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Found 134 cases where Location is Vermont and Vaccination Date on/after '2015-05-01'

Table

   
AgeCountPercent
< 3 Years139.7%
3-6 Years96.72%
6-9 Years42.99%
9-12 Years64.48%
12-17 Years85.97%
17-44 Years2216.42%
44-65 Years3425.37%
65-75 Years1914.18%
75+ Years1611.94%
Unknown32.24%
TOTAL134100%

Case Details

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VAERS ID:580298 (history)  Vaccinated:2015-05-11
Age:13.0  Onset:0000-00-00
Gender:Female  Submitted:0000-00-00
Location:Vermont  Entered:2015-06-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Depression; Asthma
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.K0072640IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4680AA0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Blister, Erythema, Injection site erythema, Injection site swelling, Pruritus, Skin tightness
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Began 2 days after injection with redness, swelling, tightness of the right arm and grouped vesicles on erythematous base covering extremities and think -very pruritic with dermatographism.

VAERS ID:580760 (history)  Vaccinated:2015-06-02
Age:40.0  Onset:2015-06-03, Days after vaccination: 1
Gender:Female  Submitted:2015-06-07, Days after onset: 4
Location:Vermont  Entered:2015-06-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Possibly shingles flare up.
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTP: DTP (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Private     Purchased by: Private
Symptoms: Lymphadenopathy, Musculoskeletal pain, Myalgia, Neck pain
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Very sore muscle for 4 day straight. Could not touch it, it was so painful. 5 days after shot developed swollen supraclavicular lymph node and shoulder and neck pain.

VAERS ID:580777 (history)  Vaccinated:2015-06-04
Age:4.0  Onset:2015-06-04, Days after vaccination: 0
Gender:Male  Submitted:2015-06-04, Days after onset: 0
Location:Vermont  Entered:2015-06-05, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Probiotic
Current Illness: None
Preexisting Conditions: BACTRIM-rash
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPV: DTAP + IPV (KINRIX)GLAXOSMITHKLINE BIOLOGICALS3N7Y7 IMLA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.L0024210SCLA
Administered by: Private     Purchased by: Public
Symptoms: Body temperature increased, Lacrimation increased, Pain, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Lacrimal disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 1-2 hours after receiving vaccines-c/o body aches, "not feeling well". 5 hours after receiving vaccines-temp 102 degrees F, rash on face, watery eyes.

VAERS ID:585030 (history)  Vaccinated:2015-06-12
Age:1.3  Onset:2015-06-12, Days after vaccination: 0
Gender:Male  Submitted:2015-07-08, Days after onset: 26
Location:Vermont  Entered:2015-07-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: swelling~DTaP+IPV+HepB+Hib (Foreign)~~0.00~Patient
Other Medications:
Current Illness: No
Preexisting Conditions: Wheat and dairy allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS 3IMRL
IPV: POLIO VIRUS, INACT. (POLIOVAX)SANOFI PASTEUR 3IMRL
Administered by: Private     Purchased by: Other
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Entire leg swelled to twice normal size, and became hot and red.

VAERS ID:585911 (history)  Vaccinated:2015-07-10
Age:32.0  Onset:2015-07-11, Days after vaccination: 1
Gender:Female  Submitted:2015-07-15, Days after onset: 4
Location:Vermont  Entered:2015-07-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamins; Pepcid AC
Current Illness: None; 33 wks pregnant
Preexisting Conditions: Allergies to latex, Tylenol, epinephrine, amoxicillin.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC4765AA1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Cough, Exposure during pregnancy, Injected limb mobility decreased, Injection site induration, Injection site pain, Musculoskeletal discomfort, Pain in jaw, Tenderness
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Osteonecrosis (broad), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Arthritis (broad)
Write-up: Pt described an increasing soreness at injection site which advanced to not being able to move arm by the end of the day 7/11. By 7/12 pt states the discomfort started moving up her neck to her jaw. Jaw very sore to touch and when she bent forward the pressure was extremely painful. All joints began to become painful, difficulty making a fist with her hands, ankles, knees sore. Persistent dry cough developed. No fever. Injection site with large area of induration but no advancing erythema. Went to see PCP who recommended OTC antihistamine.

VAERS ID:587901 (history)  Vaccinated:2015-07-10
Age:69.0  Onset:2015-07-10, Days after vaccination: 0
Gender:Female  Submitted:2015-07-27, Days after onset: 17
Location:Vermont  Entered:2015-07-27
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHL72442 IMUN
Administered by: Other     Purchased by: Other
Symptoms: Injected limb mobility decreased, Injection site hypoaesthesia, Pain in extremity
SMQs:, Tendinopathies and ligament disorders (broad)
Write-up: Patient''s arm was really sore for a week (also and she said her arm felt numb at the site of injection) and she couldn''t lift the arm for few days. She had to go to the ER where she was told the needle might have hit the blood vessel.

VAERS ID:588426 (history)  Vaccinated:2015-07-31
Age:11.0  Onset:2015-07-31, Days after vaccination: 0
Gender:Male  Submitted:2015-08-04, Days after onset: 4
Location:Vermont  Entered:2015-08-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None. Mother gave Benadryl and used cool compresses following reaction.
Current Illness: No
Preexisting Conditions: Mother reports that she has multiple allergies
Diagnostic Lab Data: Spoke w mother today 8/4/2015 and redness is dissolving, hardened area softening.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU5058AB SCRA
Administered by: Public     Purchased by: Other
Symptoms: Erythema, Hypoaesthesia, Induration, Injection site hypoaesthesia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mother describes a reddened area on upper arm, grew to the size of a "face cloth". Had a hard center, numbness at site of injection and down the arm.

VAERS ID:589751 (history)  Vaccinated:2015-08-06
Age:33.0  Onset:2015-08-06, Days after vaccination: 0
Gender:Female  Submitted:2015-08-13, Days after onset: 7
Location:Vermont  Entered:2015-08-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Valcyclovir 1 gm-2 tabs as needed; gabapentin 400 mg-twice a day
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC4765AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Migraine, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)
Write-up: Blurriness in one eye, with migraine in frontal area.

VAERS ID:589825 (history)  Vaccinated:2015-08-06
Age:12.0  Onset:2015-08-06, Days after vaccination: 0
Gender:Male  Submitted:2015-08-10, Days after onset: 4
Location:Vermont  Entered:2015-08-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamins
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS3RB2G1UNLA
HPV9: HPV (GARDASIL 9)MERCK & CO. INC.K0262472UNRA
Administered by: Private     Purchased by: Public
Symptoms: Chills, Decreased appetite, Fatigue, Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Pt received Hep A and HPV vaccine at approximately 11 AM on 8-6-15-mom called at 4:30 the same day with concerns of chills-decreased appetite and fatigue-pt then had severe vomiting for several hrs and went to ER.

VAERS ID:589924 (history)  Vaccinated:2015-08-08
Age:29.0  Onset:2015-08-12, Days after vaccination: 4
Gender:Female  Submitted:2015-08-13, Days after onset: 1
Location:Vermont  Entered:2015-08-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Allergy: Prednisone
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.K0084090IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4774AA0IMLA
Administered by: Public     Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site warmth, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient received the vaccine on (8/08/2015). Irregular border of swelling near the injection site on the left deltoid muscle (proximal lateral). The site is approximately 3 inch in diameter and 1/16 inch elevation on 8/12/2015, patient reports that it has worsened today (8/13/2015) and increased to 2 swelling sites connecting each other, each site is approximately 3 inches in diameter on 8/13/2015. It is red, elevated, warm to touch and tender. Patient reports that it hurts when she tries to work using left arm muscle, and it is painful when she sleeps on her side. Patient has tried Ibuprofen and it did not work for the pain. The injection site is on her left arm.

VAERS ID:590084 (history)  Vaccinated:2015-07-27
Age:61.0  Onset:2015-07-29, Days after vaccination: 2
Gender:Female  Submitted:2015-08-04, Days after onset: 6
Location:Vermont  Entered:2015-08-11, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Sulfa allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.K0219191SCLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Approximately 48 hours after administration, patient experienced erythema, swelling and itchiness at injection site. Symptoms have since subsided without any treatment necessary.

VAERS ID:590461 (history)  Vaccinated:2015-07-31
Age:16.0  Onset:0000-00-00
Gender:Male  Submitted:2015-08-07
Location:Vermont  Entered:2015-08-14, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Migraines; depression
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS3RB2G1IMLA
Administered by: Private     Purchased by: Public
Symptoms: Rash erythematous, Rash generalised, Rash maculo-papular, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient developed a pruritic full body erythematous maculopapular rash the day after Hep A #2. Rash persisted for 5 days before I treated it with prednisone. Not otherwise ill.

VAERS ID:590789 (history)  Vaccinated:2015-07-08
Age:59.0  Onset:2015-07-17, Days after vaccination: 9
Gender:Male  Submitted:2015-08-14, Days after onset: 28
Location:Vermont  Entered:2015-08-19, Days after submission: 5
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: UNK
Preexisting Conditions: None
Diagnostic Lab Data: Lab tests unknown
CDC Split Type: 2015SA117498
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEUR 0UNRA
Administered by: Other     Purchased by: Other
Symptoms: Burning sensation, Exfoliative rash, Laboratory test, Pityriasis rubra pilaris, Rash erythematous, Rash pruritic
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Initial unsolicited report received from a healthcare professional on 3 August 2015. A 59-year-old male patient had received a first dose of ADACEL (batch number, route of administration not reported) in right deltoid on 8 July 2015. The patient''s illness at the time of vaccination, pre-existing physician diagnosed allergies, birth defects, medical conditions were reported as none and concomitant medication were reported as none. On 17 July 2015, nine days after vaccination, the patient developed a red scaling rash that had spread starting from his head progressing to his face and then full trunk. It both itches and burns. The patient was diagnosed with pityriasis rubra pilaris. Reporter consider it as a life-threatening illness. The patient required ER visit. The patient had tried triamcinolone cream without success as corrective treatment and was concerned that this may lead to more serious physical conditions such as liver and spleen enlargement. The patient''s blood work is pending and he is being seen as a case at a symposium this week for evaluation and treatment. Laboratory investigations were reported as ''labs''. At the time of this report, the event outcome was not recovered. Documents held by sender: none.

VAERS ID:590899 (history)  Vaccinated:2015-08-07
Age:1.0  Onset:2015-08-10, Days after vaccination: 3
Gender:Male  Submitted:2015-08-12, Days after onset: 2
Location:Vermont  Entered:2015-08-18, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.K0161540SCLL
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHL539373IMLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.L0013260SCRL
Administered by: Private     Purchased by: Public
Symptoms: Erythema multiforme, Rash generalised
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: MMR, VARIVAX and PREVNAR given Thursday. Monday night without other signs of illness developed a rash. Tuesday morning I saw him an it covered his entire body and was clearly erythema multiforme.

VAERS ID:591381 (history)  Vaccinated:2015-08-20
Age:5.0  Onset:2015-08-22, Days after vaccination: 2
Gender:Female  Submitted:2015-08-24, Days after onset: 2
Location:Vermont  Entered:2015-08-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER 3SYRLA
Administered by: Unknown     Purchased by: Other
Symptoms: Erythema, Hyperaesthesia, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Upper arm is swollen, elevated and red if it is touched or bumped she screams.

VAERS ID:591485 (history)  Vaccinated:2015-08-10
Age:59.0  Onset:2015-08-10, Days after vaccination: 0
Gender:Female  Submitted:2015-08-25, Days after onset: 15
Location:Vermont  Entered:2015-08-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Symbicort, Losartan, montelukast, pravastatin, verapamil
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU4971AA IMLA
Administered by: Unknown     Purchased by: Private
Symptoms: Hallucination, Hyperhidrosis, Pain, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Psychosis and psychotic disorders (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Body aches, fever (40.0 C), shakes, sweating, waking with hallucinations of people she knew.

VAERS ID:593958 (history)  Vaccinated:2015-09-03
Age:30.0  Onset:2015-09-04, Days after vaccination: 1
Gender:Female  Submitted:2015-09-05, Days after onset: 1
Location:Vermont  Entered:2015-09-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC. 0IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Headache, Injection site pain, Mobility decreased, Myalgia, Pyrexia, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Severe arm pain at site of injection that limited mobility, vomiting, fever, dizziness, myalgia, headache.

VAERS ID:596219 (history)  Vaccinated:2015-09-11
Age:65.0  Onset:2015-09-13, Days after vaccination: 2
Gender:Female  Submitted:2015-09-18, Days after onset: 5
Location:Vermont  Entered:2015-09-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Anastrazole 1mg, zolpidem 5mg, pantoprazole 40mg, gabapentin 300mg
Current Illness: None known
Preexisting Conditions: N/A
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHL992610IMLA
Administered by: Other     Purchased by: Public
Symptoms: Myalgia, Rash macular
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Normal soreness of deltoid muscle after IM injection, but several days later red blotch rash developed just below injection site last thru to report date of 9/18/15. Aprox. size 3 inches by 4 inches.

VAERS ID:596676 (history)  Vaccinated:2015-09-11
Age:82.0  Onset:2015-09-16, Days after vaccination: 5
Gender:Female  Submitted:0000-00-00
Location:Vermont  Entered:2015-09-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHL871171UNLA
Administered by: Other     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Redness at the injection site. Pain at the injection site.

VAERS ID:596772 (history)  Vaccinated:2015-09-11
Age:52.0  Onset:0000-00-00
Gender:Male  Submitted:2015-09-18
Location:Vermont  Entered:2015-09-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Methotrexate
Current Illness: None acute
Preexisting Conditions: Sulfa abx; CIPRO; codeine
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.K0078260UNLA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Body temperature increased, Injection site erythema
SMQs:, Neuroleptic malignant syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt got PNEUMOVAX due to new dx of rheumatoid arthritis. 1 day after vaccine got temp 101, redness at site resolved - for several days had severe (L) wrist pain resolved with ALEVE.

VAERS ID:596952 (history)  Vaccinated:2015-09-16
Age:68.0  Onset:2015-09-17, Days after vaccination: 1
Gender:Female  Submitted:2015-09-21, Days after onset: 4
Location:Vermont  Entered:2015-09-22, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Furosemide
Current Illness:
Preexisting Conditions: NKA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURUI4355AA IMUN
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHL87117 IMUN
Administered by: Other     Purchased by: Private
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Localized redness, swelling, warm to touch, mild itching of left deltoid.

VAERS ID:596955 (history)  Vaccinated:2015-09-17
Age:92.0  Onset:2015-09-17, Days after vaccination: 0
Gender:Female  Submitted:2015-09-22, Days after onset: 5
Location:Vermont  Entered:2015-09-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURUI442AB UNLA
Administered by: Other     Purchased by: Private
Symptoms: Feeling cold, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)
Write-up: Pt developed chills, shaking. Brought to ER by daughter.

VAERS ID:597283 (history)  Vaccinated:2015-09-24
Age:2.0  Onset:2015-09-24, Days after vaccination: 0
Gender:Female  Submitted:2015-09-25, Days after onset: 1
Location:Vermont  Entered:2015-09-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Acute URI
Preexisting Conditions: Milk and environmental allergies
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT)MEDIMMUNE VACCINES, INC.FJ20990IN 
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: On-call physician took call from mom at 10:15pm. Within 45 min of vaccine face was red, then at night developed large hive on (L) cheek. Mom gave BENADRYL and child went to sleep. Never had any respiratory symptoms.

VAERS ID:598153 (history)  Vaccinated:2015-09-22
Age:65.0  Onset:2015-09-24, Days after vaccination: 2
Gender:Female  Submitted:2015-10-01, Days after onset: 7
Location:Vermont  Entered:2015-10-01
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHL437000IMLA
Administered by: Other     Purchased by: Public
Symptoms: Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Left shoulder pain, persistent -rates 4/10 at rest and 8/10 with movement.

VAERS ID:598387 (history)  Vaccinated:2015-09-21
Age:85.0  Onset:2015-09-22, Days after vaccination: 1
Gender:Female  Submitted:2015-09-23, Days after onset: 1
Location:Vermont  Entered:2015-09-25, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Lisinopril, Neomycin, COLACE; HLD; COPD; Hypothyroid; Depression
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHL846310IMLA
Administered by: Public     Purchased by: Other
Symptoms: Erythema, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 1 day after administration patient developed left arm pain, swelling, redness affecting entire arm, without dyspnea, hives, dysphagia. Saw in clinic 2 days after vaccine, swelling improving, no treatment required.

VAERS ID:601520 (history)  Vaccinated:2015-09-24
Age:84.0  Onset:2015-09-25, Days after vaccination: 1
Gender:Female  Submitted:2015-10-08, Days after onset: 13
Location:Vermont  Entered:2015-10-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine; BENICAR; CENTRUM; B12; DITROPAN; EVISTA; KLOR-CON; MIROLAX; NEXIUM; Loratidine
Current Illness: None
Preexisting Conditions: GERD; HTN
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUI428AB IMLA
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHU3612300IMLA
Administered by: Other     Purchased by: Unknown
Symptoms: Erythema, Injection site pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Right upper extremity erythema, pruritis surrounding injection site. Onset 12 hours after vaccination. Improving with BENADRYL, loratadine added. Erythema persistent $g 1 week after vaccination.

VAERS ID:602186 (history)  Vaccinated:2015-09-30
Age:72.0  Onset:2015-10-01, Days after vaccination: 1
Gender:Female  Submitted:2015-10-05, Days after onset: 4
Location:Vermont  Entered:2015-10-13, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine; Estradiol; IMMODIUM; Probiotic; TYLENOL
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURVI459AB1IMLA
Administered by: Other     Purchased by: Private
Symptoms: Chills, Dizziness, Fatigue, Headache, Pain, Vertigo
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (narrow)
Write-up: Dizziness, vertigo, chills, headache, fatigue, soreness. Onset the following evening after administration 10-1-15 lasting continuously through 10-5-15.

VAERS ID:602483 (history)  Vaccinated:2015-09-24
Age:42.0  Onset:2015-09-24, Days after vaccination: 0
Gender:Female  Submitted:2015-10-02, Days after onset: 8
Location:Vermont  Entered:2015-10-06, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PRILOSEC; ADVIL; multivit.; eryth. oph. oint.
Current Illness: Stye
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC4765AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Local swelling, Musculoskeletal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Severe swelling and pain of shoulder, symptoms were somewhat improved but still persistent 1 week after.

VAERS ID:602622 (history)  Vaccinated:2015-10-09
Age:39.0  Onset:2015-10-10, Days after vaccination: 1
Gender:Unknown  Submitted:0000-00-00
Location:Vermont  Entered:2015-10-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Regualr Diabetes visit
Preexisting Conditions: Allergy to sulfa; Diagnosis of Diabetes
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU5309AA IMRA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.K007826 IMRA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Local swelling, Pain, Pruritus
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)
Write-up: Local swelling/redness/itching achyness.

VAERS ID:602792 (history)  Vaccinated:2015-10-09
Age:56.0  Onset:2015-10-11, Days after vaccination: 2
Gender:Female  Submitted:2015-10-15, Days after onset: 4
Location:Vermont  Entered:2015-10-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT)GLAXOSMITHKLINE BIOLOGICALS93T79 IMLA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Musculoskeletal pain, Neck pain, Pain, Pain in extremity
SMQs:, Rhabdomyolysis/myopathy (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Pt initially felt no pain when vaccine administered on Friday 10/9/15. Sunday 10/11/15 in the evening arm started to hurt. By Monday patient was in "agony" and saw physician. Pt said she couldn''t move her arm without pain at this time. Pain also sometimes radiates through shoulder into neck. MD prescribed muscle relaxant and Tylenol with codeine. Pt did not take Tylenol with codeine but did take muscle relaxant at night and took 600 mg of ibuprofen which she said helped. Spoke with patient on Wed 10/14 and again on Thurs 10/15/15. She said pain is getting lesser every day but still present somewhat. Advised massaging the muscle, moving it as much as possible and icing it if necessary.

VAERS ID:603232 (history)  Vaccinated:2015-10-13
Age:80.0  Onset:2015-10-13, Days after vaccination: 0
Gender:Female  Submitted:2015-10-17, Days after onset: 4
Location:Vermont  Entered:2015-10-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT)GLAXOSMITHKLINE BIOLOGICALS 0SYRLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site pain, Musculoskeletal stiffness, Neck pain
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)
Write-up: 10/13/15 Immunization given about 4:28 pm. 10/15/15 9:58 am patients daughter called and said patient was experiencing pain and stiffness from injection site of left deltoid up shoulder to back of neck. Pt applied ice and had taken ALEVE and at afternoon was not getting worse and doing better. At 8:00 pm patients daughter said patient was feeling better.

VAERS ID:603233 (history)  Vaccinated:2015-10-03
Age:67.0  Onset:2015-10-03, Days after vaccination: 0
Gender:Male  Submitted:2015-10-17, Days after onset: 14
Location:Vermont  Entered:2015-10-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: High blood pressure
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURUI456AA1UNLA
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHJ676460UNLA
Administered by: Other     Purchased by: Other
Symptoms: Injection site pain, Musculoskeletal stiffness, Neck pain
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad)
Write-up: 10/3/15 had immunization at retail pharmacy. 10/5/15 came into pharmacy and described having pain and stiffness going from site of injection up arm, across shoulders and up neck; pharmacist called covering MD who verified no red line from injection site and gave pager # if needed and advised ER if condition worsens. Pt iced and took acetaminophen and reported continuing improvement/complete recovery.

VAERS ID:603305 (history)  Vaccinated:2015-10-14
Age:16.0  Onset:2015-10-14, Days after vaccination: 0
Gender:Male  Submitted:2015-10-16, Days after onset: 2
Location:Vermont  Entered:2015-10-19, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: XOPENEX HFA
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU5309AA0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU5178AA0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site discomfort, Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Significant redness, swelling and discomfort of left shoulder area.

VAERS ID:603499 (history)  Vaccinated:2015-10-02
Age:75.0  Onset:2015-10-02, Days after vaccination: 0
Gender:Female  Submitted:2015-10-20, Days after onset: 18
Location:Vermont  Entered:2015-10-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 10 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT)GLAXOSMITHKLINE BIOLOGICALSL94EX2UNUN
Administered by: Private     Purchased by: Unknown
Symptoms: Dyspnoea, Muscular weakness, Pain in extremity, Restless legs syndrome
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)
Write-up: Leg pain, restless legs, progressive weakness of extremities, neck, difficulty breathing.

VAERS ID:604128 (history)  Vaccinated:2015-10-19
Age:60.0  Onset:2015-10-20, Days after vaccination: 1
Gender:Female  Submitted:2015-10-21, Days after onset: 1
Location:Vermont  Entered:2015-10-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  UNLA
VARZOS: ZOSTER (NO BRAND NAME)UNKNOWN MANUFACTURER  UNRA
Administered by: Private     Purchased by: Unknown
Symptoms: Injection site reaction, Local reaction
SMQs:
Write-up: Local reaction - zoster vaccine (R) deltoid. Recommended Topical hydrocortisone.

VAERS ID:604519 (history)  Vaccinated:2015-10-09
Age:52.0  Onset:2015-10-19, Days after vaccination: 10
Gender:Male  Submitted:2015-10-23, Days after onset: 4
Location:Vermont  Entered:2015-10-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Depression, reflux, CAD
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUARIX)GLAXOSMITHKLINE BIOLOGICALS43E971IMLA
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETH 0SYR 
Administered by: Unknown     Purchased by: Unknown
Symptoms: Wrong drug administered
SMQs:, Medication errors (narrow)
Write-up: Patient is 52 years old and has CAD. He is indicated for the Pneumovax. Nurse was not aware of the two different pneumococcal vaccines. Ended up grabbing Prevnar 13 from the refrigerator and gave him the injection. She did not notice it was not the correct vaccine until she was unable to document the vaccination in the chart. The lot number, etc.. is not available for me to report. He also received a flu shot on the same day.

VAERS ID:606230 (history)  Vaccinated:2015-10-26
Age:  Onset:2015-10-28, Days after vaccination: 2
Gender:Unknown  Submitted:0000-00-00
Location:Vermont  Entered:2015-10-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Asthma
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.K0249760UNRA
Administered by: Public     Purchased by: Unknown
Symptoms: Erythema, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: RA-redness, no swelling, sore right arm. No reaction on left arm where flu shot was given.

VAERS ID:606676 (history)  Vaccinated:2015-10-31
Age:81.0  Onset:2015-10-31, Days after vaccination: 0
Gender:Female  Submitted:2015-11-02, Days after onset: 2
Location:Vermont  Entered:2015-11-02
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: KEFLEX; naproxen; COLACE; senna; MIRALAX; TYLENOL XS
Current Illness: None known
Preexisting Conditions: NKDA; HTN; GERD; Heart valve disorder; costochondritis
Diagnostic Lab Data: Done at ER 11/1/15 -$g doppler US to arm, EKG, UA. Rx''d KEFLEX 500 mg and advised PCP appt 11/2
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.K0202150IMLA
Administered by: Private     Purchased by: Public
Symptoms: Abdominal pain, Cellulitis, Chest pain, Dyspnoea, Electrocardiogram, Erythema, Injection site erythema, Injection site pain, Injection site swelling, Local reaction, Pain in extremity, Peripheral swelling, Pruritus, Ultrasound Doppler, Urine analysis
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt reports left arm swelling, erythema that started about 2 hours s/p pneumonia vaccination - seen in ER on 11/1 (-) doppler U/S. Treated for cellulitis. Here for recheck. (L) arm w/ 5 x 8 cm erythema and mild swelling medial upper arm - no erythema at injection site. ? localized reaction vs cellulitis rec complete antbx FU if sx persist/worsen. Assessed pt via ODI. Pt reporting difficulty breathing, chest pain, generalized abdominal pain, and (L) arm pain. Pt going through application process and received some vaccinations to same arm yesterday. Began to have itching last night, now upper arm on the underside is red and swollen and tender to touch. Pt denies any drug allergies, unable to specify which vaccination was received. Pt has not tried anything for pain relief. Pt has good pulses to bilateral upper extremities. Lung sounds clear bilaterally on exam. History somewhat difficult to obtain due to language barrier.

VAERS ID:606958 (history)  Vaccinated:2015-10-30
Age:61.0  Onset:2015-10-30, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Vermont  Entered:2015-11-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No known allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.L0135460SCLA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt rec''d ZOSTAVAX 10/30. Called to report 11/3 index-card sized raised, red, pruritic area that developed over the weekend. No other symptoms. Used home care/local therapy on the area. Improving today.

VAERS ID:607913 (history)  Vaccinated:2015-11-02
Age:62.0  Onset:2015-11-03, Days after vaccination: 1
Gender:Female  Submitted:2015-11-06, Days after onset: 3
Location:Vermont  Entered:2015-11-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: SYNTHROID
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: CHEST X-RAYS BLOOD WORK ALSO CHECKED HEART
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.  SCLA
Administered by: Unknown     Purchased by: Other
Symptoms: Abdominal pain upper, Arthralgia, Back pain, Blood test, Body temperature increased, Cardiovascular examination, Chest X-ray, Chest pain, Headache, Nausea, Neck pain
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: HEADACHE-STOMACH ACHE-JOINT PAIN BACKACHE-NECK ACHE-ON 11/4-CHEST PAIN NAUSEA ALONG WITH OTHER SYMPTOMS TEMP 101 B/P 70 OVER 40 THOUGHT I WAS HAVING HEART ATTACK AMBULANCE CALL ENDED IN ER.

VAERS ID:608028 (history)  Vaccinated:2015-10-20
Age:63.0  Onset:2015-10-21, Days after vaccination: 1
Gender:Female  Submitted:2015-11-06, Days after onset: 16
Location:Vermont  Entered:2015-11-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Urinary tract infection
Preexisting Conditions: Meperidine allergy
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT)GLAXOSMITHKLINE BIOLOGICALS7754S UNRA
Administered by: Private     Purchased by: Private
Symptoms: Back pain, Fatigue, Headache, Pain in extremity
SMQs:, Retroperitoneal fibrosis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Arm soreness, fatigue, headache, back pain - no treatment necessary.

VAERS ID:608049 (history)  Vaccinated:2015-11-02
Age:59.0  Onset:2015-11-04, Days after vaccination: 2
Gender:Male  Submitted:2015-11-05, Days after onset: 1
Location:Vermont  Entered:2015-11-06, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Nasal congestion/Cough
Preexisting Conditions: Penicillin Allergy
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU5310CA1IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Erythema at injection site (4 x 5 cm) nontender. Full function of (L) arm. Given Rx for BENADRYL 25 mg QHS.

VAERS ID:609010 (history)  Vaccinated:2015-11-10
Age:6.0  Onset:2015-11-11, Days after vaccination: 1
Gender:Female  Submitted:2015-11-11, Days after onset: 0
Location:Vermont  Entered:2015-11-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Public
Symptoms: Injection site swelling, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Fever, swelling at injection site, muscle pain.

VAERS ID:609536 (history)  Vaccinated:2015-10-26
Age:1.4  Onset:2015-11-04, Days after vaccination: 9
Gender:Female  Submitted:2015-11-05, Days after onset: 1
Location:Vermont  Entered:2015-11-13, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU5319DA0IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.K0240360SCLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.L0235930SCRL
Administered by: Private     Purchased by: Public
Symptoms: Pyrexia, Rash generalised, Seizure
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Fever, rash (all over body). Seizure.

VAERS ID:609655 (history)  Vaccinated:2015-11-10
Age:52.0  Onset:2015-11-11, Days after vaccination: 1
Gender:Male  Submitted:2015-11-13, Days after onset: 2
Location:Vermont  Entered:2015-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amitriptyline; tramadol; furosemide; enalapril; amlodipine; Lantus; meloxicam; metformin; Novolog; Vitamin D
Current Illness: No patient reports feeling well
Preexisting Conditions: Diabetes, Neuropathy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT)GLAXOSMITHKLINE BIOLOGICALS7DT2Y0IMLA
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.L0213670IMLA
Administered by: Other     Purchased by: Private
Symptoms: Erythema, Fatigue, Nausea, Pain in extremity, Pyrexia, Skin tightness
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Began to feel feverish, tired, nausea. Redness began to spread over upper arm Wed evening: pain and tightness in upper arm, by Thursday the redness had covered most of upper arm to elbow. The patient saw a NP at his physicians office around 4:00PM Thursday and she prescribed a ZPAK.

VAERS ID:609748 (history)  Vaccinated:2015-11-09
Age:82.0  Onset:2015-11-12, Days after vaccination: 3
Gender:Female  Submitted:2015-11-13, Days after onset: 1
Location:Vermont  Entered:2015-11-13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURUI520AA0IMLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness, swelling, tenderness at injection site. Treated with KEFLEX 250 mg PO QID x 5 days.

VAERS ID:610307 (history)  Vaccinated:2015-10-28
Age:61.0  Onset:2015-10-30, Days after vaccination: 2
Gender:Female  Submitted:2015-11-17, Days after onset: 18
Location:Vermont  Entered:2015-11-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi vitamins - D and C
Current Illness:
Preexisting Conditions: Allergy to iodine
Diagnostic Lab Data: Vaccine reaction/resolved - no tx
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.L0282820SCLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Vaccination site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Two days following vaccination. pt. experienced soreness and redness at vaccine site -9 x 12 cm - no itching - no infection - no bulls eye, no petechia.

VAERS ID:610424 (history)  Vaccinated:2015-10-14
Age:41.0  Onset:2015-10-15, Days after vaccination: 1
Gender:Male  Submitted:2015-11-18, Days after onset: 34
Location:Vermont  Entered:2015-11-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: No
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT)SANOFI PASTEURUI439AB IMLA
Administered by: Other     Purchased by: Private
Symptoms: Influenza
SMQs:
Write-up: Severe flu symptoms, called out of work. Lasted 24-36 hours. Did not seek medical help. Slept for the most part of the day.

VAERS ID:610543 (history)  Vaccinated:2015-11-06
Age:63.0  Onset:2015-11-08, Days after vaccination: 2
Gender:Female  Submitted:2015-11-18, Days after onset: 10
Location:Vermont  Entered:2015-11-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER    
Administered by: Unknown     Purchased by: Private
Symptoms: Insomnia, Pain
SMQs:
Write-up: Started as dull ache and has continued to increase to a more intense ache... taking Advil to be able to sleep.

VAERS ID:610603 (history)  Vaccinated:2015-10-06
Age:58.0  Onset:2015-10-07, Days after vaccination: 1
Gender:Female  Submitted:2015-11-18, Days after onset: 42
Location:Vermont  Entered:2015-11-19, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Diabetes
Diagnostic Lab Data: Exam normal
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU5310CA IMRA
Administered by: Private     Purchased by: Unknown
Symptoms: Haematoma, Laboratory test normal, Pain in extremity
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Hematoma, arm pain. Next day continuous.

VAERS ID:611220 (history)  Vaccinated:2015-09-03
Age:67.0  Onset:2015-09-05, Days after vaccination: 2
Gender:Female  Submitted:2015-10-05, Days after onset: 30
Location:Vermont  Entered:2015-11-19, Days after submission: 45
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: UNK
Preexisting Conditions: Unknown
Diagnostic Lab Data: Lab tests unknown
CDC Split Type: 2015SA136221
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURUI428AB IMRA
Administered by: Other     Purchased by: Other
Symptoms: Injection site erythema, Injection site mass, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Initial unsolicited report received from a pharmacist on 05 September 2015. This case involves a 67-year-old female patient who was vaccinated with first dose of FLUZONE HD (batch number: UI428AB, expiry date: 19 March 2016) via intramuscular route in right deltoid on 03 September 2015. Reporter denied any illness at time of vaccination, pre-existing physician-diagnosed allergies, birth defects, medical conditions. Concomitant medications were not reported. On 05 September 2015, two days post vaccination, the patient developed redness at injection site, lump at site, warmth and red ring around injection site. Laboratory data and corrective treatments were not reported. At the time of this report, the outcome of the events was unknown. List of documents held by sender: none.

VAERS ID:612051 (history)  Vaccinated:2015-10-20
Age:48.0  Onset:2015-10-21, Days after vaccination: 1
Gender:Female  Submitted:2015-11-26, Days after onset: 36
Location:Vermont  Entered:2015-11-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: TYLENOL; NEXIUM; Gabapentin; SYNTHROID; CADUET; Citalopram; ADVAIR; CLARITIN
Current Illness: None
Preexisting Conditions: Sciatic; Allergy - NSAIDS OTC and prescription, Tramadol; KEFLEX, Clindamycin; Seasonal allergies; Codeine
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME)UNKNOWN MANUFACTURER  IMLA
Administered by: Public     Purchased by: Other
Symptoms: Injection site pain, Muscle spasms, Muscle tightness
SMQs:, Dystonia (broad), Extravasation events (injections, infusions and implants) (broad)
Write-up: Employee flu, vaccine give left upper arm. Hurt a little as fluid injected, but seemed normal injection, achy as usual following day. With 1-2 days it continued to be nagging, but was having spasms/tightness. After a couple of weeks spread to tightness in shoulder and neck, incorporated left shoulder blade. I first thought it would go away. Taking TYLENOL 2-3 x day since beginning, recently tried muscle relaxants; routine visit with chiropractor suggest PT and see PCP for continued spasms/tightening-$g saw PCP starting PT scan and PCP said I should call Employee Health.

VAERS ID:613328 (history)  Vaccinated:2015-12-03
Age:61.0  Onset:2015-12-04, Days after vaccination: 1
Gender:Female  Submitted:2015-12-06, Days after onset: 2
Location:Vermont  Entered:2015-12-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN)NOVARTIS VACCINES AND DIAGNOSTICS15722P IMUN
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.L012478 SCUN
Administered by: Other     Purchased by: Private
Symptoms: Rash erythematous, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Rash and red, itchy spots after getting ZOSTAVAX vaccine.

VAERS ID:614568 (history)  Vaccinated:2015-12-10
Age:83.0  Onset:2015-12-12, Days after vaccination: 2
Gender:Female  Submitted:2015-12-12, Days after onset: 0
Location:Vermont  Entered:2015-12-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Potassium chloride, spironolactone, magnesium oxide, folic acid, pantoprazole, sulfasalazine, cartia xt
Current Illness: No
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHM069010IMLA
Administered by: Other     Purchased by: Other
Symptoms: Headache, Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient came in on Saturday 12/12/15 at 5:45pm two days after receiving the vaccine with a swollen, red, painful injection site. She also complained of a headache. I told her she may be having a mild allergic reaction to the vaccine or one of its ingredients and suggested she take Benadryl and ibuprofen for the swelling and pain, respectively as well as recommended a cold pack being applied to the swollen area for about 20 minutes to relieve some of the swelling as well.

VAERS ID:615709 (history)  Vaccinated:2015-12-01
Age:65.0  Onset:2015-12-02, Days after vaccination: 1
Gender:Female  Submitted:2015-12-19, Days after onset: 17
Location:Vermont  Entered:2015-12-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Clonazepam; Doxepin; PREMPRO
Current Illness:
Preexisting Conditions: Chronic fatigue syndrome; Possible Lyme
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURUI459AB0IMRA
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHM206390IMLA
Administered by: Other     Purchased by: Other
Symptoms: Injected limb mobility decreased, Lymphadenopathy
SMQs:, Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Patient followed up with pharmacy a week after receiving immunizations to state she had swollen lymph nodes in arm that received flu shot and that she couldn''t raise that arm initially. And she was in bed for several days.

VAERS ID:616561 (history)  Vaccinated:2015-12-14
Age:65.0  Onset:2015-12-20, Days after vaccination: 6
Gender:Female  Submitted:2015-12-22, Days after onset: 2
Location:Vermont  Entered:2015-12-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Calcium carbonate/vitamin D3; Cholecalciferol; Diphenhydramine; Doxylamine succinate; Lysine; Magnesium; Methylcellulose; Multivitamin; Naproxen
Current Illness: No illness noted
Preexisting Conditions: PMR (polymyalgia rheumatica); Heart murmur; Raynaud''s disease; Osteoporosis; Colon polyp
Diagnostic Lab Data: Patient seen by primary MD on 12/21/15
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHM206390IMRA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient developed redness, swelling and itching to right upper outer arm and painful to touch on 12/20/15. The redness, swelling and itching improved, however, was still present on 12/21/15. Patient seen in office visit on 12/21/15. Patient had been applying ice and cortisone cream at onset. This treatment and BENADRYL was recommended at MD visit.

VAERS ID:617881 (history)  Vaccinated:2016-01-06
Age:36.0  Onset:2016-01-06, Days after vaccination: 0
Gender:Male  Submitted:2016-01-07, Days after onset: 1
Location:Vermont  Entered:2016-01-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT)GLAXOSMITHKLINE BIOLOGICALSAT3CC0IMRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Dizziness, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Write-up: Husband of client received IIV4 Flulaval at 2:25 pm on 1/6/16 during a clinic visit with wife and 4 week old infant. This client is a 36 year old male with no history of illness and no history of chronic illness. Client was asked all required and necessary questions regarding past experience with vaccinations, allergies to eggs and/or vaccine components. Client stated no negative events occurred from vaccinations, the last vaccination being a TD. This was his first flu shot he was receiving to protect his 4 week old daughter. Flulaval (Lot: AT3CC, NCD 19515-898-11), 0.5ml, was administered IM to right deltoid at 2:25pm. Fifteen minutes following vaccination with Flulaval client reports going into bathroom, feeling lightheaded, lowering himself to the floor and then vomited. He returned to office and then reported to another nurse that he had nearly passed out when he had a vaccination in the past. Vital signs were taken, 108/76, Pulse regular 80. Client appeared pale and was sat at table, provided a drink, and asked to remain in place for monitoring. At 3:30pm this client desired to leave with wife/baby reporting he felt better. His pulse was 80 regular. At time of event the Nursing Supervisor was informed and present for entire follow up monitoring. Client was advised at time of department from office to seek medical attention for further symptoms. A follow up telephone call was made to client at 4 pm, he was attempting to eat, but reports vomiting what he had eaten. This RN instructed patient to have wife drive him home, and to lay down.

VAERS ID:619856 (history)  Vaccinated:2016-01-15
Age:1.0  Onset:2016-01-17, Days after vaccination: 2
Gender:Female  Submitted:2016-01-20, Days after onset: 3
Location:Vermont  Entered:2016-01-20
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT)SANOFI PASTEURU5338BA1IMRL
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS294X90IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.K0740360SCRL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.L0264050SCLL
Administered by: Public     Purchased by: Public
Symptoms: Altered state of consciousness, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: About 30 hrs after getting MMR, V, Hep A, Flu vaccine, pt has brief period of altered level of consciousness while bathing, possible mild seizure (mom reported some brief shaking), f/b vomiting and then promptly fell asleep. Responsive at time of mom''s call with NL breathing and temp.

VAERS ID:621353 (history)  Vaccinated:2016-01-23
Age:82.0  Onset:2016-01-24, Days after vaccination: 1
Gender:Female  Submitted:2016-01-29, Days after onset: 5
Location:Vermont  Entered:2016-01-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Epidermal Steroid Injection, Hydrocodone/APAP, Zolpidem, Benicar/HCTZ, Amlodipine
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHM564420IMLA
Administered by: Other     Purchased by: Private
Symptoms: Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pain in arm where vaccine was administered, and continually ongoing pain up until current date of 01/29/16.

VAERS ID:621884 (history)  Vaccinated:2016-02-03
Age:55.0  Onset:2016-02-03, Days after vaccination: 0
Gender:Female  Submitted:2016-02-04, Days after onset: 1
Location:Vermont  Entered:2016-02-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ventolin, Lipitor, Singulair, Nexium, Wellbutrin, Klonopin, Advair, HCTZ
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data: n/a
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSFB3A32IMLA
Administered by: Public     Purchased by: Public
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)
Write-up: Vaccine administered after is expiration date.

VAERS ID:622406 (history)  Vaccinated:2016-02-03
Age:11.0  Onset:2016-02-05, Days after vaccination: 2
Gender:Female  Submitted:2016-02-11, Days after onset: 6
Location:Vermont  Entered:2016-02-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Allergic to amoxicillin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSP22P31IMLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Localized 4"round, red, slightly raised circle around injection site and painful.

VAERS ID:622596 (history)  Vaccinated:2015-08-13
Age:40.0  Onset:2015-08-14, Days after vaccination: 1
Gender:Female  Submitted:2015-12-30, Days after onset: 138
Location:Vermont  Entered:2016-02-12, Days after submission: 44
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Aspirin allergy in infancy
Diagnostic Lab Data: Tested negative for Lyme, Lupus, Arthritis; Hep B antibodies present
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (NO BRAND NAME)UNKNOWN MANUFACTURER 1UNAR
Administered by: Other     Purchased by: Other
Symptoms: Activities of daily living impaired, Antiphospholipid antibodies negative, Arthralgia, Bone pain, Borrelia test negative, Gait disturbance, Hepatitis B antibody positive, Muscular weakness, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Liver infections (narrow), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Eosinophilic pneumonia (broad), Osteonecrosis (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)
Write-up: Muscle weakness and pain, bone and joint pain - felt arthritic, could not drive because of muscle weakness. Could barely walk for 10 days - chiropractic care, E.R. visit, phys. visit - lab tests.

VAERS ID:622962 (history)  Vaccinated:2016-02-10
Age:15.0  Onset:2016-02-12, Days after vaccination: 2
Gender:Male  Submitted:2016-02-17, Days after onset: 5
Location:Vermont  Entered:2016-02-17
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concerta 36mg; Ventolin HFA
Current Illness:
Preexisting Conditions: ADHD; Cough Variant Asthma; Migraine
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU5304AB7IMLA
HPV9: HPV (GARDASIL 9)MERCK & CO. INC.L0192972IMLA
Administered by: Private     Purchased by: Public
Symptoms: Aggression, Headache, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Hostility/aggression (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)
Write-up: Blurry vision, headache, combative.

VAERS ID:623260 (history)  Vaccinated:2016-02-18
Age:0.2  Onset:2016-02-18, Days after vaccination: 0
Gender:Female  Submitted:2016-02-22, Days after onset: 4
Location:Vermont  Entered:2016-02-22
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX)GLAXOSMITHKLINE BIOLOGICALS4922C0PO 
HIBV: HIB (ACTHIB)SANOFI PASTEURUI378AAA0IMLL
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHM290420IMRL
Administered by: Public     Purchased by: Public
Symptoms: Incorrect route of drug administration, Product packaging confusion
SMQs:, Medication errors (narrow)
Write-up: Pt was administer medication (Pediarix) via incorrect route (orally) due to confusion with packaging similarities to Rotavirus.

VAERS ID:624287 (history)  Vaccinated:2016-02-29
Age:5.0  Onset:0000-00-00
Gender:Male  Submitted:2016-02-29
Location:Vermont  Entered:2016-02-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: No
Preexisting Conditions: NKA, No medical Hx
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS5G9430IMRA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.K0138670SCLA
Administered by: Public     Purchased by: Unknown
Symptoms: Drug administered to patient of inappropriate age, No adverse event
SMQs:, Medication errors (narrow)
Write-up: No adverse events to report.

VAERS ID:624309 (history)  Vaccinated:2016-02-15
Age:1.5  Onset:2016-02-15, Days after vaccination: 0
Gender:Female  Submitted:2016-02-29, Days after onset: 14
Location:Vermont  Entered:2016-02-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSX9LB70IMLL
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.K0148330SCLL
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.L0264080SCRL
Administered by: Public     Purchased by: Public
Symptoms: Circumstance or information capable of leading to medication error, Injection site infection, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Medication errors (narrow)
Write-up: During immunization visit as the Varicella vaccine was being injected the child moved and vaccine was injected too shallow. At the time child appeared to be OK and we planned to repeat vaccine at a later date. One week later the parent called and informed us that a week after she had taken the child to a provider after the site become swollen. The provider said to the parent that the site may have had an infection and treated the child with antibiotics. The parent said the swelling was now going down.

VAERS ID:626181 (history)  Vaccinated:2016-03-07
Age:49.0  Onset:2016-03-07, Days after vaccination: 0
Gender:Male  Submitted:2016-03-08, Days after onset: 1
Location:Vermont  Entered:2016-03-08
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole; Sucralfate; CRESTOR; VENTOLIN
Current Illness:
Preexisting Conditions: NKDA; HTN; GERD
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU5243AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Impaired work ability, Injection site erythema, Injection site pain, Injection site warmth, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)
Write-up: Pt. was administered Tdap during routine PE 3/7. States he went home and arm was sore, red, and hot at injection site. Pt reports pain this morning in (L) arm only, is not able to work. Site feels hot to touch today, afebrile. Pt took TYLENOL last night and applied ice to site. Improvement in symptoms today.

VAERS ID:626442 (history)  Vaccinated:2016-03-02
Age:17.0  Onset:2016-03-03, Days after vaccination: 1
Gender:Male  Submitted:2016-03-04, Days after onset: 1
Location:Vermont  Entered:2016-03-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data: To ER on 3/4/16
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS294X90IMUN
HPV4: HPV (GARDASIL)MERCK & CO. INC.L0192970IMUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU5058AC IM 
Administered by: Private     Purchased by: Public
Symptoms: Back pain, Decreased appetite, Diarrhoea, Dizziness, Fatigue, Headache, Immediate post-injection reaction, Rash
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Pt appeared light headed immediately after immunizations, which care was rendered, mom in attendance on 3/3/16. Next day mom called to report diarrhea, rash on bilat arms, fatigued, headache, poor appetite and not taking in fluids. Also with lower back pain. Sent to ER 3/4/16.

VAERS ID:626980 (history)  Vaccinated:2016-03-14
Age:20.0  Onset:2016-03-14, Days after vaccination: 0
Gender:Female  Submitted:2016-03-14, Days after onset: 0
Location:Vermont  Entered:2016-03-14
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT)SANOFI PASTEURUI440AB3IMRA
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALS793JR0IMLA
Administered by: Private     Purchased by: Other
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)
Write-up: GAVE HEP A VACCINE WHICH HAD EXPIRED LAST MONTH.

VAERS ID:628265 (history)  Vaccinated:2016-03-03
Age:  Onset:2016-03-03, Days after vaccination: 0
Gender:Unknown  Submitted:2016-03-21, Days after onset: 17
Location:Vermont  Entered:2016-03-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1603USA007667
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMR: MEASLES + MUMPS + RUBELLA (MMR II)MERCK & CO. INC.K002816 SCUN
Administered by: Other     Purchased by: Other
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)
Write-up: Information has been received from a physician referring to a patient of unknown age and gender. The patient''s medical history and drug reactions/allergies were not reported. On 03-MAR-2016 the patient was vaccinated with an expired dose of M-M-R II (rHA) (dose unknown, lot # K002816, expiration date 25-FEB-2016, subcutaneous) (expired product administered). No known adverse effects were reported. Additional information has been requested.

VAERS ID:629066 (history)  Vaccinated:2016-03-21
Age:60.0  Onset:2016-03-23, Days after vaccination: 2
Gender:Female  Submitted:2016-03-24, Days after onset: 1
Location:Vermont  Entered:2016-03-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: HCTZ; LEXAPRO
Current Illness:
Preexisting Conditions: NKDA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.L029481 SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, 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)
Write-up: (R) upper arm with blanching/redness noted approx. 1/2 dollar size. Pt c/o itching- mild swelling which was improving remarkably. No evidence of cellulitis. Tx: Rest, ice and BENADRYL PRN. Pt declined and will continue to monitor.

VAERS ID:629452 (history)  Vaccinated:2016-03-23
Age:25.0  Onset:2016-03-24, Days after vaccination: 1
Gender:Female  Submitted:2016-03-24, Days after onset: 0
Location:Vermont  Entered:2016-03-25, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Wellbutrin
Current Illness:
Preexisting Conditions: NKDA; Seasonal depression
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV9: HPV (GARDASIL 9)MERCK & CO. INC.L0444752IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Left deltoid with 4" x 5" red, warm, swollen area, distal to injection site. Symptoms started 1 day post injection worsened overnight into day 2 post injection. Some tingling in fingers with certain positions. Recommended ice, evaluation, ibuprofen, and BENADRYL

VAERS ID:630198 (history)  Vaccinated:2016-04-01
Age:67.0  Onset:2016-04-02, Days after vaccination: 1
Gender:Female  Submitted:2016-04-04, Days after onset: 2
Location:Vermont  Entered:2016-04-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VENLAFAXINE, ENALAPRIL, PANTOPRAZOLE
Current Illness: NONE
Preexisting Conditions: NONE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.L0391260SCLA
Administered by: Other     Purchased by: Public
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: REDNESS AT INJECTION SITE (1.5 INCH x 3 INCHES), WARMTH.

VAERS ID:631860 (history)  Vaccinated:2016-04-14
Age:72.0  Onset:2016-04-14, Days after vaccination: 0
Gender:Female  Submitted:2016-04-15, Days after onset: 1
Location:Vermont  Entered:2016-04-18, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fish oil; SYNTHROID; Lisinopril; ASA; ARICEPT; Simvastatin; NAMENDA; Nifedipine
Current Illness: No
Preexisting Conditions: DM; HLP; HTN; Congenital Absence of right arm
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHM502591IMRA
Administered by: Private     Purchased by: Public
Symptoms: Extra dose administered, No adverse event
SMQs:, Medication errors (narrow)
Write-up: Patient receive 2 dosed of PREVNAR 13 3 months apart. No physical reaction to this immunization.

VAERS ID:634048 (history)  Vaccinated:2016-03-29
Age:4.0  Onset:2016-03-31, Days after vaccination: 2
Gender:Female  Submitted:2016-03-31, Days after onset: 0
Location:Vermont  Entered:2016-05-03, Days after submission: 33
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPV: DTAP + IPV (KINRIX)GLAXOSMITHKLINE BIOLOGICALST325H0IMRL
Administered by: Private     Purchased by: Public
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Hives 2 days after vaccine given covers whole body.

VAERS ID:634172 (history)  Vaccinated:2016-04-21
Age:0.3  Onset:0000-00-00
Gender:Female  Submitted:2016-05-04
Location:Vermont  Entered:2016-05-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPV: DTAP + IPV (KINRIX)GLAXOSMITHKLINE BIOLOGICALS3N7Y71IMLL
Administered by: Unknown     Purchased by: Public
Symptoms: Unevaluable event
SMQs:
Write-up: No adverse event identified.

VAERS ID:634173 (history)  Vaccinated:2016-04-25
Age:0.3  Onset:0000-00-00
Gender:Female  Submitted:2016-05-04
Location:Vermont  Entered:2016-05-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPV: DTAP + IPV (KINRIX)GLAXOSMITHKLINE BIOLOGICALS3N7Y7 IMLL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:
Write-up: No adverse event identified.

VAERS ID:634180 (history)  Vaccinated:2016-05-03
Age:12.0  Onset:2016-05-04, Days after vaccination: 1
Gender:Female  Submitted:2016-05-04, Days after onset: 0
Location:Vermont  Entered:2016-05-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV9: HPV (GARDASIL 9)MERCK & CO. INC.L0432132UNLA
Administered by: Other     Purchased by: Other
Symptoms: Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: TC from mom 5/4/16. Received #3 HPV 5/3/16 pm. Developed a fever only 101.6-$g102.5. No other symptoms.

VAERS ID:634198 (history)  Vaccinated:2016-05-02
Age:5.0  Onset:2016-05-02, Days after vaccination: 0
Gender:Male  Submitted:2016-05-03, Days after onset: 1
Location:Vermont  Entered:2016-05-04, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Allergy to Amox (rash)
Diagnostic Lab Data: None needed
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPV: DTAP + IPV (KINRIX)GLAXOSMITHKLINE BIOLOGICALSH53CL IMLA
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.L031098 SCRA
Administered by: Private     Purchased by: Unknown
Symptoms: Listless, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: Fever to 105 this morning, decreased to 100.4 after several hours, no treatment given. Also listless.

VAERS ID:635644 (history)  Vaccinated:2016-05-05
Age:64.0  Onset:2016-05-08, Days after vaccination: 3
Gender:Male  Submitted:2016-05-16, Days after onset: 8
Location:Vermont  Entered:2016-05-16
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC. 0IMLA
Administered by: Other     Purchased by: Private
Symptoms: Erythema, Eyelid pain, Herpes zoster, Ocular hyperaemia, Pain, Rash, Rash vesicular, Secretion discharge, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad), Periorbital and eyelid disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Redness and rash appeared on my forehead above the right temple 3 days after the (05/05/2016) shingles immunization; each day the rash developed slowly in size, slight bubbling, and very slight swelling; after 9 days, my right eye became very red, bloodshot, and a small bubble appeared on each of my eyelids; no itching was associated with the rash; on day 9, I also began infrequently to experience sharp pains shooting down the rash and into my eyelids; I treated the rash with bag balm for four days, but switched to Calamine lotion on day 10. It had a very effective drying impact on the skin and stopped the little weeping I was getting from slight pocks in my skin. Today I saw a physician and ophthalmologist who prescribed Prednisolone drops 2x/day for my right eye and Acyclovir 800 mg tablets 5x/day for shingles.

VAERS ID:636688 (history)  Vaccinated:2016-04-15
Age:64.0  Onset:2016-04-15, Days after vaccination: 0
Gender:Female  Submitted:2016-05-24, Days after onset: 39
Location:Vermont  Entered:2016-05-24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no illness
Preexisting Conditions: induced hypothyroidism, cirrhosis, C.O.P.D.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (NO BRAND NAME)UNKNOWN MANUFACTURER 1SYRLA
Administered by: Public     Purchased by: Other
Symptoms: Injection site erythema, Injection site induration, Injection site pain, Injection site swelling, Mobility decreased, Neuralgia
SMQs:, Peripheral neuropathy (narrow), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Raised red site, hard & painful at site....next day I could barely move my arm & one month later still occasional nerve [?] pain.

VAERS ID:637064 (history)  Vaccinated:2016-05-19
Age:  Onset:2016-05-19, Days after vaccination: 0
Gender:Unknown  Submitted:2016-05-23, Days after onset: 4
Location:Vermont  Entered:2016-05-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1605USA010373
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.K020215 SYRUN
Administered by: Other     Purchased by: Other
Symptoms: Expired product administered, No adverse event
SMQs:, Medication errors (narrow)
Write-up: Information has been received from a nurse referring to a patient of unknown age and gender. Information about concurrent condition, medical history and concomitant medication was not provided. On 19-MAY-2016 the patient was inadvertently vaccinated with an expired dose of PNEUMOVAX 23 (lot # K020215, expiration date 15-MAY-2016, dose, dose# and route unknown). No adverse effect reported. The outcome of the event was unknown. Additional information has been requested.

VAERS ID:637266 (history)  Vaccinated:2016-05-21
Age:66.0  Onset:2016-05-21, Days after vaccination: 0
Gender:Female  Submitted:2016-05-26, Days after onset: 5
Location:Vermont  Entered:2016-05-26
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.L0241290IMLA
Administered by: Other     Purchased by: Private
Symptoms: Neck pain, Pain, Pain in extremity
SMQs:, Arthritis (broad), Tendinopathies and ligament disorders (broad)
Write-up: Throbbing, severe pain approximately 2 hours after vaccination. Pain in neck and down arm. Took TYLENOL but little improvement. Spoke with pt 5-25-16 8 am and she reported it was 80% better.

VAERS ID:637687 (history)  Vaccinated:2016-05-23
Age:60.0  Onset:2016-05-24, Days after vaccination: 1
Gender:Female  Submitted:2016-05-24, Days after onset: 0
Location:Vermont  Entered:2016-05-25, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ADVAIR; PROZAC
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARZOS: ZOSTER (ZOSTAVAX)MERCK & CO. INC.L0323970SCRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 3.5 cm x 7 cm area of painful, tender, warm erythema along lateral right upper arm onset this morning.

VAERS ID:640300 (history)  Vaccinated:2016-05-25
Age:10.0  Onset:2016-05-25, Days after vaccination: 0
Gender:Male  Submitted:2016-05-25, Days after onset: 0
Location:Vermont  Entered:2016-05-27, Days after submission: 2
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hx of 34 week prematurity; mild pulmonary stenosis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.L0432130IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU5228BA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALS9Y57K0IMLA
Administered by: Private     Purchased by: Public
Symptoms: Face injury, Fall, Immediate post-injection reaction, Seizure, Tooth fracture
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad)
Write-up: Pt was given MENACTRA and HPV in (R) arm. Seconds later was given Tdap in (L) arm and immediately fell forward off table and hit face on floor. Seizure for less than 20 seconds. Broke off tooth in process. Pt with hx anxiety with vaccines especially.

VAERS ID:640319 (history)  Vaccinated:2016-06-19
Age:80.0  Onset:0000-00-00
Gender:Female  Submitted:2016-06-21
Location:Vermont  Entered:2016-06-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.L0148760SYRLA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site pain, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Left deltoid - redness, soreness, warm to touch.

VAERS ID:641577 (history)  Vaccinated:2016-06-28
Age:9.0  Onset:2016-06-28, Days after vaccination: 0
Gender:Female  Submitted:2016-06-29, Days after onset: 1
Location:Vermont  Entered:2016-06-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: fluoxetine; albuterol
Current Illness: No
Preexisting Conditions: Allergy, AUGMENTIN; anxiety; asthma; autism
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.M0009951SCLA
Administered by: Private     Purchased by: Other
Symptoms: Anxiety, Dizziness, Fall, Foaming at mouth, Gaze palsy, Head injury, Musculoskeletal stiffness, Syncope, Unresponsive to stimuli
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), Convulsions (broad), Dystonia (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), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (broad), Hypoglycaemia (broad)
Write-up: Patient was getting stickers after shot, Mom said patient didn''t respond to her question then patient reported feeling dizzy. Her body became stiff, eyes rolled back, her arms were stiff, foamy mouth and was unresponsive. She fell to the floor. Mom wasn''t able to catch her so she hit her head. Dr. arrived to evaluate and patient came to and was interactive and immediately oriented to where she was but anxious. Fam. history of petit mal seizures. Unclear if episode was syncope/vagal response or seizure, although would be very brief and without postictal phase if seizure. Full exam normal. Reassurance. F/U visit 6/29/16 diagnosed as syncope after vaccination.

VAERS ID:641670 (history)  Vaccinated:2016-06-30
Age:28.0  Onset:2016-06-30, Days after vaccination: 0
Gender:Male  Submitted:2016-07-04, Days after onset: 4
Location:Vermont  Entered:2016-07-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft
Current Illness: None.
Preexisting Conditions: None.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER 2IMRA
Administered by: Private     Purchased by: Other
Symptoms: Immediate post-injection reaction, Injection site bruising, Injection site induration, Injection site swelling, Pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow)
Write-up: Immediate swelling at injection site. Soreness and swelling for 2 days after. 4 days later and there is a large bruise around injection site and even larger area around that is hard and swollen.

VAERS ID:642253 (history)  Vaccinated:2016-07-05
Age:87.0  Onset:2016-07-06, Days after vaccination: 1
Gender:Male  Submitted:2016-07-07, Days after onset: 1
Location:Vermont  Entered:2016-07-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Acetaminophen, meclizine as needed.
Current Illness: No.
Preexisting Conditions: Prostate cancer.
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (NO BRAND NAME)UNKNOWN MANUFACTURER  IMRA
Administered by: Private     Purchased by: Other
Symptoms: Feeling abnormal, Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Dementia (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Patient experienced redness, swelling, hot to touch area, over entire right bicep. States "I did not feel like myself."

VAERS ID:643461 (history)  Vaccinated:2016-07-13
Age:5.0  Onset:2016-07-14, Days after vaccination: 1
Gender:Female  Submitted:2016-07-15, Days after onset: 1
Location:Vermont  Entered:2016-07-15
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Peanut allergy
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAPIPV: DTAP + IPV (KINRIX)GLAXOSMITHKLINE BIOLOGICALS43HB30IMLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Local reaction
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Immunization administered 2 days ago. Swelling and erythema present at site 1 day after administration. Large local reaction. Advised PRN antihistamines for itchiness.

VAERS ID:643825 (history)  Vaccinated:2016-07-14
Age:7.0  Onset:0000-00-00
Gender:Male  Submitted:2016-07-19
Location:Vermont  Entered:2016-07-19
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALSZ2M9L5IMRA
Administered by: Private     Purchased by: Public
Symptoms: Wrong drug administered
SMQs:, Medication errors (narrow)
Write-up: 7 year old male given DtaP instead of Tdap.

VAERS ID:644449 (history)  Vaccinated:2016-07-18
Age:49.0  Onset:2016-07-19, Days after vaccination: 1
Gender:Male  Submitted:2016-07-21, Days after onset: 2
Location:Vermont  Entered:2016-07-21
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.L0198360IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEUR782220IMLA
Administered by: Private     Purchased by: Public
Symptoms: Injection site erythema, Injection site pain, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Redness, swelling, tenderness to injection site. Evaluated by provider 7/21 recommend ice to area, monitor for improvement, RTC, if any concerns/no improvement in 5 days.

VAERS ID:645269 (history)  Vaccinated:2016-06-29
Age:11.0  Onset:2016-06-30, Days after vaccination: 1
Gender:Male  Submitted:2016-07-01, Days after onset: 1
Location:Vermont  Entered:2016-07-25, Days after submission: 24
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: multivitamin
Current Illness:
Preexisting Conditions: Allergy to amoxicillin
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV9: HPV (GARDASIL 9)MERCK & CO. INC.L0192970IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU5186AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site induration, Injection site reaction, Injection site warmth, Pallor
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: 9 cm indurated warm local blanching area surrounding vaccine.

VAERS ID:645443 (history)  Vaccinated:2016-07-28
Age:34.0  Onset:2016-07-29, Days after vaccination: 1
Gender:Female  Submitted:2016-07-29, Days after onset: 0
Location:Vermont  Entered:2016-07-29
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prenatal vitamin, Vitamin D, probiotic, calcium + magnesium supplement
Current Illness: none
Preexisting Conditions: Sulfa-antibiotics
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALS542F3 IMLA
Administered by: Private     Purchased by: Public
Symptoms: Chills, Faeces soft, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mild fever 99.4-100.4, chills, body aches, soft bowel movements.

VAERS ID:646932 (history)  Vaccinated:2015-12-04
Age:72.0  Onset:2015-12-04, Days after vaccination: 0
Gender:Female  Submitted:2016-08-09, Days after onset: 248
Location:Vermont  Entered:2016-08-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: None
Diagnostic Lab Data:
CDC Split Type: USSA2015SA208185
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE)SANOFI PASTEURUI524AA UNLA
Administered by: Other     Purchased by: Unknown
Symptoms: Dysgeusia
SMQs:, Taste and smell disorders (narrow)
Write-up: Initial unsolicited report received from a non-healthcare professional on 07 December 2015. This case involves a 72-years old female patient who was vaccinated with a dose of FLUZONE HD (batch number: UI524AA, dose, dose in series and route of administration was not reported) in the left arm on 04 December 2015. The patient''s illness at time of vaccination, pre-existing physician diagnosed allergies, birth defects, medical conditions were reported as none and denied any other vaccinations within four weeks of vaccinations. The patient''s concomitant medications were not reported. On 04 December 2015, thirty minutes following the vaccination, the patient had developed metallic taste. Laboratory data and corrective treatment was not reported. On an unknown date, the patient was recovered from the event (after 1.5 day). List of documents held by sender: none.

VAERS ID:647206 (history)  Vaccinated:2016-07-26
Age:18.0  Onset:0000-00-00
Gender:Female  Submitted:2016-07-27
Location:Vermont  Entered:2016-08-09, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD)MERCK & CO. INC.L0392692SCLA
Administered by: Private     Purchased by: Public
Symptoms: Wrong drug administered
SMQs:, Medication errors (narrow)
Write-up: Patient was inadvertently given MMRV instead of MMR; they were next to each other in the fridge and grabbed the wrong one, even though the bottle was checked.

VAERS ID:647250 (history)  Vaccinated:2016-08-05
Age:77.0  Onset:2016-08-08, Days after vaccination: 3
Gender:Female  Submitted:2016-08-10, Days after onset: 2
Location:Vermont  Entered:2016-08-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: carvedilol, furosemide, lisinopril
Current Illness: NONE
Preexisting Conditions: NONE. PT HAD PNEUMONIA VACCINATION BEFORE
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHM67951 IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: On 08/08/2016, patient noticed warmth and redness around injection site. On 08/10/2016, patient came to pharmacy with symptoms.

VAERS ID:647289 (history)  Vaccinated:2016-07-26
Age:74.0  Onset:2016-07-26, Days after vaccination: 0
Gender:Male  Submitted:2016-08-11, Days after onset: 16
Location:Vermont  Entered:2016-08-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Zocor, hyzaar, Zoloft, aspirin, fish oil, calcium, glucosamine chondroitin, albuterol, multivitamin
Current Illness: No
Preexisting Conditions: CAD, HTN, arthritis
Diagnostic Lab Data: ER did labs, chest CT. Seen for f/u in doctor''s office. Referral to cardiology.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PNC13: PNEUMO (PREVNAR13)PFIZER/WYETHM793200IMLA
Administered by: Public     Purchased by: Private
Symptoms: Chest X-ray, Chest pain, Feeling hot, Malaise, Pain, Pericarditis
SMQs:, Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Body aches, chest pain, feeling hot, malaise. Diagnosed with pericarditis in ER.

VAERS ID:647823 (history)  Vaccinated:2016-08-02
Age:2.0  Onset:2016-08-03, Days after vaccination: 1
Gender:Male  Submitted:2016-08-12, Days after onset: 9
Location:Vermont  Entered:2016-08-12
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (INFANRIX)GLAXOSMITHKLINE BIOLOGICALS22M9L1IMRL
Administered by: Private     Purchased by: Public
Symptoms: Body temperature, Injection site erythema, Injection site swelling, Vomiting
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Clients guardian called on 8/3/16 reporting (R) leg was swollen had a temp of 101.0 and was vomiting. 8/4/16 temp 99.5 (R) leg near inj. site red, swelling had gone down then increased. After phone call came to office measured about 7 in diameter reddened area, reported on 8/3/16 had vomited 3 times.

VAERS ID:648353 (history)  Vaccinated:2016-08-16
Age:62.0  Onset:2016-08-16, Days after vaccination: 0
Gender:Female  Submitted:2016-08-18, Days after onset: 2
Location:Vermont  Entered:2016-08-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: BENTYL 20mg QID
Current Illness: None
Preexisting Conditions: J44.9; K58.0; I70.0; T30.9; F17.200
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
PPV: PNEUMO (PNEUMOVAX)MERCK & CO. INC.L0198350IMLA
Administered by: Private     Purchased by: Public
Symptoms: Erythema, Pain in extremity, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Administered 8/16/16. Tuesday night pain and redness started in arm. Wednesday pm fever started: pt reports 100.4. Pt administered TYLENOL immediately and fever subsided. Current temp 97.8.

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