23
Entered: 2012-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR G1130 / UNK RA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Induration, Oedema peripheral, Pain in extremity
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 4" X 5" induration and swelling area over anterior triceps. Patient reports much less pain today, able to flex/extend at elbow with no discomfort. Distal neurosensory/neurovascular intact Left arm. No evidence for any necrosis. Intact, equivalent strength biceps/triceps compared to Right arm.


VAERS ID: 459930 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Unknown  
Vaccinated:2012-07-17
Onset:2012-07-23
   Days after vaccination:6
Submitted: 2012-07-23
   Days after onset:0
Entered: 2012-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV307 / UNK LA / -

Administered by: Military       Purchased by: Military
Symptoms: Human chorionic gonadotropin positive, Maternal exposure during pregnancy
SMQs:, Tumour markers (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: B HCG
CDC Split Type:

Write-up: No event. Pt had negative pregnancy test 17JUL when test given and returns today 24JUL with positive test. Pt was pregnant at time of vaccine anthrax but B HCG was negative.


VAERS ID: 460550 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Unknown  
Vaccinated:2012-05-18
Onset:2012-05-18
   Days after vaccination:0
Submitted: 2012-07-22
   Days after onset:65
Entered: 2012-07-24
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER 0408Z / 1 RA / UN

Administered by: Other       Purchased by: Private
Symptoms: Expired drug administered, No adverse event, Rubella antibody positive
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Loratadine; MIRENA
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 07/06/2012, Rubella antibody test, 108, Positive
CDC Split Type: WAES1205USA04187

Write-up: Information has been received from a pharmacist a patient who on 18-MAY-2012 was vaccinated with a dose of MMR (Lot# 667319/0408Z, dose and route not reported), that had an expiration date of 18-MAR-2012. No symptoms reported. It was unspecified whether the patient sought attention or not. Follow up information was received from the pharmacist reported that the 26 years old female patient who at 14:14 on 18-MAY-2012 was vaccinated on the right arm with the first dose of MMR (Lot# 667319/0408Z). There was no illness at time of vaccination. The concomitant therapies included MIRENA. On 06-JUL-2012 the patient''s rubella antibodies test revealed 108 IU/mL which indicate immune. No adverse events reported. No further follow up was planned. Additional information is not expected.


VAERS ID: 460403 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Unknown  
Vaccinated:2012-06-25
Onset:2012-07-08
   Days after vaccination:13
Submitted: 2012-07-27
   Days after onset:19
Entered: 2012-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B078BA / 1 LA / IM

Administered by: Unknown       Purchased by: Other
Symptoms: Condition aggravated, Deep vein thrombosis, Guillain-Barre syndrome, Immunoglobulin therapy, Maternal exposure during pregnancy, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 16 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol Zyrtec
Current Illness: None
Preexisting Conditions: Asthma, history of DVT during previous pregnancy.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Progressive upper and lower extremity weakness felt to be Guillain Barre Syndrome. Please note patient is pregnant. Given IVIG, found to have DVTs left lower extremities, now receiving Gamunex (different type of IVIG) with full dose Lovenox. Slight improvement in upper extremity strength but patient extremely weak in lower extremities 3/5 strength at hips.


VAERS ID: 460404 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Maryland  
Vaccinated:2012-07-24
Onset:2012-07-24
   Days after vaccination:0
Submitted: 2012-07-27
   Days after onset:3
Entered: 2012-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UH522AB / UNK LA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1418AA / 1 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B077BA / 1 RA / IM

Administered by: Military       Purchased by: Military
Symptoms: Blood culture, C-reactive protein, CSF culture, Computerised tomogram head, Full blood count, Headache, Lumbar puncture, Malaise, Metabolic function test, Myalgia, Polymerase chain reaction, Pyrexia, Red blood cell sedimentation rate
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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Morphine sulfate Lyrica Wellbutrin Prozac Celebrex Percocet
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CT head, Lumbar puncture, CBC, CMP, ESR, CRP, blood cultures, CSF cultures and PCR.
CDC Split Type:

Write-up: Severe myalgias, malaise, headache and fever.


VAERS ID: 460407 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Texas  
Vaccinated:2012-07-12
Onset:2012-07-12
   Days after vaccination:0
Submitted: 2012-07-27
   Days after onset:15
Entered: 2012-07-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0738AA / UNK LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Injection site anaesthesia
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: na
CDC Split Type:

Write-up: Quarter size numbness around injection site.


VAERS ID: 461191 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2012-07-30
Entered: 2012-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Alopecia
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Drug hypersensitivity
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1205USA04339

Write-up: Information has been received from a consumer concerning her currently 26 year old daughter with penicillin allergy who on an unspecified date was vaccinated with a dose of GARDASIL (site, dose and lot# not reported). The patient''s mother reported that her daughter had "lost about 1/4 of her hair amount, mostly at the crown", after receiving the second dose of GARDASIL. At the time of the report, the patient was recovering. The patient did not seek medical attention. The relationship between GARDASIL and the adverse event was unknown. No further information is available.


VAERS ID: 462030 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Connecticut  
Vaccinated:2012-04-03
Onset:2012-04-04
   Days after vaccination:1
Submitted: 2012-08-02
   Days after onset:120
Entered: 2012-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0690AA / 1 UN / IM

Administered by: Public       Purchased by: Public
Symptoms: Eyelid function disorder, Nausea
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Periorbital and eyelid disorders (narrow), Ocular motility disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PRILOSEC; MICROGESTIN
Current Illness: Gastrooesophageal reflux disease, Continuing
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1206USA03417

Write-up: Information has been received from a nurse practitioner concerning a 26 year old female patient with gastrooesophageal reflux disease and no drug reactions/Allergies who on 03-APR-2012 was vaccinated IM with the first dose of GARDASIL. Concomitant therapy included omeprazole and MICROGESTIN. On 04-APR-2012 the patient found that it was very difficult to open her eyes in the morning. She also had nausea. These problems resolved as the day progressed. The patient recovered on 04-APR-2012 in the evening. The patient sought medical attention by going to the nurse practitioner''s office. No treatment was given for the events. No lab diagnostics studies were performed. Follow up information has been received from nurse practitioner refers to 26 year old female patient with no illness at time of vaccination and none pre-existing allergies, birth defects and medical conditions. It was reported that patient presented for second dose of GARDASIL on 05-JUN-2012 (dose, route and Lot # not reported) and reported that on the morning following her first injection of GARDASIL on 03-APR-2012 on 14:19 (dose not reported, IM, right deltoid, Lot#668985/0690AA) it was very difficult to open her eyes. She believes she might have also nauseous. Patient stated she might have experienced similar symptoms in past after GARDASIL "but this was worse". The patient recovered on 04-APR-2012. Additional information is not expected.


VAERS ID: 460969 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Ohio  
Vaccinated:2012-08-02
Onset:2012-08-03
   Days after vaccination:1
Submitted: 2012-08-03
   Days after onset:0
Entered: 2012-08-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1542AA / UNK RA / SC
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1410AA / UNK LA / SC

Administered by: Public       Purchased by: Private
Symptoms: Erythema, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Did have chickenpox as a child but needed proof for college so she opted to get shots instead of a titer.
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Left arm become swollen and red.


VAERS ID: 461164 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Rhode Island  
Vaccinated:2012-06-26
Onset:2012-07-06
   Days after vaccination:10
Submitted: 2012-08-06
   Days after onset:31
Entered: 2012-08-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR H1223 / UNK RA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0188AA / UNK RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U4021AE / UNK LA / UN

Administered by: Military       Purchased by: Military
Symptoms: Abnormal sensation in eye, Aphasia, Depressed level of consciousness, Disturbance in attention, Fatigue, Full blood count, Haematocrit decreased, Haemoglobin normal, Mean cell haemoglobin concentration increased, Mean cell haemoglobin normal, Mean cell volume normal, Memory impairment, Photophobia, Platelet count normal, Red blood cell count normal, Red cell distribution width, Vision blurred, Visual impairment, White blood cell count decreased
SMQs:, Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Daily Multivitamin
Current Illness: None
Preexisting Conditions: Diagnosed with Latent TB Infection in 2012 with no respiratory symptoms. Negative CXR in JUN 2012. Started taking Rifampin 600 mg/day in late JUL 2012. History of seasonal allergies symptoms controlled with OTC antihistamines. Has not required use of allergy medications for about 6 years. NKDA.
Allergies:
Diagnostic Lab Data: 22 Jun 2012, CBC, Blood; WBC 4.8 x10(3)/mcL; RBC 4.78 x10(6)/mcL; Hemoglobin 14.8 g/dL; Hematocrit 40.9%; MCV 85.6 fL; MCH 30.9 pg; MCHC 36.1 (H)g/dL; RDW CV 11.4 (L)%; Platelets 219x10(3)/mcL
CDC Split Type:

Write-up: On 28 JUN 2012, patient, who was in his usual state of good health, received IPV and MMR vaccines in right upper arm, and on 26 JUN 2012, had received MGC vaccine in his left upper arm. He does not recall any significant local reactions at his vaccination sites. He denies any systemic symptoms during the first week after vaccine receipt. At the time of vaccine receipt, patient was attending Officer Development School (ODS). [Attended ODS from period of 10 JUN through 13 July]. During the last week of ODS (6 through 13 JUL), patient was sleep deprived as a result of intensive training, so when he noted fatigue, difficulty concentrating, and decreased mental alertness, he attributed theses symptoms to lack of sleep. However, following ODS, after patient was getting sufficient sleep and on TAD status, he noted ongoing symptoms such as "mental fatigue", difficulty comprehending materials he read, forgetfulness, difficulty finding appropriate words during conversations, and decrease in his attention span. Denies significant mood changes. No difficulty in comprehending typical conversations and no disorientation. No history of recent head trauma. Denies associated headaches or dizziness. Awakens feeling physically rested; when he wakes up, he feels awake (not sleepy), but he is not alert, and the remainder of the day, he does not feel alert or attentive. Patient used to run 2-4 miles several times per week. He has tried to run since symptom onset, but says although he feels his body is able, he cannot push himself mentally to complete the run. His physician training over the last couple of weeks has primarily been 20 minutes of weight training several days per week. No snoring or apneic episodes reported. (Patient had normal sleep studies in 2007 after surgery.) Around 2-3 weeks ago, Patient also noted onset pressure behind eyes bilaterally with photophobia and visual changes. Intensity of pressure behind eyes is rated as 3/10 most of time, but worsens when focusing visually or concentrating. Closing eyes for several minutes seems to help. Patient describes experiencing mild blurring of words appearing on TV screen, while watching TV, sees "afterimages" after he looks at an illuminated object or light, and sees "superimposed" images following words on his Kindle screen. Denies double vision or flashes of light. Patient does not wear contacts or glasses. Denies sinus pressure, nasal congestion or PND. Able to function in his current status, but is often frustrated with limitations. Relying on smartphone as memory aide. Concerned, as he will be starting his first year of Prosthodontics Residency next week. Patient denies recent acute infections prior to symptom onset. At the time of vaccine receipt, the only medication he was taking was a daily multivitamin. Denies history of previous adverse events following immunizations. Patient received HPV (1) vaccine on 19 JUL without noting exacerbation of symptoms.


VAERS ID: 461280 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: New York  
Vaccinated:2012-08-06
Onset:2012-08-06
   Days after vaccination:0
Submitted: 2012-08-08
   Days after onset:2
Entered: 2012-08-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 3 LA / SYR

Administered by: Public       Purchased by: Private
Symptoms: Arthralgia, Asthenia, Burning sensation, Chills, Dizziness, Eye irritation, Fatigue, Feeling cold, Headache, Hyperhidrosis, Nausea
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Corneal disorders (broad), Vestibular disorders (broad), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Joint aching, weakness, fatigue, nausea, body burning up and cold at the same time, teeth chattering, eyes burning up, dizziness, headache, sweaty. 2 days since, symptoms still present, but less severe.


VAERS ID: 461469 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Michigan  
Vaccinated:2012-08-08
Onset:2012-08-08
   Days after vaccination:0
Submitted: 2012-08-09
   Days after onset:1
Entered: 2012-08-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB533AA / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Drug administered to patient of inappropriate age, No adverse event
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: n/a~ ()~~0.00~Patient
Other Medications: Norco, Carafate, Zofran
Current Illness: No
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Pt was given the pediatric/adolescent dose of the Hepatitis A vaccine, instead of the adult dose. This was discovered about 5 minutes after pt was given the dose, by another medical assistant. Pt was told what happened, and tolerated the injection fine without complications.


VAERS ID: 461820 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Missouri  
Vaccinated:2012-08-10
Onset:2012-08-10
   Days after vaccination:0
Submitted: 2012-08-13
   Days after onset:3
Entered: 2012-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / UNK LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Chills, Convulsion, Malaise, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Topiramate 100MG BID
Current Illness: None
Preexisting Conditions: Allergies to Indocin, Darvon, Triptan class of drugs; Medical conditions of migraine and partial seizures
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Whole body convulsions and chills sudden onset with fever, fever spiked to 103.2, maintained after two hours and convulsions/chills stopped. Nausea/emesis. One hour after fever onset, took diphenhydramine and ibuprofen, fever unrelenting. Fever broken around 8 hours after onset. Rest of following day (8/11/2012) maintained normal body temp with intermittent low grade spikes, however had malaise and general feeling of illness.


VAERS ID: 461918 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Arizona  
Vaccinated:2012-08-10
Onset:2012-08-11
   Days after vaccination:1
Submitted: 2012-08-14
   Days after onset:3
Entered: 2012-08-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS - / 1 LA / IM

Administered by: Public       Purchased by: Other
Symptoms: Dizziness, Fatigue, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Started feeling really tired and dizzy around noon time on 8/11/12. Felt sick to my stomach; NO VOMITING OR DIARRHEA. Symptoms continued on Sunday 8/12 as well. Symptoms finally went away on Sunday evening. I took a total of 1 dramamine during the symptoms to try and relieve the dizziness which helped only slightly.


VAERS ID: 461964 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Puerto Rico  
Vaccinated:2012-07-31
Onset:2012-08-02
   Days after vaccination:2
Submitted: 2012-08-07
   Days after onset:5
Entered: 2012-08-14
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1849AA / UNK LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC5213081AA / UNK RA / IM

Administered by: Other       Purchased by: Private
Symptoms: Cellulitis, Injection site erythema, Injection site inflammation, Injection site pain, Pyrexia, White blood cell count increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: WBC count 19.3
CDC Split Type:

Write-up: Pain, redness, inflammation on area of injection (left arm). Fever - 39 degrees. Dx. Cellulitis Tx DURICEF 500mg bid x 7 d.


VAERS ID: 462062 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Texas  
Vaccinated:2012-08-10
Onset:2012-08-11
   Days after vaccination:1
Submitted: 2012-08-15
   Days after onset:4
Entered: 2012-08-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MEN: MENINGOCOCCAL (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public       Purchased by: Private
Symptoms: Chills, Dizziness, Fatigue, Headache, Influenza like illness, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Flu-like symptoms, tired, light-headed, fever, chills, headache.


VAERS ID: 462177 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: California  
Vaccinated:2012-08-13
Onset:2012-08-14
   Days after vaccination:1
Submitted: 2012-08-16
   Days after onset:2
Entered: 2012-08-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 RA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Erythema, Injection site haematoma, Injection site pain, 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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Allegra-D, Benadryl
Current Illness: No Illnesses
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Bruising and mild pain at administration site, two days later redness had spread about three inches in diameter, it feels like a welt, itchy, pain had increased, still a bruise at administration site.


VAERS ID: 462633 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2012-06-13
Onset:0000-00-00
Submitted: 2012-06-15
Entered: 2012-08-21
   Days after submission:67
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1743AA / 1 LA / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Graves disease
Preexisting Conditions: Methimazole
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: PNEUMOVAX injected IM into (L) deltoid on 6/13/2012. Site became red, warm, swollen - confirmed on exam today, approximately 7 cm in diameter, mildly tender. No associated lymphangitic streaking / axillary adenopathy.


VAERS ID: 462833 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Utah  
Vaccinated:2012-08-15
Onset:2012-08-17
   Days after vaccination:2
Submitted: 2012-08-22
   Days after onset:5
Entered: 2012-08-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0088AE / 1 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Pain
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Tension HA''s; Fibromyalgia; ADD; Asthma; Depression; Posttraumatic stress dis
Allergies:
Diagnostic Lab Data: Patient instructed to try ice/Ibuprofen
CDC Split Type:

Write-up: Patient describes "horrible shooting" pain down arm when moved. Vaccine administered 8-15-12 complaint 8-17-12.


VAERS ID: 462994 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2012-08-21
Onset:2012-08-22
   Days after vaccination:1
Submitted: 2012-08-23
   Days after onset:1
Entered: 2012-08-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL) / SANOFI PASTEUR UT4467AA / 1 LA / ID

Administered by: Other       Purchased by: Other
Symptoms: Injection site erythema, Injection site swelling, Pruritus generalised, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: JOLESSA 0.15/0.03
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient called me today complaining of raised red/purple area around injection site, fever of 101 degrees F, and an itching all over her body. She received the FLUZONE intradermal injection.


VAERS ID: 463153 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Florida  
Vaccinated:2012-05-21
Onset:2012-08-21
   Days after vaccination:92
Submitted: 2012-08-26
   Days after onset:5
Entered: 2012-08-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH716AD / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Chest discomfort, Dyspnoea, Productive cough, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: On 8/21/2012 at 3:05 PM pt received influenza vaccine Fluzone and PPD/TB skin test few minutes apart, same day. Well tolerated at the clinic. When she gets home she developed SOB, chest tightness, wheezing, and wet cough. Treated at home by parents who are nurses with steroids and albuterol orally. Shortly after symptoms resolved. Pt returned to HC on 8/24/2012 at 12:15 PM for PPD/TB skin test results and reported the event at that time. Now pt is doing well, no complains at this moment.


VAERS ID: 463573 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Unknown  
Vaccinated:2011-02-21
Onset:2011-03-08
   Days after vaccination:15
Submitted: 2012-08-30
   Days after onset:540
Entered: 2012-08-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV269 / 1 UN / UN
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR VV04003A / UNK UN / ID

Administered by: Military       Purchased by: Military
Symptoms: Activities of daily living impaired, Adverse drug reaction, Anxiety, Aphagia, Arthralgia, Asthenia, Blister, Blood creatine phosphokinase normal, Blood folate normal, Blood iron normal, Blood thyroid stimulating hormone normal, Chest pain, Condition aggravated, Contusion, Cough, Dehydration, Depression, Diarrhoea, Disturbance in attention, Drug screen negative, Dyspnoea, Escherichia infection, Excoriation, Fall, Fatigue, Feeling abnormal, Full blood count normal, Gastrooesophageal reflux disease, Generalised vaccinia, HIV test negative, Haematocrit decreased, Haemoglobin normal, Human chorionic gonadotropin negative, Injection site scab, Insomnia, Iron binding capacity total normal, Irritability, Joint injury, Malaise, Metabolic function test normal, Muscle fatigue, Muscle spasms, Nausea, Pain in extremity, Panic attack, Papule, Platelet count normal, Poor quality sleep, Post-traumatic stress disorder, Radioallergosorbent test negative, Rash erythematous, Rash pruritic, Red blood cell count decreased, Red blood cell sedimentation rate normal, Red cell distribution width normal, Skin lesion, Skin reaction, Sleep study normal, Thyroxine free normal, Transferrin saturation, Tremor, Urine analysis normal, Urine uric acid normal, Ventricular extrasystoles, Vision blurred, Vitamin B1, Vitamin B12 normal, Vomiting, X-ray limb normal
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haematopoietic erythropenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Ventricular tachyarrhythmias (narrow), Dementia (broad), Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (narrow), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZYRTEC; CELEXA; B6; SINGULAIR; NEXIUM; NASONEX; INDERAL; IUD
Current Illness: None
Preexisting Conditions: PMH: (+) PPD treated 1991 (age 7); Fractured collar bone 1998; Child birth 2004 and 2006; Kidney infection 2006; Wisdom teeth pulled 2009; Lasik 2010; D&C 2011 injured left knee 2011; Essential tremors 2011 (symptom onset high school to right hand); Depression 2010
Allergies:
Diagnostic Lab Data: 6/26/2012 RAST-wide geographic screen all <0.35 (absent; 6/2012-2008: Normal or negative: UA, TSH, FT4, iron, iron binding, iron sat, CMP, HCG, vitamin B12, CPK, folate, urate, ESR, drug screen, HIV; 7/31/2009 vit B1 88.2; CBC normal with 4/16/2012 findings: RBC 4.16, H/H 13.0/36.9, RDW 12.4, platelets 182, otherwise normal. 7/17/2012 x-ray left hand: no fractures or dislocation, no degenerative changes; 1/20/2012 x-ray left knee: no bone pathology seen, soft tissue unremarkable, no significant degenerative changes; 9/19/2011 sleep study: did not demonstrate significant OSA or abnormalities...suggest holter for frequent PVC seen during study
CDC Split Type:

Write-up: Patient received AVA #1 with primary SPV on 2/21/2011. She was in good health with no remembered adverse events to AVA vaccine other than a sore arm "as if someone punched me" for about 1 week with full resolution. Her TBI mental health screening (ANAM) was "average" on 2/21/2012. She left late Feb 2011. On 3/8/2011 (day 15) she presented to medical with scattered pruritic bumps described as small red bumps with white centers. Her exam documented multiple skin lesions, papules, vesicles with some papules to upper/lower extremities shoulders and trunk. She denied any fever, nausea, vomiting, shortness of breath, chest pain, or other systemic symptoms. Her SPV site was forming a scab. Providers diagnosed "generalized vaccinia or reaction to the mites noted at JBB(?)". She was treated with ATARAX, Z-pak, and BACITRACIN. She reported resolution of all symptoms approximately 4 weeks later. While this skin reaction was resolving, she also reported injuring her left knee (3/22/2011-dx patella contusion, abrasion) falling off bike and was given MOTRIN and sent for physical therapy (PT). On 4/9/2011 she was unable to attend PT due to being "sick". She advised clinic provider she experienced nausea, vomiting, diarrhea, inability to eat x 3 days, and had shortness of breath, chest pain and difficulty sleeping (due to work schedule). She reported presenting to a field ER and was treated for "dehydration with 4 liters of fluid". (Unable to locate this visit, however on 6/21/2011 visit she reported she had E. Coli and on 8/3/2011 she advised provider she had cramping and diarrhea from antibiotics for 7/2/2011 pharyngitis). In July 2011 she felt "trapped" and "enclosed". She was not eating, sleeping poorly, and was highly irritable and had tremors to her right hand. She first noted right hand tremors in high school but never sought medical treatment for. Patient is left handed. She was seen by psych providers and diagnosed with "panic attacks/anxiety" and treated with AMBIEN and later PROZAC. However PROZAC made her feel like a zombie with lack of energy and she had problems concentrating. She was medevac''ed in July 2011 for further outpatient therapy. From 8/2011 to 2/2012 she completed evaluations for GERD (on PRILOSEC w/relief), sleep apnea-restless leg syndrome (not demonstrated), and PTSD/depression (meds helping). Patient reported increase in tremors when anxious and when on PROZAC (changed to CELEXA and B6). On 2/25/2012 she received her second AVA vaccination. Within 24 hours she advised her husband reported increased irritability and that she tossed around at night kicking in her sleep. Patient reported she was unsure of her surroundings and had problems concentrating. Her providers reportedly increased her psych meds by 1/2 dose which did help and made her feel better. Neurology evaluation 2/28/2012 documented tremors began in high school and increased with travel, when nervous or doing PT, eating, and holding objects. She was given a diagnosis of essential tremors that worsen with stress, fatigue and anxiety. She was placed on INDERAL for tremors and common migraines without aura since age 4 years. As of May 2012 she continues to complain of generalized muscle fatigue on left side of body, being tired and had recurrent left knee pain. Patient reported having increased tremors to right hand that are now episodically interfering with ADL. She also advised she is experiencing some visual blurriness. She describes problems focusing at distance but can see up close. She had LASIK surgery in 2010 with 20/20 vision but now says vision is "so/so". She has not f/u with ophthalmologist. She is also being evaluated for "allergies due to 3 week chronic cough". In 2012 she was started in vitamin B6 for symptoms of chronic fatigue (2012 thyroid studies and iron/iron binding normal and hCG negative).


VAERS ID: 464422 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: New York  
Vaccinated:2012-09-07
Onset:2012-09-07
   Days after vaccination:0
Submitted: 2012-09-09
   Days after onset:2
Entered: 2012-09-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Private       Purchased by: Other
Symptoms: Abdominal pain, Constipation, Diarrhoea, Dizziness, Vaginal haemorrhage
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe abdominal pain and cramping, diarrhea, constipation, dizziness, vaginal spotting.


VAERS ID: 464560 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Kentucky  
Vaccinated:2012-07-13
Onset:2012-07-23
   Days after vaccination:10
Submitted: 2012-09-10
   Days after onset:49
Entered: 2012-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR VV04003A / UNK UN / ID

Administered by: Military       Purchased by: Military
Symptoms: Bacterial disease carrier, Biopsy skin abnormal, Blister, Eczema vaccinatum, Erythema, Erythema multiforme, Fungal test negative, Gram stain positive, Headache, Injection site erythema, Injection site induration, Injection site scab, Injury, Neck pain, Papule, Pruritus, Rash, Rash papular, Scab
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Skin tumours of unspecified malignancy (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sertraline 100 mg
Current Illness: None noted
Preexisting Conditions: Penicillin allergy
Allergies:
Diagnostic Lab Data: See above - punch biopsy done
CDC Split Type:

Write-up: Pt seen in primary care clinic on 7-25-12 with neck pain and lumps that started about 2 week after smallpox vaccination. Per provider the vaccination area was covered with bandaid and site was scabbed over. Entire region had induration and erythema. Pt given Toradol 60 mg injection in clinic and advised to do warm compresses. Pt seen in ER on 7-1-12 with rash and headache. Given Decadron 10 mg orally in ER and discharged with rx''s for Benadryl and Fioricet. Pt seen in primary care clinic on 7-27 after being referred back from ER with complaints of itchy, small blisters on extremities, trunk and face. PCP suspected possible self innoculation, gave rx''s for Benadryl and Atarax, and referred patient to dermatology clinic. Dermatologist''s exam noted 20 papules approximately 0.5-1 cm with central crust formaulation and halo of erythema. Punch biopsy was done of a representative lesion. Pt was started on Cotrimoxazole DS, Bactroban to nares, and Hibiclens wash to cover for possible MRSA and advised to continue the Atarax for nighttime itching. Biopsy noted that there was bacterial colonization of the lesion; fungal stains were negative, gram stains highlights gram positive cocci. Differential diagnosis included post-smallpox vaccine papular spongiotic dermatitis with mechanical trauma, erythema multiforme, and eczema vaccinatum.


VAERS ID: 464582 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Wisconsin  
Vaccinated:2012-08-08
Onset:2012-08-09
   Days after vaccination:1
Submitted: 2012-09-09
   Days after onset:31
Entered: 2012-09-10
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH716AA / 7+ RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Immobile, Musculoskeletal pain, Musculoskeletal stiffness, Pain, Soft tissue inflammation
SMQs:, Rhabdomyolysis/myopathy (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Insulin (Humalog and Lantus); Synthroid
Current Illness: No
Preexisting Conditions: Diabetes
Allergies:
Diagnostic Lab Data: Inflamation of the Synovium tissue
CDC Split Type:

Write-up: Shoulder Pain, Stiffness, Soreness, Immobility, Treated with Ibuprofen 800mg with no effect.


VAERS ID: 464748 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Massachusetts  
Vaccinated:2012-09-04
Onset:2012-09-04
   Days after vaccination:0
Submitted: 2012-09-10
   Days after onset:6
Entered: 2012-09-11
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / 1 RA / UN

Administered by: Private       Purchased by: Private
Symptoms: Dyspnoea, Oedema peripheral, Pneumonia, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Minor allergic rxn.~Influenza (Seasonal) (no brand name)~0~0.00~Patient
Other Medications: DUONEB; EPIPEN or Albuterol as needed
Current Illness: No
Preexisting Conditions: Asthma; Chronic respiratory infections & bronchitis; Allergic to: nuts, bananas, bee, and many medications.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives and bit of trouble breathing within 3 minutes of immunization; given BENADRYL. Medicine got rid of hives but 3-4 hours later had to take another dose. Next day, arm so swollen couldn''t get arm through sleeve. Went to doctor who recommended over the counter MOTRIN. Has an appointment on 9/11 with pulmonologist because doctor thinks she has pneumonia now.


VAERS ID: 464851 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Alabama  
Vaccinated:2012-09-10
Onset:2012-09-10
   Days after vaccination:0
Submitted: 2012-09-12
   Days after onset:2
Entered: 2012-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Fatigue, Nasal congestion, Nausea, Rhinorrhoea, Throat irritation
SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Scratchy throat, nausea, runny/stuffy dose, tired.


VAERS ID: 464861 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Alaska  
Vaccinated:2012-09-07
Onset:2012-09-08
   Days after vaccination:1
Submitted: 2012-09-12
   Days after onset:4
Entered: 2012-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV307 / 7+ LA / IM
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2108 / 5 NS / IN
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR G1124 / 3 RA / IM

Administered by: Military       Purchased by: Military
Symptoms: Erythema, Injection site warmth, Local swelling, Pain
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness, local swelling, warm at injection site, soreness.


VAERS ID: 464884 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Virginia  
Vaccinated:2012-09-06
Onset:2012-09-07
   Days after vaccination:1
Submitted: 2012-09-12
   Days after onset:5
Entered: 2012-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1860AA / 1 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B085AA / 1 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Discomfort, Erythema, Injection site oedema, Injection site pruritus, Skin warm, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Depo-Provera
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Significant edema at injection site, L arm 5X5cm, Redness, hot to touch, occasional discomfort, hives above and along site, pruritis for 5+ days. Denies systemic symptoms.


VAERS ID: 464959 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Massachusetts  
Vaccinated:2012-08-24
Onset:2012-08-25
   Days after vaccination:1
Submitted: 2012-09-13
   Days after onset:19
Entered: 2012-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C3837AA / UNK RA / IM

Administered by: Public       Purchased by: Other
Symptoms: Hypoaesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None known.
Current Illness: None noted.
Preexisting Conditions: None noted.
Allergies:
Diagnostic Lab Data:
CDC Split Type: MA1204

Write-up: Patient reports numbness in fingertips starting the day after receiving Tdap vaccine. Continuing as of 8/30/2012. Medical evaluation recommended.


VAERS ID: 465135 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Illinois  
Vaccinated:2012-09-14
Onset:2012-09-14
   Days after vaccination:0
Submitted: 2012-09-15
   Days after onset:1
Entered: 2012-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK RA / IM

Administered by: Public       Purchased by: Other
Symptoms: Chills, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None.
Preexisting Conditions: None.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: High fever (measured at 39.4 C) and violent shaking and chills from 10 pm to 4 am, alleviated with multiple doses of Benadryl PO and Tylenol, total of 2.5 g in about 6 hours. Symptoms improved after breaking of fever at around 4-5 AM.


VAERS ID: 465144 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Minnesota  
Vaccinated:2012-09-15
Onset:2012-09-15
   Days after vaccination:0
Submitted: 2012-09-15
   Days after onset:0
Entered: 2012-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 RA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Dizziness, Migraine, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Butalbital/acetaminophen/caffeine tablets (for migraines)
Current Illness: None
Preexisting Conditions: Allergies to Triptans.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Drowsiness (may not be related), migraine-like headache, slight dizziness.


VAERS ID: 465160 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Washington  
Vaccinated:2012-09-01
Onset:2012-09-01
   Days after vaccination:0
Submitted: 2012-09-16
   Days after onset:15
Entered: 2012-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204801 / UNK LA / IM

Administered by: Public       Purchased by: Other
Symptoms: Cold sweat, Dizziness, Pruritus, Tremor, Vision blurred
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Feeling light headed, shaky, cold sweats, blurred vision, itchy below her knees.


VAERS ID: 465346 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Illinois  
Vaccinated:2012-09-07
Onset:2012-09-08
   Days after vaccination:1
Submitted: 2012-09-08
   Days after onset:0
Entered: 2012-09-16
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH713AB / 1 LA / SYR

Administered by: Other       Purchased by: Other
Symptoms: Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NUVARING
Current Illness: No
Preexisting Conditions: Clindamycin
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. had injection site swelling, entire width of arm and about 1 inch above and below injection site.


VAERS ID: 465575 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Tennessee  
Vaccinated:2012-09-12
Onset:0000-00-00
Submitted: 2012-09-14
Entered: 2012-09-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH721AB / UNK RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B085CA / 2 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: DEPO-PROVERA Injections
Current Illness: None
Preexisting Conditions: Per pt: Thyroid Dz; Anemia; Anxiety
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt given TDAP & was not needed; previously vaccinated.


VAERS ID: 465580 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: New York  
Vaccinated:2012-09-12
Onset:2012-09-13
   Days after vaccination:1
Submitted: 2012-09-14
   Days after onset:1
Entered: 2012-09-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B085BA / UNK LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Fatigue, Injected limb mobility decreased, Injection site pain, Injection site warmth, Nausea, Pain in extremity, 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), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril; BCP
Current Illness:
Preexisting Conditions: Sulfa
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client states 24 hours post administration fever, N/V, fatigue and pain to arm. Today one week later, still having pain to left arm - deltoid tender to touch and warm, decreased ROM as well. Plans to follow up with her PCP, seen by PCP. Seen by NP prior to leaving.


VAERS ID: 465637 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Arizona  
Vaccinated:2012-09-10
Onset:2012-09-16
   Days after vaccination:6
Submitted: 2012-09-19
   Days after onset:3
Entered: 2012-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4152AA / UNK LA / SYR

Administered by: Other       Purchased by: Private
Symptoms: Burning sensation, Middle insomnia, Musculoskeletal discomfort, Musculoskeletal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Depression (excl suicide and self injury) (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi-Vitamin (1 daily)
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: MRI requested, but not yet performed by Primary Care Physician.
CDC Split Type:

Write-up: Woke up in middle of night with left shoulder feeling of internal burning sensation and extreme pain and discomfort. This has been felt since day 1 after the vaccination, but it finally reached a point to where it was extremely painful, instead of gradually subsiding.


VAERS ID: 465737 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Kansas  
Vaccinated:2012-09-18
Onset:2012-09-19
   Days after vaccination:1
Submitted: 2012-09-20
   Days after onset:1
Entered: 2012-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL) / SANOFI PASTEUR UT4466BA / 2 LA / ID

Administered by: Public       Purchased by: Private
Symptoms: Feeling abnormal, Injection site erythema, Injection site induration, Injection site nodule, Injection site warmth, Migraine, Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Migraine, swollen arm, hard knot in injection site, redness and fever in injection site, states feels crummy.


VAERS ID: 465759 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2012-09-19
Onset:2012-09-20
   Days after vaccination:1
Submitted: 2012-09-20
   Days after onset:0
Entered: 2012-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2139 / UNK NS / IN

Administered by: Military       Purchased by: Military
Symptoms: Erythema, Skin swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BCP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Onset ~ 20 hours after FluMist; No Sx from immunization until 2 hours prior to presentation in office; erythema and mild swelling of skin surrounding the mouth, but not involving the lips or tongue; Benadryl and cool compress recommended for treatment.


VAERS ID: 466017 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: New Mexico  
Vaccinated:2012-09-19
Onset:2012-09-20
   Days after vaccination:1
Submitted: 2012-09-20
   Days after onset:0
Entered: 2012-09-21
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1204701A / UNK RA / UN

Administered by: Other       Purchased by: Private
Symptoms: Musculoskeletal stiffness, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient c/o arm tingling and "locking up".


VAERS ID: 469601 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Unknown  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2012-09-25
Entered: 2012-09-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 1 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Inappropriate schedule of drug administration
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1209USA005037

Write-up: This spontaneous report as received from a 26 years old female consumer refers to herself. The patient was vaccinated intramuscularly with her first dose of 0.5 ml GARDASIL (lot number not provided) in 2008. No other co-suspects were reported. No concomitant medications were reported. The patient was scheduled to receive her second dose in the near future. The patient explained that any subsequent doses after her next scheduled injection would occur after she had turned 27 years old. It was unspecified if the patient had sought medical attention. Additional information is not expected.


VAERS ID: 466456 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Montana  
Vaccinated:2012-09-15
Onset:2012-09-16
   Days after vaccination:1
Submitted: 2012-09-26
   Days after onset:10
Entered: 2012-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS - / UNK LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Activities of daily living impaired, Joint range of motion decreased, Musculoskeletal pain, Musculoskeletal stiffness, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin; Vitamin C; Cod Liver Oil; Flax seed Oil
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None. I am hoping that time will heal. If not, I will seek medical advice.
CDC Split Type:

Write-up: I received the flu shot in my left deltoid, as in other years. However this year, the typical soreness developed into limited range of motion in my left shoulder that persists today. My shoulder is stiff, gets "stuck," and then must "crack back in place." It is very sore in the morning, and sometimes I awaken in the middle of the night in pain as I turn in bed. It is difficult to do activities of daily living like dressing, bathing, etc. I am not sure if the needle hit a nerve or tendon or why this happened. But this is very debilitating. I am hoping that time will heal. Note that I had received the Dtap vaccine in the same location about a week earlier. I specifically asked the administrator if that would pose a problem and she said "no."


VAERS ID: 466461 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Texas  
Vaccinated:2012-09-19
Onset:2012-09-19
   Days after vaccination:0
Submitted: 2012-09-26
   Days after onset:7
Entered: 2012-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA691AA / 1 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4152AA / 1 RA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Anxiety, Palpitations, Pharyngeal oedema, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal allergic conditions (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac
Current Illness: None
Preexisting Conditions: Codeine allergy
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Hives, Itching, Throat Swelling, Heart Racing, Anxiety. Treated in ED x 2 with steroids, Benadryl.


VAERS ID: 466538 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Texas  
Vaccinated:2012-09-22
Onset:2012-09-23
   Days after vaccination:1
Submitted: 2012-09-26
   Days after onset:3
Entered: 2012-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other       Purchased by: Private
Symptoms: Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: High fever and vomiting.


VAERS ID: 466589 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Georgia  
Vaccinated:2012-09-26
Onset:2012-09-26
   Days after vaccination:0
Submitted: 2012-09-27
   Days after onset:1
Entered: 2012-09-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA738AA / UNK RA / IM

Administered by: Public       Purchased by: Private
Symptoms: Injection site erythema, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: By the afternoon of receiving the vaccine - the patient - started feeling aches to Rt. arm - reddened area appeared around injection site - patient started having fever 101 degrees - 102 degrees by the night of vaccine rec''d.


VAERS ID: 466906 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Texas  
Vaccinated:2012-09-28
Onset:2012-09-28
   Days after vaccination:0
Submitted: 2012-09-28
   Days after onset:0
Entered: 2012-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVC111AA / 1 RA / IM

Administered by: Other       Purchased by: Private
Symptoms: Condition aggravated, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Employee states that she had shortness of breath, asked employee when it started she stated she has been under alot of stress and has had shortness of breath this pass week. Instructed employee to have seat in the breakroom until she was better.


VAERS ID: 467043 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Kentucky  
Vaccinated:2012-09-28
Onset:2012-09-29
   Days after vaccination:1
Submitted: 2012-09-30
   Days after onset:1
Entered: 2012-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. G006863 / 1 RA / SC

Administered by: Other       Purchased by: Other
Symptoms: Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported heat and pain at injection site patient taking ibuprofen.


VAERS ID: 467092 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Virginia  
Vaccinated:2012-10-01
Onset:2012-10-01
   Days after vaccination:0
Submitted: 2012-10-01
   Days after onset:0
Entered: 2012-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1203801 / UNK RA / IM

Administered by: Public       Purchased by: Other
Symptoms: Dizziness, Feeling hot, Gaze palsy
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Ocular motility disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient began feeling dizzy, and warm; patient''s eyes appeared to roll back into her head and EMT was called.


VAERS ID: 467098 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: California  
Vaccinated:2012-09-25
Onset:2012-09-25
   Days after vaccination:0
Submitted: 2012-10-01
   Days after onset:6
Entered: 2012-10-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH715AB / 1 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Muscle twitching, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: oral contraceptives
Current Illness: no
Preexisting Conditions: Unsure. Has stated allergy to Bactrim. Unknown if Physician diagnosed.
Allergies:
Diagnostic Lab Data: none ordered
CDC Split Type:

Write-up: Fever, body aches x one night. Right arm muscle twitching intermittent x 6 days s/p vaccination. Vaccine was given in left deltoid.


VAERS ID: 467367 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2012-10-02
Onset:2012-10-02
   Days after vaccination:0
Submitted: 2012-10-02
   Days after onset:0
Entered: 2012-10-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B089AA / 1 LA / UN

Administered by: Private       Purchased by: Private
Symptoms: Loss of consciousness, Paraesthesia, Peripheral coldness
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: She has had similar vasovagal responses to vaccines prior
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Within 10 seconds lost consciousness for 10 seconds probable vasovagal reaction. Tongue & hands were cool, felt tingling. BENADRYL given at 10:05, pulse ox raised from 83 to 99% in 15 minutes. It took 1 hour to recover.


VAERS ID: 472474 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Unknown  
Vaccinated:2012-09-05
Onset:0000-00-00
Submitted: 2012-10-03
Entered: 2012-10-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 3 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, Maternal exposure during pregnancy, Pregnancy test positive
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZANTAC
Current Illness: Gastrooesophageal reflux disease
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 09/08/2012, Pregnancy test, Positive
CDC Split Type: WAES1209USA004441

Write-up: This spontaneous prospective pregnancy report as received from a nurse practitioner refers to a 23 years old female patient with gastrooesophageal reflux disease. The patient''s history of previous pregnancies and live births is not known. The patient was vaccinated with the first, second and third dose of GARDASIL (Lot# unspecified) intramuscularly on 12-NOV-2007, 21-JAN-2011 and 05-SEP-2012. No other co-suspects were reported. Concomitant medications included: ZANTAC. The patient became pregnant with an LMP of 01-AUG-2012 and an EDD of 09-MAY-13 before receiving the third dose of vaccine. The pregnancy was discovered via home pregnancy test on 08-SEP-2012. The patient was exposed to GARDASIL during trimester 1. The patient is still pregnant. The patient had sought medical attention via seeing the nurse practitioner. Additional information has been requested.


VAERS ID: 467555 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Indiana  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2012-09-19
Entered: 2012-10-04
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH715AA / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Pain, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Started 20 to 30 min after getting the shot. I feel pain and it hurts more when moving pain is from shoulder to elbow 9/17/12.


VAERS ID: 467700 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: New Jersey  
Vaccinated:2012-10-04
Onset:2012-10-04
   Days after vaccination:0
Submitted: 2012-10-04
   Days after onset:0
Entered: 2012-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH752AB / 1 LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U4335AA / 1 RA / IM

Administered by: Other       Purchased by: Private
Symptoms: Dizziness, Dyspnoea, Hyperhidrosis, Immediate post-injection reaction, Pallor, Posture abnormal, Tremor, Unresponsive to stimuli, Yellow skin
SMQs:, Cholestasis and jaundice of hepatic origin (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was administered Tdap (R arm) and 2012 PF Flu (L arm) both IM. After 5 seconds of administration of second vaccine (Tdap), patient stood up and felt dizzy. He was helped to sit down. Another 15 seconds later he was unresponsive to his name being called, his left arm started shaking and his body curled up. His face and fingertips became pale yellow and he was sweating. In another 10 seconds, he came back and responded to his name and answered questions. He then reported feeling better. He was given some water and a glucose tablet while 911 call was initiated. 5 minutes later he reported shortness of breath which lasted 15 seconds. About 10 minutes after the initial symptoms presented, patient was responding normally and paleness relieved gradually. Ambulance squad arrived around 5:30pm took statements and determined that patient was capable of going home on his own with his mother. Patient walked out on his own and seemed to have recovered.


VAERS ID: 467735 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Texas  
Vaccinated:2012-10-04
Onset:2012-10-04
   Days after vaccination:0
Submitted: 2012-10-04
   Days after onset:0
Entered: 2012-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED P58907 / 1 LA / UN

Administered by: Other       Purchased by: Unknown
Symptoms: Dizziness, Feeling hot, Heart rate increased, Injection site pruritus, Nervousness
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 10 min after Flu shot. Pt. began to feel "hot, dizzy and shaky". Itching at vaccination site. Pt symptoms intermittent with same intensity and rapid HR.


VAERS ID: 472670 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Unknown  
Vaccinated:2012-07-25
Onset:2012-08-08
   Days after vaccination:14
Submitted: 2012-10-04
   Days after onset:57
Entered: 2012-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1696AA / 1 LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Lymphadenopathy
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluconazole
Current Illness: Food allergy; Seasonal allergy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1209USA011462

Write-up: This spontaneous report was received from a register nurse concerning a 26 year old female patient with seasonal allergies (unspecified) and seafood allergy and no pertinent medical history who on 25-JUL-2012 was vaccinated with dose 1 of GARDASIL, intramuscularly in the left arm (lot number 1696AA, expiration date 12-SEP-2014). No other co-suspects were reported. Concomitant therapy included fluconazole, one tablet administered later the dame day the vaccine was administered). The nurse reported that about two weeks after vaccination (approximately on 08-AUG-2012) with GARDASIL the patient experienced swollen glands in her armpits. The nurse reported that the patient''s swollen glands first occurred about two weeks after vaccination. The nurse reported that the swollen glands went away but reoccurred about a week later and had continued to recur to the present time (exacts dates, number of occurrences and duration of the swollen glands was unspecified). The nurse reported that the swollen glands occurred under both armpits at the same time and at other times under one armpit (with can be either the left armpit or the right armpit). At the time of the report, the patient had not recovered from the event. Additional information has been requested.


VAERS ID: 467986 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Michigan  
Vaccinated:2012-09-26
Onset:2012-09-26
   Days after vaccination:0
Submitted: 2012-10-05
   Days after onset:9
Entered: 2012-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED P50108 / 1 LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Dyspnoea, Eye discharge
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none reported.
Preexisting Conditions: none reported
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Discharge from eyes, shortness of breath.


VAERS ID: 467999 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Colorado  
Vaccinated:2012-10-04
Onset:2012-10-04
   Days after vaccination:0
Submitted: 2012-10-05
   Days after onset:1
Entered: 2012-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA726EA / UNK RA / IM

Administered by: Other       Purchased by: Private
Symptoms: Hypoaesthesia, Injection site reaction, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None documented
Current Illness: No
Preexisting Conditions: None noted
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient describes tingling down her right arm where tha vaccine was administered and some numbness and tingling in her index finger.


VAERS ID: 467883 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Utah  
Vaccinated:2012-04-19
Onset:0000-00-00
Submitted: 2012-09-28
Entered: 2012-10-06
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0466AA / UNK UN / SC

Administered by: Other       Purchased by: Other
Symptoms: Antibody test negative, Blood glucose normal, Blood group A, Blood pressure increased, Blood thyroid stimulating hormone decreased, Episiotomy, Haematocrit increased, Haemoglobin increased, Hepatitis B surface antigen negative, Hepatitis B test negative, Injection site erythema, Injection site irritation, Injection site rash, Laboratory test normal, Maternal exposure during pregnancy, Nausea, Perineal laceration, Platelet count normal, Pregnancy test positive, Pregnancy test urine, Rash erythematous, Rubella antibody negative, Skin irritation, Smear cervix normal, Streptococcus test negative, Treponema test negative, Ultrasound antenatal screen normal, Urinary tract infection, Viral test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypertension (narrow), Hypothyroidism (broad), Hyperthyroidism (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VALTREX; ZOFRAN; PNV
Current Illness: Non-smoker; Prophylaxis; Routine health maintenance; Nausea
Preexisting Conditions: Anaemia; Hypoglycaemia; 04/13/2012, Injection site rash (red); 04/13/2012, Injection site irritation
Allergies:
Diagnostic Lab Data: Blood glucose, normal routine pregnancy labs; Blood grouping, A+; Blood grouping, negative; Blood thyroid stimulating hormone, 1.6; Gestational hypertension, normal routine pregnancy labs; Haematocrit, 41.5; Haemoglobin 14; Hepatitis B surface antigen, negative; Hepatitis B virus test, normal routine pregnancy labs; Laboratory test, normal routine pregnancy labs; Platelet count, 215; 12/10/2011, Pregnancy test, positive; Smear cervix, normal, Date Unknown; Streptococcus test, normal routine pregnancy labs; Treponema test, negative; 04/12/2012, Viral test, Not immune; Diagnostic, Rubella: non-imm; Diagnostic, Surgery of wisdom teeth; 02/08/2012, Diagnostic, systolic blood pressure 114; diastolic blood pressure 76; 02/08/2012, Diagnostic, 14.1, pregnancy verification, within normal limits; 02/08/2012, 23.78; 02/22/2012, Diagnostic, 10 weeks of prenatal survey, within normal limits; 03/08/2012, Diagnostic, 102/60; 03/22/2012, Diagnostic, 19.6, 20 wks US for anatomy, within normal limits; 04/12/2012, Diagnostic, 100/58; 05/10/2012, Diagnostic, 112/76
CDC Split Type: WAES1204USA03488

Write-up: Information has been received from a physician for VARIVAX (Merck), a Pregnancy Registry product, concerning a 26 year old female patient with none drug reactions or allergies reported with a history of 1 pregnancy (also reported as 1st pregnancy) and 0 live births who on 12-APR-2012, the patient was tested for varicella antibodies before vaccination with VZV containing vaccine. This test showed that the patient was not immune. On 19-APR-2012, the patient was vaccinated SC with 0.5 ml of a dose of VARIVAX (Merck) (lot number: 671026/0835AA). The patient was vaccinated at private MD office. Concomitant therapy included VALTREX. The physician (also reported as a nurse) reported that a patient was administered VARIVAX (Merck) and she was pregnant. On an unspecified date, urine pregnancy test and ultrasound were performed (results not provided). It was reported that LMP was on 04-NOV-2011 and EDD would be on 10-AUG-2012. No treatment was given for the treatment of the adverse event. Follow-up information has been received from a physician via pregnancy questionnaire indicated that the female patient with no previous pregnancies and no previous live births who on 19-APR-2012 was vaccinated with a 0.5 ml dose of VARIVAX (Merck) (lot number: 0466AA, previously reported as 671026/0835AA). Concomitant therapies included: ZOFRAN and PNV. On 22-FEB-2012, an ultrasound was performed results within normal limits 10 weeks fetal "Survey". Follow-up information has been received from a physician via pregnancy questionnaire and prenatal medical record indicated that the female patient with 1 previous pregnancy and no previous live birth, a history of surgery of wisdom teeth, hypoglycemic and anemic, no known drug allergies, no other medical history, or condition herself/family who in the fall of 2011 was vaccinated with a dose of flu shot. On 12-APR-2012 she was vaccinated with a dose of Tdap (lot # not reported). On 12-APR-2012, patient was tested for varicella antibodies and result showed not immune. On 13-APR-2012 the patient developed local irritation and rash (red). On 19-APR-2012 she was vaccinated with a 0.5 ml dose of VARIVAX (Merck) (lot # 671026/0835AA). On 10-DEC-2011 pregnancy test was positive. LMP was on 04-NOV-2011 and EDD would be on 10-AUG-2012. It was planned pregnancy. The patient had birth control with ORTHO TRI-CYCLEN in past year which was stopped in July 2011. During pregnancy, she was no problems except moderate nausea and vomiting 5 times a week. No treatment for nausea or vomiting. She was now using OTC prenatal vitamins and tolerated them. Ultrasound was performed on 08-FEB-2012 and 22-MAR-2012 showed 14.1 and 19.6 weeks of gestation. All prenatal and physical examinations performed were within normal limits. Follow-up information has been received from a registered nurse indicating that the patient did receive the flu shot, but the patient hadn''t been vaccinated in their office, so she did not know the exact date, which flu vaccine the patient received, or the lot number. She was also unaware of where the patient was vaccinated. Follow-up information has been received from a licensed practical nurse concerning the female patient, who on 31-JUL-12 at 38 weeks and 4 days of gestation delivered a female infant weighing 3231.18 gms or 7 lbs 2 ozs via vaginal delivery. The infant''s APGAR scores are not available. Upon delivery, the infant was noted to be a normal, healthy newborn. The patient was also placed on OMEGA-3. It was reported that the patient had an urinary tract infection (UTI) during pregnancy (approximately in March 2012). UTI was treated with MACROBID 200mg for 14 days. It was also reported that, on approximately 04-JUL-2012 ("at 37.3 weeks") the patient experienced elevated blood pressure. It was reported that, on 31-JUL-2012 (during delivery) the patient had episiotomy and second stage laceration. Laboratory tests were reported as "normal, routine pregnancy labs" included Group B Streptococcus test, Blood glucose test, Hepatitis B test, Pregnancy-induced Hypertension Test (PIH) and some unspecified "labs" (dates and results unknown). At the time of the report, the patient''s outcome for elevated blood pressure, UTI, episiotomy and second stage laceration was unknown. Additional information is not expected.


VAERS ID: 468059 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: California  
Vaccinated:2012-09-17
Onset:2012-09-17
   Days after vaccination:0
Submitted: 2012-10-07
   Days after onset:20
Entered: 2012-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LA / UN

Administered by: Unknown       Purchased by: Private
Symptoms: Abdominal pain upper, Arthralgia, Asthenia, Chills, Headache, Injection site pain, Nausea, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No. Pain at injection site.
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Stomach ache and nausea followed by chills, fever, and vomiting. Experienced bad headache, paint in joints and overall weakness.


VAERS ID: 468174 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Texas  
Vaccinated:2012-10-05
Onset:2012-10-05
   Days after vaccination:0
Submitted: 2012-10-08
   Days after onset:3
Entered: 2012-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 123122 / 1 LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Fatigue, Nausea, Rash, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Implanon (intradermal contraceptive), which was inserted in the left upper, inner arm.
Current Illness: None Known
Preexisting Conditions: None Identified
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Fatigue and Nausea. Vomiting two times. Rash on bilateral hands two to three hours post. Rash subsided within 4 hours of onset.


VAERS ID: 468693 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: California  
Vaccinated:2012-10-05
Onset:2012-10-05
   Days after vaccination:0
Submitted: 2012-10-10
   Days after onset:5
Entered: 2012-10-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LA / UN

Administered by: Private       Purchased by: Other
Symptoms: Abdominal pain upper, Asthenia, Chills, Fatigue, Headache, Irritability, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: None~ ()~~0.00~Patient
Other Medications: Zovia birth control.
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None. I spoke to a pharmacist, who said my reaction was not an allergic reaction, and nothing to "worry" about. She said I would feel better within a week and today, 10/10/2012 I do feel back to normal.
CDC Split Type:

Write-up: Fever and Chills. Headache. Aches and pains all over my body, especially the injection site lasting until 10/8/2012. Nausea and stomach cramps lasting until 10/8/2012. Fatigue and weakness lasting until 10/8/2012. Irritability lasting until 10/8/2012.


VAERS ID: 468817 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: South Carolina  
Vaccinated:2012-10-01
Onset:2012-10-02
   Days after vaccination:1
Submitted: 2012-10-03
   Days after onset:1
Entered: 2012-10-10
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH712AB / 1 LA / IM

Administered by: Military       Purchased by: Military
Symptoms: Erythema, Pruritus, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling/erythema 50 mm, warm to the touch, itchy.


VAERS ID: 468915 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Arizona  
Vaccinated:2012-10-09
Onset:2012-10-09
   Days after vaccination:0
Submitted: 2012-10-09
   Days after onset:0
Entered: 2012-10-10
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL) / SANOFI PASTEUR UT4471AA / 1 LA / ID

Administered by: Private       Purchased by: Private
Symptoms: Dizziness, Headache, Injection site erythema, Injection site warmth, Nausea, Somnolence, Throat tightness, Tremor, Unresponsive to stimuli, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This 26 year old female presents with: 1. vaccine reaction. The symptoms began 15 minutes ago. The symptoms are reported as being moderate. The location is physician office. Aggravating factors include reaction to intradermal flu vaccine. She states the symptoms are acute. Patient received the intradermal Flu vaccine at 12:00pm (given by Dr in left deltoid) and at 12:15pm patient''s left deltoid at injection site was red and warm at injection site she became dizzy and nausea and then started vomiting, patient stated her head started hurting, and her throat felt tight patient''s blood pressure was 141/80 with a pulse was 121 Dr check the patient and ordered 50mg of BENADRYL (given at 12:30pm Im Right Glute by Ma) patient was taken to a room and blood pressure was rechecked at 12:30 and it was 121/77 pulse of 100 O2 was 97%, at 12:34 patient began to shake and was unresponsive and Dr used smelling salt and patient became responsive right away blood pressure was 122/82, pulse was 93 and O2 99%. Dr ordered patient 1000ml of 0.9% sodium chloride (lot # 15-184-JT Exp 3-1-2014) IV, IV Fluid started at 1:05pm by Dr in patients right arm. Blood pressure was taken again at 12:45pm 109/72 pulse 87 and O2 was 98%, patient finished IV fluids at 1:48pm and blood pressure was 114/77 pulse was 81 and O2 was 98% and patient stated she was feeling better, and was helped up and walked around without dizziness or nausea. Before going home patient was informed per Dr to take 50mg of oral BENADRYL if symptoms of nausea, dizziness, vomiting return and if patient has any difficult breathing to either call 911 or go to the Er and has to have someone with her today to keep a watch on her, patient friend picked her up and her husband was going to be home with her the rest of the day. Patient left at 2:00pm. Called patient at 3:34pm to check to see how she was doing she stated she was sleepy and laying down and husband was home and stated she still has a little dizziness, reinforce if any trouble breathing to either call 911 or go to ER patient stated OK.


VAERS ID: 468963 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2012-09-25
Onset:2012-09-26
   Days after vaccination:1
Submitted: 2012-10-02
   Days after onset:6
Entered: 2012-10-10
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA708BA / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0012AE / UNK RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0087AE / 1 LA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Cellulitis
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZYRTEC; Albuterol
Current Illness: None
Preexisting Conditions: Asthma; Seasonal allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Cellulitis - 2 days after. BACTRIM DS 800/160 mg oral tab NORCO 5/325.


VAERS ID: 468978 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: South Carolina  
Vaccinated:2012-10-05
Onset:2012-10-08
   Days after vaccination:3
Submitted: 2012-10-11
   Days after onset:3
Entered: 2012-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 12263P / UNK LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Condition aggravated, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HCTZ
Current Illness: Anxiety, HTN
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Paresthesia L Arm lasting out to 10/11/12, presently c/o of same to L leg. Able to use all extremities, no resp complaints or other neuropathies. Same complaint stated by patient last year after injection, denies further complications.


VAERS ID: 469120 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Washington  
Vaccinated:2012-10-03
Onset:2012-10-04
   Days after vaccination:1
Submitted: 2012-10-11
   Days after onset:7
Entered: 2012-10-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (NO BRAND NAME) / UNKNOWN MANUFACTURER FAV308 / 1 RA / UN
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2139 / 3 NS / IN
SMALL: SMALLPOX (NO BRAND NAME) / UNKNOWN MANUFACTURER VV04003A / 1 LA / ID

Administered by: Military       Purchased by: Military
Symptoms: Erythema, Headache, Injection site reaction, Musculoskeletal pain, Pyrexia, Tremor
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Patient denies illnesses at time of vaccination.
Preexisting Conditions: Patient with history of bilateral shoulder trauma (2010); other past medical history denied.
Allergies:
Diagnostic Lab Data: Directed physical examination of affected area performed on 10/10/2012; no neurological deficits noted; examination otherwise unremarkable.
CDC Split Type:

Write-up: Patient reports local erythema and musculo-skeletal pain at injection site, as well as intermittent tremor of right arm, headache, and subjective fever.


VAERS ID: 469371 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: New Jersey  
Vaccinated:2012-09-20
Onset:2012-09-20
   Days after vaccination:0
Submitted: 2012-10-12
   Days after onset:22
Entered: 2012-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH714AB / UNK RA / IM

Administered by: Public       Purchased by: Other
Symptoms: Hypoaesthesia, Immediate post-injection reaction, Injection site erythema, Injection site pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Allergy - amoxicillin; Hx of Gastroparesis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Flu vaccine administered 9/20/12 8:30 AM. Pain, redness at site instantly. Numbness and tingling down (R) arm and pain (8 out of 10) continues for 3 weeks.


VAERS ID: 469475 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Alaska  
Vaccinated:2011-06-22
Onset:2012-01-01
   Days after vaccination:193
Submitted: 2012-10-12
   Days after onset:284
Entered: 2012-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1570Z / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Maternal exposure during pregnancy, Premature delivery, Premature labour, Sinusitis, Ultrasound antenatal screen normal
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins (unspecified); Vitamin D (unspecified); folic acid
Current Illness: Pregnancy
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 07/19/2011, Within normal limits, intrauterine pregnancy (IUP) at 7+4 weeks
CDC Split Type: WAES1110USA04004

Write-up: Information has been received from a physician, for GARDASIL, a Pregnancy Registry product, concerning a 26 year old patient with no significant past medical history and no concurrent medical conditions who was vaccinated with a 0.5 ml dose of GARDASIL on 06-APR-2011 (lot # 666987/1016Z) and a 0.5 ml dose on 22-JUN-2011 (lot # 668260/1570Z) respectively. Concomitant therapy included folic acid, vitamin D and multivitamin. Subsequently, the patient became pregnant. Estimated conception date was 08-JUN-2011. Estimated delivery date was 02-MAR-2012. Date of last menstrual period was approximately 27-MAY-2011. The patient had a dating ultrasound on approximately 19-JUL-2011, at IntraUterine Pregnancy 7 days + 4 weeks. The result was within normal limits. It was reported that the patient had 2 previous pregnancies and 1 full term delivery. No birth defects or infant complications in previous pregnancy. No pre-term deliveries, spontaneous abortions, elective terminations or fetal deaths (stillbirths). The patient developed sinus infection on an unspecified date. In September 2011, the patient started taking erythromycin for the treatment of sinus infection. At the time of reporting, the patient''s outcome for sinus infection was unknown. Follow up information has been received from the physician who reported that she did not have access to the patient''s medical records any longer, but did recall the outcome of the pregnancy. She reported the patient delivered her baby girl at 32 weeks gestation (in approximately January 2012) via vaginal delivery. The physician did not recall the date of birth or weight of the baby. She could not recall why she went into early labor. However, she stated she saw the patient earlier this summer with her baby. She stated the baby was health with no congenital anomalies and that the baby did quite remarkably post delivery with no residual heart, lung or brain or other organ dysfunctions with the early delivery. That was all the information she could recall. At the time of the report the outcome of early labor was unknown. Upon internal review early labor was considered to be an other important medical event. The child''s case is reported in case # 1210USA004750. Additional information is not expected.


VAERS ID: 469501 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: New York  
Vaccinated:2012-09-28
Onset:2012-09-28
   Days after vaccination:0
Submitted: 2012-10-08
   Days after onset:10
Entered: 2012-10-12
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED P58306 / 1 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Sensation of heaviness, Throat irritation, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Hypertension - taking ramipril
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: C/o heaviness to both legs. Scratchy throat, tightening up. Escorted to Emergency Dept. Started on prednisone by mouth.


VAERS ID: 469433 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Minnesota  
Vaccinated:2012-10-13
Onset:2012-10-13
   Days after vaccination:0
Submitted: 2012-10-13
   Days after onset:0
Entered: 2012-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED P59608 / UNK LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4247AA / UNK RA / IM

Administered by: Military       Purchased by: Military
Symptoms: Hyperhidrosis, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: None
Preexisting Conditions: NKDA,
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Diaphoresis, nausea, vomiting. Treated symptomatically all the while with stable vital signs. Took nourishment, left our facility @ noon then presented again @ 1630 w/ vomiting. Was taken to facility for further evaluation.


VAERS ID: 469746 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Michigan  
Vaccinated:2012-09-28
Onset:2012-09-29
   Days after vaccination:1
Submitted: 2012-10-11
   Days after onset:12
Entered: 2012-10-13
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH713AB / 7+ LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prednisone
Current Illness: None
Preexisting Conditions: Asthma; PCOS
Allergies:
Diagnostic Lab Data: Lab/Tests N/A; Per patient per doctor - allergy to suspension from shot.
CDC Split Type:

Write-up: Patient developed rash on torso. Patient contacted her personal physician and took BENADRYL according to doctors instructions with follow up appt on 10/7/12. Dr. provided steroid shot. Patient took ALLEGRA then BENADRYL with no relief.


VAERS ID: 469943 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Washington  
Vaccinated:2012-10-15
Onset:2012-10-15
   Days after vaccination:0
Submitted: 2012-10-16
   Days after onset:1
Entered: 2012-10-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA726EA / 2 AR / UN

Administered by: Other       Purchased by: Other
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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 10/15/12 after receiving flu vaccine patient experienced a seizure. She was transported to local ED for care.


VAERS ID: 473531 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Montana  
Vaccinated:2011-12-07
Onset:2011-12-14
   Days after vaccination:7
Submitted: 2012-09-21
   Days after onset:281
Entered: 2012-10-17
   Days after submission:26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS AC52B073CA / UNK UN / UN

Administered by: Public       Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions: The subject had no vaccines given on the same date as the BOOSTRIX. The subject had no alcohol or tobacco use.
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: A0958316A

Write-up: This case was reported by a healthcare professional, via a sales representative, and described the occurrence of rash on hands and feet in a male subject aged between 20 and 29 years old who was vaccinated with BOOSTRIX (GlaxoSmithKline). On 7 December 2011 the subject received a dose of BOOSTRIX (unknown route). In December 2011, less than one week after vaccination with BOOSTRIX, the subject experienced rash on hands and feet. At the time of reporting the outcome of the event was unspecified. The healthcare professional considered the event was unrelated to vaccination with BOOSTRIX. Follow-up information was received on 04 January 2012 via nurse who is the immunization provider. The 26-year-old male subject previously received DTaP and Td form; no adverse events followed previous vaccinations. On 14 December 2011, seven days after the initial dose of BOOSTRIX the subject experienced the rash on hands and feet that resolved on 19 December 2012. The reporting nurse considered the rash on hands and feet unrelated to vaccination with BOOSTRIX. At the time of the report no additional information was provided.


VAERS ID: 470493 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Arizona  
Vaccinated:2012-10-16
Onset:2012-10-17
   Days after vaccination:1
Submitted: 2012-10-18
   Days after onset:1
Entered: 2012-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1205701 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rash.


VAERS ID: 470737 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Florida  
Vaccinated:2012-10-16
Onset:2012-10-17
   Days after vaccination:1
Submitted: 2012-10-22
   Days after onset:5
Entered: 2012-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. H011889 / 2 LA / SC

Administered by: Other       Purchased by: Private
Symptoms: Computerised tomogram, Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trisprintec; Venlafaxine 150 mg
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Per patient CT was done at ER
CDC Split Type:

Write-up: Headache.


VAERS ID: 470816 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Virginia  
Vaccinated:2011-11-01
Onset:2011-11-01
   Days after vaccination:0
Submitted: 2012-10-23
   Days after onset:357
Entered: 2012-10-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 RA / -

Administered by: Public       Purchased by: Other
Symptoms: Asthenia, Dizziness, Fatigue, Pallor, Palpitations
SMQs:, Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 10 minutes after receiving the vaccination, patient experienced intense palpitations and dizziness. This progressed into pallor physical weakness and fatigue within 10 minutes and lasting approximately four hours. No treatment was delivered as patient lived alone and fell asleep upon entering home.


VAERS ID: 471101 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2012-09-01
Submitted: 2012-10-24
   Days after onset:53
Entered: 2012-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA009269

Write-up: This spontaneous report as received from a physician refers to a 26 years old female patient. The patient was vaccinated with the second dose of GARDASIL. Lot # and route were no reported. In early September 2012, the patient developed Guillain Barre after receiving her second dose of GARDASIL. It was unspecified whether the patient received her second dose on time, and it was indicated that the patient would not be receiving a third dose. The patient was hospitalized in unspecified hospital. Unspecified treatment was given for the events. The outcome of Guillain Barre was reported as recovering/resolving. Additional information has been requested.


VAERS ID: 471577 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2012-10-16
Onset:2012-10-16
   Days after vaccination:0
Submitted: 2012-10-17
   Days after onset:1
Entered: 2012-10-24
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA735AA / UNK UN / IM

Administered by: Other       Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), 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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives on chest developed 6 hrs after vaccine. Injection site red, swollen, size of silver dollar. Patient treated w/ antihistamines.


VAERS ID: 476246 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Unknown  
Vaccinated:2012-10-01
Onset:2012-10-01
   Days after vaccination:0
Submitted: 2012-10-24
   Days after onset:23
Entered: 2012-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1947AA / UNK LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Injection site swelling, Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA007543

Write-up: This spontaneous report as received from a pharmacist refers to a 26 years old female patient with no pertinent medical history and no allergies. The patient was vaccinated with 0.5 ml PNEUMOVAX23 (lot # 1947AA, exp 20-OCT-2013, Intramuscular, left arm) on 01-OCT-2012 for Vaccination. There was no concomitant medications. On 01-OCT-2012 the patient developed welts and swelling of the left arm at the injection site in the evening. The patient sought medical attention. Treatment was Ibuprofen. The patient was recovered as reported. This is one of the two reports from the same source using the same PNEUMOVAX23 LOT. The other report was captured in marrs #1210US007540. Additional information is not expected.


VAERS ID: 471521 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Nevada  
Vaccinated:2012-07-20
Onset:0000-00-00
Submitted: 2012-10-25
Entered: 2012-10-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV307 / 2 - / -
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR VV04003A / 1 - / -
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR G1124 / 1 - / -

Administered by: Military       Purchased by: Military
Symptoms: Dysphagia, Pharyngeal oedema, Pyrexia, Rash pruritic, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: This patient received the smallpox, anthrax, and typhoid vaccines and two days later developed an itching rash which developed into a fever. The patient then went to the emergency room three days later and also complained of a swollen, scratchy throat with difficulty swallowing.


VAERS ID: 471643 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Oregon  
Vaccinated:2011-11-01
Onset:2011-11-01
   Days after vaccination:0
Submitted: 2012-10-26
   Days after onset:360
Entered: 2012-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / -

Administered by: Public       Purchased by: Other
Symptoms: Asthenia, Chills, Influenza, Tremor, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Claritin
Current Illness: Maybe a mild cold, maybe just allergies. This happened one year ago.
Preexisting Conditions: Seasonal Allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: I woke up after an hour of sleep with violent chills and shaking and an overall feeling of weakness similar to bad flu. The ''illness'' only lasted about 24 hours. I also had an outbreak of hives for the first time in my life 1-2 months later which lasted for 2 horrible weeks. No way to know that it was related though. This was my first ever flu shot that I know of.


VAERS ID: 471731 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Unknown  
Vaccinated:2012-10-04
Onset:2012-10-21
   Days after vaccination:17
Submitted: 2012-10-28
   Days after onset:7
Entered: 2012-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR VV04003A / 1 LA / OT

Administered by: Military       Purchased by: Military
Symptoms: Rash erythematous, Rash papular
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None Reported
Preexisting Conditions: None Reported
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt developed Mildly erythematous, raised, umbilicated (some) papules on hands (palms fingers, wrists) and elbows. Consulted CDC and felt to be "benign, Accrual papulovesicular eruption".


VAERS ID: 474667 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Unknown  
Vaccinated:2012-05-30
Onset:2012-10-25
   Days after vaccination:148
Submitted: 2012-10-29
   Days after onset:4
Entered: 2012-10-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0121AE / 1 UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Injection site erythema, Injection site rash, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1210USA012773

Write-up: This spontaneous report as received from a nurse practitioner refers to a 27 years old female patient who was not pregnant with no pertinent medical history and no drug reactions/allergies. The patient was vaccinated intramuscularly with her first and only dose of GARDASIL (lot # 0121AE, expiration date 29-SEP-2014) on 30-MAY-2012. There were not concomitant medications. On 25-OCT-2012 the patient experienced a red, raised rash with one bump at the injection site. The patient called the reporting nurse practitioner for medical attention. No treatment was given. No laboratory diagnostics studies were performed. The outcome of the events was reported as not recovered/not resolved. Additional information has been requested.


VAERS ID: 472102 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: North Dakota  
Vaccinated:2012-10-26
Onset:2012-10-29
   Days after vaccination:3
Submitted: 2012-10-30
   Days after onset:1
Entered: 2012-10-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / 1 LA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Abdominal discomfort, Diarrhoea, Headache, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Repeated vomiting & diarrhea, upset stomach, headache. Lasted beyond 24 hours. Treated by resting and drinking fluids.


VAERS ID: 472348 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Ohio  
Vaccinated:2012-10-02
Onset:2012-10-03
   Days after vaccination:1
Submitted: 2012-10-22
   Days after onset:19
Entered: 2012-10-30
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH721AB / UNK LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Erythema, Induration, Influenza like illness
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 50 x 40mm red induration. Flu-like symptoms, temp 98.8.


VAERS ID: 472760 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Missouri  
Vaccinated:2012-10-15
Onset:2012-10-16
   Days after vaccination:1
Submitted: 2012-10-17
   Days after onset:1
Entered: 2012-10-31
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH714AA / 1 AR / IM

Administered by: Other       Purchased by: Other
Symptoms: Injection site warmth, Peripheral coldness, Sensation of heaviness
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NK pre-existing conditions
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine was administered on 10/15/12. Patient awaken the next morning between 6:45-7am on 10/16/12 experiencing coldness within the injection arm and the site was warm to touch. Plus patient complained arm felt weighted down.


VAERS ID: 472767 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Washington  
Vaccinated:2012-10-26
Onset:2012-10-30
   Days after vaccination:4
Submitted: 2012-11-02
   Days after onset:3
Entered: 2012-11-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. H012973 / 1 RA / IM

Administered by: Military       Purchased by: Military
Symptoms: Axillary mass, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None addressed
Allergies:
Diagnostic Lab Data: Prescribed antibiotics by Dr
CDC Split Type:

Write-up: On 2 Nov 12 member came in to clinic presenting concern with raised red round bump underneath left arm. Member denies chest pain, fever, but states underarm swollen and feels like a bruise. Seen by Dr.


VAERS ID: 473316 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: North Carolina  
Vaccinated:2012-10-09
Onset:2012-10-09
   Days after vaccination:0
Submitted: 2012-11-03
   Days after onset:25
Entered: 2012-11-05
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED - / UNK RA / IM

Administered by: Military       Purchased by: Military
Symptoms: Arthralgia, Back pain, Chills, Headache, Malaise, Myalgia, Nausea, Pyrexia, Vaccine positive rechallenge
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: NKDA; PMH neg for serious childhood illnesses, congenital defects or disease. No hosp or surgeries.
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 26 y/o male sent to HC on walk-in basis by occupational health. No official consult placed in system. Pt walks into HC at 3:15PM (10 OCT12) c/o "fever, chills, muscle aches & pains in knees and lower back, nausea and HA at 27.5 hours s/p receipt of AFLURIA IM, placed in Rt deltoid around noon on yesterday (09 OCT 12). He denies any difficulty swallowing or breathing, angio or periorbital edema, lip swelling, thickening of tongue, wheezing or hives in the first 3 hours s/p receipt of the vaccine. No other vaccines administered at the same time, other than PPD, which is non-contributory. No other vaccines received in the previous 30 days. Denies prior viral or GI illness in the past 30 days. Felt fine until bedtime last evening around 9-10PM, when low grade fever of 99.6F and chills began, accompanied by general malaise, HA, nausea (no V or D), muscle/joint aches- bilateral knees (no redness, swelling or warmth of knees or other joints) and lower back ache. Went to bed. Sx have continued throughout the day today. Pt has not taken any OTC ibuprofen or TYLENOL. Denies personal hx of RA, lupus or arthritis. No eczema, asthma, psoriasis, sickle cell or G6PD deficiency. Denies numbness or tingling in feet or extremities. Denies mental confusion or blurred vision. Pt states he feels this way every time he gets the flu shot.


VAERS ID: 473432 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Nebraska  
Vaccinated:2012-08-01
Onset:2012-08-02
   Days after vaccination:1
Submitted: 2012-08-10
   Days after onset:8
Entered: 2012-11-05
   Days after submission:87
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0399AE / 1 LA / UN

Administered by: Other       Purchased by: Other
Symptoms: Erythema, Skin warm, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Lg raised $g 10 cm erythematous warmth to palpation tender area.


VAERS ID: 475951 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Unknown  
Vaccinated:2011-10-01
Onset:0000-00-00
Submitted: 2012-11-05
Entered: 2012-11-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Drug administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1211USA001172

Write-up: This spontaneous report as received from a 26 years old female patient refers to herself. Patient stated her misuse of getting 2 of the 3 GARDASIL. The patient stated she received first dose of GARDASIL (subcutaneous, Lot#, dose unspecified) in June 2011 and second dose (Lot#, dose, route unspecified) in October 2011, but had not ever received the 3rd dose. The patient did not sought medical attention and no treatment was given for the event. The outcome was unknown. Additional information has been requested.


VAERS ID: 473252 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: South Carolina  
Vaccinated:2012-10-18
Onset:2012-10-18
   Days after vaccination:0
Submitted: 2012-11-06
   Days after onset:19
Entered: 2012-11-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UHT59AB / UNK LA / IM

Administered by: Public       Purchased by: Other
Symptoms: Pruritus, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: YAZ oral birth control
Current Illness: No
Preexisting Conditions: Allergy to penicillin
Allergies:
Diagnostic Lab Data: Saw our WC doctor, no treatment needed, employee took Benadryl on her own prior to the visit.
CDC Split Type:

Write-up: Hives and itching within two hours of receiving shot that lasted two weeks.


VAERS ID: 473616 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Rhode Island  
Vaccinated:2012-10-23
Onset:2012-10-23
   Days after vaccination:0
Submitted: 2012-10-24
   Days after onset:1
Entered: 2012-11-06
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS AFLLA762AB / 1 LA / SYR

Administered by: Other       Purchased by: Public
Symptoms: Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling & pain at injection site. Onset approx 8 hrs after injection. Patient self administered "ADVIL", applied cold compress the following morning.


VAERS ID: 473422 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Virginia  
Vaccinated:2012-11-06
Onset:2012-11-06
   Days after vaccination:0
Submitted: 2012-11-07
   Days after onset:1
Entered: 2012-11-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH746AC / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Dizziness, Dyspnoea, Feeling cold, Hot flush, Nausea
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), Cardiomyopathy (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Sprintec, Topamax, Pepcid
Current Illness:
Preexisting Conditions: Prednisone, shellfish
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt reaction at "4:30 yesterday, I had severe difficulty breathing, I got nauseated to my stomach, I had a hot flash and immediately had a cold flash and then I got dizzy and that only lasted twenty minutes. After that I just had a general shortness of breath feeling and then about 2 hours later I had another episode just like that one. All I''ve been having since then is a general shortness of breath, a little dizziness and on and off nausea".


VAERS ID: 475818 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Texas  
Vaccinated:2012-03-06
Onset:2012-03-06
   Days after vaccination:0
Submitted: 2012-03-23
   Days after onset:16
Entered: 2012-11-09
   Days after submission:231
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH463AA / UNK LA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Cold sweat, Dizziness, Injection site haemorrhage
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: The patient had no illness at the time of vaccination and had no known allergies. It was unknown if the patient took any concomitant medications. The patient received no other vaccinations within four weeks of FLUZONE.
Allergies:
Diagnostic Lab Data: Not reported
CDC Split Type: 201202657

Write-up: Initial report was received from a health care professional on 06 March 2012, as well as another manufacturer under reference number 1-367160101. A 26-year-old male patient had received an intramuscular injection in the left deltoid of FLUZONE, sanofi pasteur Inc. lot number UH463AA on 06 March 2012. Right after the vaccination, the patient experienced dizziness and cold sweats. The patient was treated with BENADRYL and sat down for 10-15 minutes. After 10 minutes, the patient''s symptoms subsided and the patient stated he "was fine". The patient also noticed "more bleeding at the injection site than any other injections he has received in the past." The patient had no illness at the time of vaccination and had no known allergies. It was unknown if the patient took any concomitant medications. The patient received no other vaccinations within four weeks of FLUZONE. The patient''s outcome was recovered. Documents held by sender: None.


VAERS ID: 475821 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Ohio  
Vaccinated:2011-10-12
Onset:2011-10-14
   Days after vaccination:2
Submitted: 2012-02-23
   Days after onset:132
Entered: 2012-11-09
   Days after submission:260
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH467AB / UNK RA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: CLOMID; Estrogen; Metformin; Progesterone
Current Illness:
Preexisting Conditions: Illness at the time of vaccination, pre-existing medical conditions, any other vaccinations within four weeks of FLUZONE and number of previous doses of influenza vaccine were unknown. The patient''s also took CLOMID, estrogen and metformin.
Allergies:
Diagnostic Lab Data:
CDC Split Type: 201200776

Write-up: Initial report was received from a health care professional on 19 January 2012. This case is one of a cluster of seven patients reported by the same reporter who each experienced adverse events following administration of FLUZONE (lot number not reported). The events for the other patients were captured in case numbers 2012-00770, 2012-00771, 2012-00772, 2012-00773, 2012-00774 and 2012-00775. A 26-year-old female patient had received an injection of FLUZONE, sanofi pasteur Inc. (lot number, route and site unknown) on 13 October 2011 and an unspecified amount of time later experienced a fever to 102, body aches and nausea. Illness at the time of vaccination, pre-existing medical conditions, any other vaccinations within four weeks of FLUZONE and number of previous doses of influenza vaccine were unknown. The patient''s also took CLOMID, estrogen and metformin. No further information was available at the time of the report. The patient''s outcome was recovered. Documents held by sender: None. Follow-up information received from a healthcare professional on 21 February 2012. The patient received an intramuscular right deltoid injection of FLUZONE, sanofi pasteur Inc. lot number UH467AB, on 12 October 2011. On 14 October 2011, the patient''s symptoms were fever (102), body achy and very nauseous. The patient''s concomitant medications included CLOMID, estrogen, metformin and progesterone (taking all medications through the month of October, not all at one time). The patient was concerned about interference with her fertility medications. The outcome remained recovered. No additional information was available. Documents held by sender: Medical timeline.


VAERS ID: 474066 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Texas  
Vaccinated:2010-06-14
Onset:2012-06-15
   Days after vaccination:732
Submitted: 2012-11-13
   Days after onset:151
Entered: 2012-11-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public       Purchased by: Other
Symptoms: Erythema, Mobility decreased, Oedema peripheral
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Parkinson-like events (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm swelled up, got really red, and couldn''t move it.


VAERS ID: 474163 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2012-11-12
Onset:2012-11-13
   Days after vaccination:1
Submitted: 2012-11-14
   Days after onset:1
Entered: 2012-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / SYR

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness and swelling in area of tetanus imm.


VAERS ID: 474164 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: South Dakota  
Vaccinated:2012-11-01
Onset:2012-11-04
   Days after vaccination:3
Submitted: 2012-11-14
   Days after onset:10
Entered: 2012-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 LA / UN

Administered by: Private       Purchased by: Other
Symptoms: Arthralgia, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: IMPLANON, IBUPROFEN
Current Illness: N/A
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: SORENESS IN UPPER ARM, PAIN IN ELBOW AND WRIST JOINTS.


VAERS ID: 474472 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: California  
Vaccinated:2012-11-07
Onset:2012-11-07
   Days after vaccination:0
Submitted: 2012-11-14
   Days after onset:7
Entered: 2012-11-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH746AA / UNK UN / IM

Administered by: Other       Purchased by: Private
Symptoms: Hypersensitivity, Hypoaesthesia, Laboratory test, Muscle twitching, Pain in extremity
SMQs:, Angioedema (broad), Peripheral neuropathy (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data: I''m not sure what tests were done
CDC Split Type:

Write-up: Flu shot 11/7 2 hrs later felt like allergic reaction in face, lips & flu symptoms - numb all over. Sore arm 11/9 PM had terrible reaction - muscle twitches, numb. Went to ER. Stayed most of night. 11/11 Another episode- muscle twitch/numb. Went to E.R.


VAERS ID: 474294 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Michigan  
Vaccinated:2012-10-30
Onset:2012-10-31
   Days after vaccination:1
Submitted: 2012-11-15
   Days after onset:15
Entered: 2012-11-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. H012650 / UNK LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Body temperature increased, Erythema, Skin warm, Type IV hypersensitivity reaction, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Patient was hospitalized for bowel obstruction. Had a colonoscopy.
Preexisting Conditions: No allergies, no birth defects, no medical conditions
Allergies:
Diagnostic Lab Data: WBC 16.0 on 11/02/12
CDC Split Type:

Write-up: Pt. presented with 104 temperature. Erythematous and warm arm. ID physician stated it was a "Type 4" reaction. Patient was discharged the following day. ID physician stated that because of rapid onset and progression he felt it was a reaction to the vaccine rather than "cellulitis".


VAERS ID: 474567 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Delaware  
Vaccinated:2012-10-22
Onset:2012-10-22
   Days after vaccination:0
Submitted: 2012-11-16
   Days after onset:25
Entered: 2012-11-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH712AB / UNK RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0895AA / 2 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Injection site erythema, Injection site rash, Injection site swelling, Muscular weakness, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Sinus infection
Preexisting Conditions: Seasonal, household chemicals and mold allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Soreness in (L) arm 1 hour after vaccination. By end of evening - had severe pain and weakness in (L) arm - "felt like someone was hitting arm with a hammer" patchy red rash from (L) shoulder to (L) elbow developed at same time and became progressively worse for 2 days. Arm was also swollen from (L) shoulder to (L) elbow during this time - "looked like fluid under the skin". Symptoms began improving after 2 days pain-free 10/27/12 pm. Rash, redness, and swelling were all gone 10/28/12 morning.


VAERS ID: 475050 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Virginia  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2012-11-20
Entered: 2012-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. AH2193 / UNK NS / IN

Administered by: Military       Purchased by: Military
Symptoms: Maternal exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. received FLUMIST and later found out she was pregnant. EDC - 07/17/2013.


VAERS ID: 475251 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Illinois  
Vaccinated:2012-11-15
Onset:2012-11-15
   Days after vaccination:0
Submitted: 2012-11-16
   Days after onset:1
Entered: 2012-11-20
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH716AC / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Chills, Diarrhoea, Injection site erythema, Injection site pain, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None stated
Current Illness: None stated
Preexisting Conditions: None stated
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Injection site moderate tenderness. Injection site moderate erythema. Mild fever with chills. Vomiting - onset at 2 hours- diarrhea onset at 2 hours lasting $g 12 hours.


VAERS ID: 478348 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: West Virginia  
Vaccinated:2012-10-19
Onset:0000-00-00
Submitted: 2012-11-20
Entered: 2012-11-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. H012570 / 1 AR / IM

Administered by: Other       Purchased by: Other
Symptoms: No adverse event, Wrong drug administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1211USA004476

Write-up: This spontaneous report was received from a registered nurse via representative refers to 4 adult patients of unknown age and gender. Onan unknown date the patients were vaccinated with a dose of LIQUID PEDVAXHIB (lot#, expiration date and route not reported). No concomitant medications were reported. The patients received LIQUID PEDVAXHIB in error when they were supposed to get an unspecified Hepatitis B Vaccine. The patients were not experiencing any known symptoms. No further information is available. Additional information has been requested.


VAERS ID: 475352 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Nevada  
Vaccinated:2012-11-07
Onset:2012-11-19
   Days after vaccination:12
Submitted: 2012-11-22
   Days after onset:3
Entered: 2012-11-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 1207201A / 2 UN / IM

Administered by: Other       Purchased by: Private
Symptoms: Bursitis, Inflammation, Musculoskeletal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient reported on 11/19/12 experiencing pain and inflammation in the right shoulder. Patient went to a physician and diagnosed with bursitis of the right shoulder.


VAERS ID: 475364 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Wisconsin  
Vaccinated:2012-10-23
Onset:2012-10-23
   Days after vaccination:0
Submitted: 2012-11-23
   Days after onset:31
Entered: 2012-11-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS AFLUA733AA / 2 RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0653AE / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site reaction, Myalgia, Pain, Pruritus, Skin warm, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Splenectomy
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Muscle tenderness in left bicep, tricep & radiating into pectoral muscle. Warm to touch. Increased pain with reaching & moving. Swelling, itching x 5 days.


VAERS ID: 475731 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Michigan  
Vaccinated:2012-11-20
Onset:2012-11-20
   Days after vaccination:0
Submitted: 2012-11-30
   Days after onset:10
Entered: 2012-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR 07549221A / 1 LA / IM

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Chest X-ray normal, Chest discomfort, Dysphonia, Electrocardiogram abnormal, Fatigue, Haematocrit normal, Haemoglobin normal, Headache, Hypoaesthesia, Lumbar puncture normal, Malaise, Musculoskeletal stiffness, Nausea, Neck pain, Paraesthesia, Sinus tachycardia, Urine analysis normal, White blood cell count increased
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Adderall XR 20MG
Current Illness: None
Preexisting Conditions: Latex sensitivity, Attention Deficit Disorder
Allergies:
Diagnostic Lab Data: EKG''s-abnormal-sinus tachycardia Lab tests-11/20/12-hi WBC, hemoglobin, hematocrit, normal on 11/23/12 urinalysis-normal Spinal Tap-normal Chest Xray-normal
CDC Split Type:

Write-up: I experienced numbness and tingling in left arm post injection about 10 minutes after. About 20 minutes post injection I began to develop tightness in chest, hoarseness in voice, dizziness and weakness. I then took myself into emergency department. Arrived at ER at about 11:15am. At this point the tightness in my chest and voice hoarseness had worsened and I had developed a severe headache and neck pain. I was triaged and immediately taken to a room for IV administration of fluids, Benadryl, Solumedrol, Pepcid. An EKG was performed and I was found sinus tachycardic. I was also provided Zofran for my nausea symptoms. After being monitored for a few hours and my symptoms had improved I was discharged home. Remaining symptoms were severe headache, neck pain and body weakness. I was discharged at about 3pm on 11/20/2012. I returned to ER at about 7:45pm due to return of tightness in chest, hoarseness in voice, increased body weakness and severe head and neck pain as well as neck and upper body stiffness. An EKG and chest xray were performed as well as a spinal tap. I was provided IV fluids, Morphine, Zantac, lorazepam, hydromorphone, diazepam and ketorlac. I was monitored and when symptoms lessened I was discharged home with medications and instructions to return if symptoms worsened. I was given prescription for Vicodin, Benadryl, prednisone, Zantac. I was discharged at about 2:00am on 11/21/2012 with medication allergic reaction and possible viral syndrome due to increased WBC. I returned again to ER on 11/23/2012 at around 10:00am due to increased head and neck pain, body weakness, nausea, fatigue and neck and upper body stiffness. I was again provided IV fluids, morphine, Valium and Zofran for nausea symptoms. I was monitored and discharged home with diagnosis of post medication allergic reaction, and spinal headaches. I was provided prescription for Fioricet and Valium and instructed to follow up with primary doctor and return if worsened symptoms. Follow up with my primary was performed on 11/28/2012. I am still experiencing the severe head pain, minor neck pain and over fatigue and malaise.


VAERS ID: 475732 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Oklahoma  
Vaccinated:2012-11-14
Onset:2012-11-26
   Days after vaccination:12
Submitted: 2012-11-30
   Days after onset:4
Entered: 2012-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LA / SYR

Administered by: Unknown       Purchased by: Private
Symptoms: Asthenia, Injection site erythema, Injection site rash, Injection site swelling, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Guillain-Barre 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)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Cephalexin 500mg, ibuprofen 200mg
Current Illness: No, just sore arm
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Horrible rash where the shot was given, red and elevated from the skin, three mosquito bite like dots inside the round rash. Mosquito bite like dots all over my back, neck and ears. My body feels very weak.


VAERS ID: 475900 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Iowa  
Vaccinated:2012-11-30
Onset:2012-11-30
   Days after vaccination:0
Submitted: 2012-11-30
   Days after onset:0
Entered: 2012-11-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE) / SANOFI PASTEUR U4497AA / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Incorrect dose administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal multivitamin
Current Illness: None
Preexisting Conditions: 21 weeks pregnant
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was mistakenly given high dose flu vaccine instead of regular flu vaccine. State vaccine program was phoned and they contacted CDC. No treatment was needed. Patient was notified.


VAERS ID: 476317 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Washington  
Vaccinated:2012-11-16
Onset:2012-11-16
   Days after vaccination:0
Submitted: 2012-11-26
   Days after onset:10
Entered: 2012-12-04
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH746AB / UNK LA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4152AA / 1 RA / IM

Administered by: Other       Purchased by: Private
Symptoms: Eye movement disorder, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None after inj - stated faints with lab draws
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Client fainted following injections positioned onto floor feet elevated - eyes rolled back - several tremors extremities awake - did not know what happened & where she was - then oriented self to place & event maintained BP - P - because B.P. decreased once medics decided to transport - to be checked out B.P. 134/86 80 - 20 - 120/60 - 80 BP 100/70 90 standing 120/88 P 88.


VAERS ID: 476953 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Pennsylvania  
Vaccinated:2012-11-02
Onset:2012-11-02
   Days after vaccination:0
Submitted: 2012-12-06
   Days after onset:34
Entered: 2012-12-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH719AA / 1 LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site erythema, Injection site rash, 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), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Developed a large red raised area at injection site, followed by rash and fever.


VAERS ID: 479864 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Unknown  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2012-11-30
Submitted: 2012-12-07
   Days after onset:7
Entered: 2012-12-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Antibody test negative
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Immunisation
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1212USA001246

Write-up: This spontaneous report as received from a pharmacist refers to a 26 years old patient with vaccination. The patient was vaccinated with M-M-R II. No other co-suspects were reported. No concomitant medications were reported. On an unknown date the patient experienced had a negative titer following vaccination with M-M-R II on 11/30/2012. No treatment information was reported. The outcome of had a negative titer following vaccination with M-M-R II is unknown. No other information to report. Additional information has been requested.


VAERS ID: 477382 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Illinois  
Vaccinated:2012-12-08
Onset:2012-12-08
   Days after vaccination:0
Submitted: 2012-12-10
   Days after onset:2
Entered: 2012-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / IM

Administered by: Military       Purchased by: Military
Symptoms: Abdominal pain, Arthralgia, Back pain, Decreased appetite, Fatigue, Headache, Nausea, Pain, Pyrexia, Thirst
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, nausea, body aches, joint pain, lower back pain, fever, sore abdomen, diarrhea, low appetite, extreme thirst, fatigue. Still occurring as of today, three days after administration.


VAERS ID: 477473 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Idaho  
Vaccinated:2012-12-08
Onset:2012-12-09
   Days after vaccination:1
Submitted: 2012-12-10
   Days after onset:1
Entered: 2012-12-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE INTRADERMAL) / SANOFI PASTEUR UT4470BA / UNK RA / SC

Administered by: Other       Purchased by: Unknown
Symptoms: Injection site rash
SMQs:, Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient called on 12/10/12 after receiving the immunization on 12/8/12 asking what she could take for a rash that had developed at site of injection. Patient advised to take BENADRYL and or hydrocortisone if discomfort continues.


VAERS ID: 477548 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Colorado  
Vaccinated:2012-10-26
Onset:2012-10-26
   Days after vaccination:0
Submitted: 2012-11-30
   Days after onset:35
Entered: 2012-12-11
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED P509088 / 1 LA / IM

Administered by: Public       Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: IMITREX; BIOXIN; PCN; MUCINEX; RELPAX; Codeine; TYLENOL
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: C/o severe redness and swelling (L) upper arm 2 hours after receiving Flu vaccine. She visited doctor in occupational health office and was followed there.


VAERS ID: 477756 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Indiana  
Vaccinated:2012-11-13
Onset:2012-11-15
   Days after vaccination:2
Submitted: 2012-12-12
   Days after onset:27
Entered: 2012-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPAB: HEP A + HEP B (TWINRIX) / GLAXOSMITHKLINE BIOLOGICALS AHABB244AA / UNK LA / IM
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UH349AA / UNK RA / SC

Administered by: Public       Purchased by: Unknown
Symptoms: Injection site erythema, Injection site haematoma, Injection site pruritus, Oropharyngeal pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Several days later had sore throat
Preexisting Conditions: States gets strep infection
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Client had yellow fever vaccine on 11-13-12 & had Hep A B #1 on 11-13-12. States she started itching to (R) arm at injection on site on 11-15-12. The area was red & had bruised according to client. The redness remains at the site is lighter per client - area measured appeared 25 mm L x 25 m W on 12-11-12.


VAERS ID: 477757 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: California  
Vaccinated:2012-12-04
Onset:2012-12-04
   Days after vaccination:0
Submitted: 2012-12-10
   Days after onset:6
Entered: 2012-12-12
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH719AD / UNK LA / UN
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4328AA / UNK RA / UN

Administered by: Unknown       Purchased by: Private
Symptoms: Maternal exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt is pregnant at the time approx. 22 wks. FLUZONE that was administered is not preservative free.


VAERS ID: 477850 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Unknown  
Vaccinated:2012-11-29
Onset:2012-11-29
   Days after vaccination:0
Submitted: 2012-12-12
   Days after onset:13
Entered: 2012-12-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 1524AA / UNK UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Dizziness, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1212USA003789

Write-up: This spontaneous report as received from a nurse practitioner refers to a 26 years old female patient with no drug reactions/ allergies and no pertinent medical history who on 29-NOV-2012, was vaccinated with a dose of GARDASIL (IM(dose not reported) (lot # 672193/1524AA, Exp: 24-AUG-2014). No other co-suspects were reported. There was no concomitant medications. The nurse reported that the patient developed severe headaches with fever and slight dizziness 5 hours after getting a dose of GARDASIL. No treatment was given for the events. The outcome of the events was reported as recovered/resolved on 30-NOV-2012. No laboratory diagnostic studies were performed. The patient sought medical attention via calling the nurse practitioner. The relatedness for the events was unknown for GARDASIL. Additional information is not expected.


VAERS ID: 478585 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Michigan  
Vaccinated:2012-11-28
Onset:2012-11-28
   Days after vaccination:0
Submitted: 2012-12-07
   Days after onset:9
Entered: 2012-12-18
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH756AA / 1 LA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Dizziness, Flushing, Influenza like illness, Injection site erythema, Injection site swelling, Injection site warmth, Nausea, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Flu-like symptoms within one-two hrs - dizziness, nausea, fever, flush - lasting up to time of this form completion. Reaction at injection site up to 4 days after, swollen, hotness, reddened area.


VAERS ID: 478930 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Washington  
Vaccinated:2012-12-11
Onset:2012-12-11
   Days after vaccination:0
Submitted: 2012-12-20
   Days after onset:9
Entered: 2012-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TETANUS DIPHTHERIA (TENIVAC) / SANOFI PASTEUR U4165AA / UNK RA / IM

Administered by: Public       Purchased by: Other
Symptoms: Erythema, Injection site pain, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamin, Metformin, Prozac and Prometrium
Current Illness: Was involved in a motor vehicle accident prior to being seen at ER
Preexisting Conditions: Allergic to Norvasc and Tramadol
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pain and soreness at injection site, skin hot to the touch with redness and swelling.


VAERS ID: 478950 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: New York  
Vaccinated:2012-11-26
Onset:2012-12-05
   Days after vaccination:9
Submitted: 2012-12-20
   Days after onset:15
Entered: 2012-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV309 / 1 UN / IM
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 07249221A / 2 NS / IN
SMALL: SMALLPOX (ACAM2000) / SANOFI PASTEUR VV04003A / 1 LA / -

Administered by: Military       Purchased by: Military
Symptoms: Erythema, Papule, Skin plaque
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Tuberculin Skin Test
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Bright red plaques and papules at face, neck, trunk and arms. Area were confluent on face. No ulcers or pustules.


VAERS ID: 479010 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Hawaii  
Vaccinated:2012-12-17
Onset:2012-12-18
   Days after vaccination:1
Submitted: 2012-12-21
   Days after onset:3
Entered: 2012-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
ANTH: ANTHRAX (BIOTHRAX) / EMERGENT BIOSOLUTIONS FAV309 / 6 LA / IM

Administered by: Military       Purchased by: Military
Symptoms: Injection site pruritus, Injection site reaction, Injection site urticaria, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: This 26 year old was referred for site reaction after receipt of AVA vaccine and assistance in VAERS filing. Prior AVA vaccines were given 1/11/11, 2/11/11, 7/12/11, and 6/18/12 with soreness to site and arm for 1-2 days. He received AVA #5 to left deltoid on 12/17/12 (AVA FAV 309) - this was given 6 months from previous dose (per AVA schedule). He denied any trauma, exercising or injury to left deltoid. Approximately 24 hours after receipt of AVA vaccine, the vaccine site began to itch. On day 2 (12/19/12) the vaccine site had a "2.5 inch circular red raised rash". He presented to medical and was diagnosed with urticaria lesion to left shoulder. Pt had not been taking any medication for the itching or site redness and advised provider he did not want/require Benadryl or topical steroid cream at this time (does not like to take medication unless needed). Pt advised on 12/20/12 the sited was still red but not as severe as yesterday. (Picture sent by pt...see below). Denied any contact with new clothing, detergents, deodorants, soaps, was not hiking, around animals, no new foods, no recent exercise/trauma to arm.


VAERS ID: 479111 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Unknown  
Vaccinated:2012-09-08
Onset:2012-09-09
   Days after vaccination:1
Submitted: 2012-12-21
   Days after onset:103
Entered: 2012-12-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Amnesia, Aphagia, Fatigue, Malaise, Maternal exposure during pregnancy, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1212USA007802

Write-up: Information has been received from a consumer, for GARDASIL, a Pregnancy Registry product, concerning a 26 years old female patient with no pertinent medical history and no drug reactions or allergies who was vaccinated with a dose of GARDASIL on 08-SEP-2012 (lot #, dose and site of administration were not provided). No other co-suspects were reported. No concomitant medications were reported. On 09-SEP-2012, the consumer stated that after the administration of GARDASIL, she experienced soreness in her arm, short term memory, fatigue, and not able to eat. She has also really sick for 2 to 3 months. No treatment was given for the adverse events. No lab diagnostic test was performed. The patient did not seek medical attention. The patient LMP and EDD were not provided. At the time of the report, the patient outcome was unknown. Additional information has been requested.


VAERS ID: 479034 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: New Mexico  
Vaccinated:2012-12-20
Onset:2012-12-20
   Days after vaccination:0
Submitted: 2012-12-22
   Days after onset:2
Entered: 2012-12-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public       Purchased by: Other
Symptoms: Back pain, Chills, Dizziness, Fatigue, Headache, Injection site urticaria, Nausea, Neck pain, Pain in extremity,