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Found 32332 cases where Vaccine is PNC13

Table

   
AgeCountPercent
< 3 Years1732153.57%
3-6 Years14924.61%
6-9 Years580.18%
9-12 Years550.17%
12-17 Years350.11%
17-44 Years2610.81%
44-65 Years13674.23%
65-75 Years496615.36%
75+ Years27938.64%
Unknown398412.32%
TOTAL32332100%

Case Details

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VAERS ID: 237522 (history)  
Form: Version 1.0  
Age: 0.44  
Sex: Male  
Location: Colorado  
Vaccinated:2005-05-05
Onset:2005-05-05
   Days after vaccination:0
Submitted: 2005-05-18
   Days after onset:13
Entered: 2005-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21A013AA / 2 LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 0806P / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH A67180E / 2 RL / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Erythema, Feeling hot
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: no
Allergies:
Diagnostic Lab Data: none
CDC Split Type: CO0502

Write-up: 5 minutes after patient was vaccinated both legs became very warm and red to the touch. MD notified, he examined patient, patient was given Benadryl 8mg and Tylenol.


VAERS ID: 383880 (history)  
Form: Version 1.0  
Age: 0.69  
Sex: Male  
Location: Minnesota  
Vaccinated:2010-03-25
Onset:2010-03-27
   Days after vaccination:2
Submitted: 2010-03-30
   Days after onset:3
Entered: 2010-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3498AA / 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH D88183 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1440Y / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: rash~Hep B (Recombivax HB)~3~0.58~Patient|rash~DTaP + IPV + Hib (Pentacel)~2~0.58~Patient|rash~Rotavirus (Rotateq)~2~0.58~Patien
Other Medications: Pt is currently on Amoxicillin, but the rash is not from this. He had this rash after last set of immunizations as well.
Current Illness: Upper Respiratory illness
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Rash which had also appeared after last immunizations.


VAERS ID: 383909 (history)  
Form: Version 1.0  
Age: 0.14  
Sex: Male  
Location: Ohio  
Vaccinated:2010-03-19
Onset:2010-03-20
   Days after vaccination:1
Submitted: 2010-03-31
   Days after onset:11
Entered: 2010-03-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3602AB / 1 LG / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E13861 / 1 LG / UN
RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS A41FB0033D / 1 MO / PO

Administered by: Unknown       Purchased by: Other
Symptoms: Blood test normal, Brain scan normal, Chest X-ray normal, Computerised tomogram normal, Convulsion, Crying, Drooling, Dyspnoea, Electroencephalogram normal, Eye disorder, Gaze palsy, Lumbar puncture normal, Muscle tightness, Musculoskeletal stiffness, Opisthotonus, Posture abnormal, Protrusion tongue, Screaming, Tremor
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Dyskinesia (narrow), Dystonia (narrow), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Corneal disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Arthritis (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Poly-Visol with iron vitamin
Current Illness: none
Preexisting Conditions: prematurity (born at 31 weeks)
Allergies:
Diagnostic Lab Data: CT scan of brain came back normal, blood tests and spinal tap for illness came back normal, EEG came back normal, lung x-ray came back normal (patient''s breathing after seizure appears stilted). Second EEG in 3 weeks.
CDC Split Type:

Write-up: patient had been screaming and crying inconsolably all night long. In morning during diaper change he would not put his legs down, so patient''s father held legs straight and patient had a seizure. Arched back, eyes glazed and rolled back in head, all limbs stiff and stretched outward, shaking all over, drooling excessively, head turned to side, jaw clenched shut, tongue sticking out in fixed position, trying to cry out but unable to. Lasted about a minute, 911 was called.


VAERS ID: 384217 (history)  
Form: Version 1.0  
Age: 0.42  
Sex: Male  
Location: California  
Vaccinated:2010-03-30
Onset:2010-03-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2010-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3532AA / 2 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44527 / 1 RL / UN

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)

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

Write-up: Acute urticaria - BENADRYL


VAERS ID: 384245 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Male  
Location: Illinois  
Vaccinated:2010-04-01
Onset:2010-04-01
   Days after vaccination:0
Submitted: 2010-04-05
   Days after onset:4
Entered: 2010-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3191AA / 4 LA / UN
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0304 / 4 RA / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44520 / 4 RA / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Negative TB skin test 4/1/10
Current Illness: None
Preexisting Conditions: Peanut, wheat, food allergies, asthma, eczema
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 6 PM - vomited x 1, followed by generalized hives - to ER where given oral steroids. Hives resolved soon after - no reoccurrence.


VAERS ID: 384353 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Male  
Location: Florida  
Vaccinated:2010-04-05
Onset:2010-04-05
   Days after vaccination:0
Submitted: 2010-04-06
   Days after onset:1
Entered: 2010-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 44519 / 1 LA / IM

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

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

Write-up: Redness and swelling at injection site. Augmentin 250mg 1 1/2 tsp Bio x 10 days


VAERS ID: 384664 (history)  
Form: Version 1.0  
Age: 1.6  
Sex: Male  
Location: Iowa  
Vaccinated:2010-03-31
Onset:2010-03-31
   Days after vaccination:0
Submitted: 2010-04-02
   Days after onset:2
Entered: 2010-04-08
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B106CA / 4 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 11234 / 4 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44520 / 5 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site induration, Injection site pain, Irritability, Pyrexia, Rhonchi, Weight bearing difficulty
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Multivitamin
Current Illness: Viral upper respiratory illness
Preexisting Conditions: No allergies; (+) Reactive airway disease with viral illness
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient developed fever 100-101, fussiness, and tenderness at immunization sites (both legs) and refused to bear weight on evening of 3/31/2010. Patient seen 4/1/10 in clinic; 101.3F, fussy & upper airway rhonchi, ears (-), lungs (-), (+) induration of thighs. (R) thigh: 3cm induration, no redness, mild tenderness. (L) thigh 5x3cm induration (both injection sites centered within induration), mild warmth, minimal redness, mild tenderness, no fluctuance. Neuro exam: alert, nl DTR''s (normal), refused to bear weight.


VAERS ID: 384702 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Male  
Location: Iowa  
Vaccinated:2010-04-05
Onset:2010-04-06
   Days after vaccination:1
Submitted: 2010-04-08
   Days after onset:2
Entered: 2010-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B15YAA / 4 LA / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB384AA / 1 LA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1545F / 2 RA / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 LA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1238B / 2 RA / UN

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

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

Write-up: (R) arm area of redness, warmth, pain, fever to 103 degrees - Lasted X 3-4 days.


VAERS ID: 384741 (history)  
Form: Version 1.0  
Age: 0.57  
Sex: Female  
Location: Georgia  
Vaccinated:2010-04-07
Onset:2010-04-08
   Days after vaccination:1
Submitted: 2010-04-08
   Days after onset:0
Entered: 2010-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B210BA / 3 RL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1124Y / 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44520 / 1 RL / IM

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

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

Write-up: small knot on right leg


VAERS ID: 384787 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2010-04-02
Entered: 2010-04-09
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1023Y / 3 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1269Y / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 RL / IM

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

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

Write-up: Erythema - Right upper thigh red raised warm area. Feb at 101.1 axillary - Cephalexin 250 mg PO TID x 7 days.


VAERS ID: 384848 (history)  
Form: Version 1.0  
Age: 0.18  
Sex: Male  
Location: South Carolina  
Vaccinated:2010-04-07
Onset:2010-04-08
   Days after vaccination:1
Submitted: 2010-04-09
   Days after onset:1
Entered: 2010-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B242AA / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF876AA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 RL / IM

Administered by: Public       Purchased by: Public
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-04-08
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: GERD diagnosed at visit
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient found dead in crib.


VAERS ID: 384854 (history)  
Form: Version 1.0  
Age: 1.02  
Sex: Female  
Location: Georgia  
Vaccinated:2010-03-30
Onset:2010-04-08
   Days after vaccination:9
Submitted: 2010-04-09
   Days after onset:1
Entered: 2010-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (HIBERIX) / GLAXOSMITHKLINE BIOLOGICALS AHIBC251AA / 4 LL / IM
MEA: MEASLES (ATTENUVAX) / MERCK & CO. INC. 0775Y / 1 LA / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44520 / 4 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1133Y / 1 RA / SC

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

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

Write-up: HALF DOLLAR SIZE RED WARM TO TOUCH ROUND SPOT


VAERS ID: 384896 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2010-03-31
Onset:2010-04-01
   Days after vaccination:1
Submitted: 2010-04-02
   Days after onset:1
Entered: 2010-04-12
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1397Y / 1 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF745AA / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1060Y / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 LL / IM

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

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

Write-up: Left leg with 2x3 inch erythema, mild swelling/induration non-fluctuant.


VAERS ID: 385027 (history)  
Form: Version 1.0  
Age: 1.45  
Sex: Male  
Location: Michigan  
Vaccinated:2010-04-13
Onset:0000-00-00
Submitted: 2010-04-13
Entered: 2010-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3386AA / 4 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF813AC / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 RL / IM

Administered by: Public       Purchased by: Public
Symptoms: Unevaluable event
SMQs:

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

Write-up: There were no adverse events observed. The child remained in the clinic approximately 30 min after the vaccines were given.


VAERS ID: 385091 (history)  
Form: Version 1.0  
Age: 1.51  
Sex: Male  
Location: Texas  
Vaccinated:2010-04-12
Onset:2010-04-13
   Days after vaccination:1
Submitted: 2010-04-14
   Days after onset:1
Entered: 2010-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3532AA / 4 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44520 / 1 RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Full blood count normal, Influenza serology negative, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Localized swelling of thigh, fever 104.6 Rectally.


VAERS ID: 385105 (history)  
Form: Version 1.0  
Age: 0.18  
Sex: Male  
Location: Washington  
Vaccinated:2010-04-12
Onset:2010-04-12
   Days after vaccination:0
Submitted: 2010-04-14
   Days after onset:2
Entered: 2010-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3563AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB818AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44527 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1527Y / 1 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Condition aggravated, Crying, Exaggerated startle response, Insomnia
SMQs:, Depression (excl suicide and self injury) (broad)

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

Write-up: Mom reports pt started crying uncontrollably 2 hours after receiving vaccines. Reports he cries all night and doesn''t sleep. She states he startles or jumps like from an electric shock and then cries unconsolably.


VAERS ID: 385109 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: Washington  
Vaccinated:2010-04-13
Onset:2010-04-13
   Days after vaccination:0
Submitted: 2010-04-14
   Days after onset:1
Entered: 2010-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3191AA / 4 LL / IM
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 16704 / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44527 / 1 RL / IM

Administered by: Private       Purchased by: Public
Symptoms: Cough, Eye swelling, Swelling face, Wheezing
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 20 min after receiving vaccines DTaP, PCV13, Hep A developed eye/face swelling w/ cough and wheezing, approximately equal to 1p 4/13. Dad gave BENADRYL, child napped, woke with no sx. Also drank some soy milk after shots but no other food or liquid. Allergic to dairy, egg.


VAERS ID: 385142 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Iowa  
Vaccinated:2010-04-01
Onset:2010-04-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2010-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3607AA / 3 LL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3266CA / 1 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44520 / 3 LL / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Apnoea, Aspiration, Condition aggravated, Death, Lissencephaly
SMQs:, Congenital, familial and genetic disorders (narrow), Acute central respiratory depression (narrow), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-04-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Recent Pneumonia
Preexisting Conditions: Lissencephaly; Aspiration; Mixed Apnea
Allergies:
Diagnostic Lab Data: received 3 vaccines < 1 hour prior to apnea/ bradycardia asystole.
CDC Split Type:

Write-up: Patient had life threatening lissencephaly aspiration (G Butter Fed) & mixed apnea known risk & partial no code.


VAERS ID: 385254 (history)  
Form: Version 1.0  
Age: 1.88  
Sex: Male  
Location: Massachusetts  
Vaccinated:2010-04-14
Onset:2010-04-14
   Days after vaccination:0
Submitted: 2010-04-15
   Days after onset:1
Entered: 2010-04-16
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1538Y / 1 LL / -
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 RL / IM

Administered by: Private       Purchased by: Public
Symptoms: Crying, Gait disturbance, Injection site induration, Injection site swelling, Poor quality sleep
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: Von Weillebrand disease type 1; mastocytoma on left anterior trunk
Allergies:
Diagnostic Lab Data: This patient was seen on 4/15/2010 and gait had returned to normal; swelling and tenderness all but gone.
CDC Split Type:

Write-up: Several hours after vaccination with PCV13 in the right thigh (IM injection), thigh swelled and became hard. Did not want to walk. Slept poorly overnight, with crying. Following morning walked with limp. NOTE: THIS IS NOT UNUSUAL IN ITSELF. HOWEVER, WE STARTED VACCINATING CHILDREN WITH PCV13 LAST WEEK, AND I HAVE RECEIVED 3 PHONE CALLS IN 5 DAYS REGARDING PAINFUL LEGS IN 15-24 MONTH OLDS, ACCOMPANIED BY RELUCTANCE OR REFUSAL TO WALK FOR MANY HOURS.


VAERS ID: 385325 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2010-04-08
Onset:2010-04-09
   Days after vaccination:1
Submitted: 2010-04-16
   Days after onset:7
Entered: 2010-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44519 / 1 LL / IM

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

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

Write-up: Fever 103.5 1 day after PCV 13. No redness at site. MOTRIN advised call if no improvement.


VAERS ID: 385326 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2010-04-12
Onset:2010-04-14
   Days after vaccination:2
Submitted: 2010-04-16
   Days after onset:2
Entered: 2010-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44519 / 1 LA / IJ

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

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

Write-up: Erythema 1.5 " warm to touch advised cool compresses, Advil call if worse.


VAERS ID: 385327 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2010-04-13
Onset:2010-04-14
   Days after vaccination:1
Submitted: 2010-04-16
   Days after onset:2
Entered: 2010-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44519 / 1 LL / IM

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

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

Write-up: Swelling at site of injection. C/O difficulty bearing weight. No redness noted. Advised ADVIL cool compresses call if worse.


VAERS ID: 385328 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2010-04-13
Onset:2010-04-15
   Days after vaccination:2
Submitted: 2010-04-16
   Days after onset:1
Entered: 2010-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44519 / 1 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Feeling hot, Gait disturbance, Tenderness
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Difficulty walking 3 X 4 cm area of warmth, erythema tender to touch. Advised MOTRIN, cool compresses call PRN.


VAERS ID: 385329 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2010-04-14
Onset:2010-04-14
   Days after vaccination:0
Submitted: 2010-04-16
   Days after onset:2
Entered: 2010-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44519 / 1 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Gait disturbance, Injection site pain, Injection site swelling
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypoglycaemia (broad)

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

Write-up: Problem with walking day of vaccine. Swelling and tenderness at site. Advised ice, Ibuprofen, call if worse.


VAERS ID: 385430 (history)  
Form: Version 1.0  
Age: 0.17  
Sex: Male  
Location: Illinois  
Vaccinated:2010-04-14
Onset:2010-04-17
   Days after vaccination:3
Submitted: 2010-04-19
   Days after onset:2
Entered: 2010-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3162BA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1379Y / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44520 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1523Y / 1 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-04-17
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZANTAC 15mg/mL 0.6 mL BID
Current Illness:
Preexisting Conditions: GERD.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: None stated.


VAERS ID: 385453 (history)  
Form: Version 1.0  
Age: 0.34  
Sex: Female  
Location: Mississippi  
Vaccinated:2010-04-14
Onset:2010-04-14
   Days after vaccination:0
Submitted: 2010-04-18
   Days after onset:4
Entered: 2010-04-20
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3592AB / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44519 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1615Y / 2 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Computerised tomogram, Full blood count, Irritability
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None.
Allergies:
Diagnostic Lab Data: CT head; CBC
CDC Split Type:

Write-up: Uncontrollable fussiness.


VAERS ID: 385497 (history)  
Form: Version 1.0  
Age: 0.53  
Sex: Male  
Location: Texas  
Vaccinated:2010-04-13
Onset:2010-04-14
   Days after vaccination:1
Submitted: 2010-04-15
   Days after onset:1
Entered: 2010-04-20
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3563AA / 1 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44527 / 1 RL / UN

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

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

Write-up: Fever.


VAERS ID: 385532 (history)  
Form: Version 1.0  
Age: 1.32  
Sex: Female  
Location: California  
Vaccinated:2010-04-19
Onset:0000-00-00
Submitted: 2010-04-20
Entered: 2010-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44527 / 5 LL / IM

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

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

Write-up: Patient received vaccine PREVNAR 13 on 04-19-10. Within 24 hours patient developed mild swelling and erythema over left thigh below injection site. Mild tenderness.


VAERS ID: 385568 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Male  
Location: Michigan  
Vaccinated:2010-04-09
Onset:2010-04-10
   Days after vaccination:1
Submitted: 2010-04-14
   Days after onset:4
Entered: 2010-04-21
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 844519 / 1 RA / IM

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

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

Write-up: Warm, red area around immunization site. Next morning, swelling and redness decreased leaving hard lump in upper (R) arm. No pain, or limitation.


VAERS ID: 385631 (history)  
Form: Version 1.0  
Age: 1.22  
Sex: Female  
Location: Michigan  
Vaccinated:2010-04-09
Onset:2010-04-18
   Days after vaccination:9
Submitted: 2010-04-21
   Days after onset:3
Entered: 2010-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3571AA / 3 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 12524 / 1 LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 3 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 12954 / 1 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Pharyngeal erythema, Rash maculo-papular
SMQs:, Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Diffuse maculo-papular rash over entire body and face, mostly truncal, but also on extremities and palms and soles. Also eyelids, lips, labia. Not in mouth. Red throat.


VAERS ID: 385703 (history)  
Form: Version 1.0  
Age: 1.24  
Sex: Female  
Location: New York  
Vaccinated:2010-04-07
Onset:2010-04-07
   Days after vaccination:0
Submitted: 2010-04-21
   Days after onset:14
Entered: 2010-04-22
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Body temperature increased, Crying, Gaze palsy, Hypotonia, Immediate post-injection reaction, Otitis media, Pyrexia, Respiratory arrest, Skin discolouration, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Depression (excl suicide and self injury) (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concomitant medications were not reported.
Current Illness: The patient''s concurrent illnesses included therapy regimen changed and irritability.
Preexisting Conditions: A past history of no reaction on previous exposure to drug.
Allergies:
Diagnostic Lab Data: Physical examination (results: when leaving office: "nothing found to be wrong") and physical examination (results: prior to vaccination - patient normal/afebrile) were done on 07-Apr-2010. Body temperature (results: per mother - 102.2 deg. F. axillary) and body temperature (results: 98 deg. F. axillary - in physician''s office) were done on 08-Apr-2010.
CDC Split Type: USWYEH14565610

Write-up: This case was considered medically important. Information regarding PREVNAR 13 was received from a healthcare professional regarding a 15-month-old female patient who experienced stopped breathing, eyes rolled back, face turned purple, went limp, crying, hives, otitis media, and temperature axillary 98 deg. F. At 15 months of age, the patient received the first dose on 07-Apr-2010. Additional suspect medication included PREVNAR. On 07-Apr-2010, prior to receiving her PREVNAR vaccination, the patient was fussy, but a physical exam was normal and the patient was afebrile. After vaccination, the patient immediately began crying, she stopped breathing, her eyes rolled back into her head, her face turned purple and she went limp in her mother''s arms. The nurse blew in the baby''s face for several seconds and the patient spontaneously started breathing again. The patient also developed hives and was treated with BENADRYL. The patient was examined and nothing else seemed to be wrong. The hives were resolving by the time the patient was leaving the office. On 08-Apr-2010, the patient was seen for a follow up visit. Her temperature was 98 degrees axillary. That same day the mother reported that the patient''s temperature was up to 102.2 degrees. The child was subsequently diagnosed with otitis media. The outcomes for the events of otitis media, crying, fever and eye rolling were not reported. The other events have resolved. No additional information was available at the time of this report.


VAERS ID: 385719 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: Michigan  
Vaccinated:2010-04-20
Onset:2010-04-21
   Days after vaccination:1
Submitted: 2010-04-22
   Days after onset:1
Entered: 2010-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP052AA / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 RL / IM

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

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

Write-up: Call from Dad today that right thigh where Prevnar 13 was given, is "slightly red and swollen about one inch in diameter" Dad also states fever of unknown number on 4/20 after shot and was given Motrin. He states child''s activity is normal running on leg and only complains of pain at touch to swollen area.


VAERS ID: 385724 (history)  
Form: Version 1.0  
Age: 1.42  
Sex: Male  
Location: New Hampshire  
Vaccinated:2010-04-21
Onset:2010-04-22
   Days after vaccination:1
Submitted: 2010-04-22
   Days after onset:0
Entered: 2010-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 2 RL / IM

Administered by: Unknown       Purchased by: Public
Symptoms: Confusional state, Lethargy, Peripheral coldness, Pyrexia, Respiratory rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Fluid in right ear (ear infection 7 weeks ago), nasal congestion.
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever (Rectal 105.4F), mild lethargy, moderate daze/confusion, rapid breathing, cold hands. Treated with Motrin, Tylenol and sponge baths


VAERS ID: 385763 (history)  
Form: Version 1.0  
Age: 1.3  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2010-04-20
Onset:2010-04-21
   Days after vaccination:1
Submitted: 2010-04-23
   Days after onset:2
Entered: 2010-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1272Y / 1 LA / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E47472 / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: No reaction on previous exposure to drug, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever with Tmax of 103 with onset within 24 hours; this was 5th dose of Prevnar using new Prevnar 13; 3 months between 4th and 5th dose; no previous adverse reaction to Prevnar


VAERS ID: 385798 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: California  
Vaccinated:2010-04-20
Onset:2010-04-21
   Days after vaccination:1
Submitted: 2010-04-22
   Days after onset:1
Entered: 2010-04-23
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44527 / 5 LA / IM

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

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

Write-up: Approximately 24 hours after receiving PCV 13 in left deltoid, area 0.5 cm red, warm and tender no fever. Saw MD 04/22/10 at 4pm Tx''ed KEFLEX and BENADRYL.


VAERS ID: 385840 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2010-04-23
Onset:2010-04-23
   Days after vaccination:0
Submitted: 2010-04-23
   Days after onset:0
Entered: 2010-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B116AB / 5 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1118Y / 2 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44519 / 1 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1304Y / 2 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Oxygen saturation decreased, Pallor, Vomiting, Wheezing
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Ranitidine 30 mg bid Albuterol 2.5 mg/3ml prn tight cough/wheeze
Current Illness: No
Preexisting Conditions: Mild Intermittent Asthma GERD Mom states allergy to chicken
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immunizations given. Within 2 minutes patient began vomiting and then progresses to wheezing and poor air exchange with a pulse ox reading of 80% within 2-3 minutes. Color dusky.


VAERS ID: 385868 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Female  
Location: Unknown  
Vaccinated:2010-04-23
Onset:2010-04-25
   Days after vaccination:2
Submitted: 2010-04-26
   Days after onset:1
Entered: 2010-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E49135 / 1 LG / IM

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

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

Write-up: Left thigh 7x18 cm area of erythema, warm to touch, no abscess, no fever, no lymphadenopathy,


VAERS ID: 385892 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Louisiana  
Vaccinated:2010-04-16
Onset:2010-04-16
   Days after vaccination:0
Submitted: 2010-04-22
   Days after onset:6
Entered: 2010-04-26
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR 03191AA / 3 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF817AB / 3 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44520 / 3 UN / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1613Y / 3 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: hives~Hib (no brand name)~2~0.30~Patient|hives~Polio Virus, Inact. (no brand name)~2~0.30~Patient|hives~DTaP (no brand name)~2~0
Other Medications: AMOXIL
Current Illness: On day 7 of AMOXIL for OM
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient broke out in hives after vaccines given - 2/15/2010 - per mom (1 day after vaccines) - ROTATEQ, DTAP, IPV, Hib, PREVNAR. The hives went away in 1 day. On 4/16/2010 - patient received ROTATEQ, DTAP, Hib, PREVNAR. Eight minutes later, he broke out in a splotchy rash in the office. We gave BENADRYL and the rash almost completely subsided.


VAERS ID: 385894 (history)  
Form: Version 1.0  
Age: 0.77  
Sex: Female  
Location: New York  
Vaccinated:2010-04-13
Onset:2010-04-13
   Days after vaccination:0
Submitted: 2010-04-16
   Days after onset:3
Entered: 2010-04-26
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF819AD / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44520 / 2 RL / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Decreased appetite, Emotional distress, Inability to crawl, Injection site pain, Injection site swelling, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever 103.5 x 3 days; inconsolable, stopped eating (but will breastfeed), stopped crawling, swelling/pain at injection site (PREVNAR site).


VAERS ID: 385925 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: Arkansas  
Vaccinated:2010-04-22
Onset:2010-04-23
   Days after vaccination:1
Submitted: 2010-04-23
   Days after onset:0
Entered: 2010-04-26
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3590AA / UNK RL / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB362AA / UNK LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44526 / UNK LL / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1164Y / UNK RL / UN

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

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

Write-up: Area of redness with swelling 1 cm X 1 cm RUT where Pentacel was given.


VAERS ID: 385948 (history)  
Form: Version 1.0  
Age: 0.33  
Sex: Female  
Location: Indiana  
Vaccinated:2010-04-22
Onset:2010-04-24
   Days after vaccination:2
Submitted: 2010-04-26
   Days after onset:2
Entered: 2010-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3606AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44520 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0768Y / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Chest X-ray, Death, Diarrhoea, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-04-25
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LASIX .4 ml TID; spironolactone .4 BID; ZANTAC 1 ml BID
Current Illness: None
Preexisting Conditions: Trisomy 21; VSD; ASD sacral dimple; respiratory depression; laryngomalacia; cardiomegaly
Allergies:
Diagnostic Lab Data: Chest x-ray 4/23/10 & 4/25/10 No significant change from previous x-rays
CDC Split Type:

Write-up: Diarrhea 4/24/10. Fever 4/25/10.


VAERS ID: 385976 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Female  
Location: Texas  
Vaccinated:2010-04-16
Onset:2010-04-21
   Days after vaccination:5
Submitted: 2010-04-27
   Days after onset:6
Entered: 2010-04-26
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B154AA / UNK RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1357Y / 2 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44520 / 1 LL / IM
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

Administered by: Private       Purchased by: Private
Symptoms: Blister, Pruritus, Pyrexia, Rash erythematous
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Varicella vaccine 4-16-10 then developed fever + rash started 4-21-10, crops of red bumps, fluid-filled vesicles, pruritic.


VAERS ID: 386054 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2010-04-21
Onset:2010-04-22
   Days after vaccination:1
Submitted: 2010-04-23
   Days after onset:1
Entered: 2010-04-27
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44519 / 5 RL / IM

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

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

Write-up: Redness at vaccine site - ( R ) thigh. ? local Rx. ~ area warm rxn pos about 3x4 cm but about 2 cm to side of injection site.


VAERS ID: 386275 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Female  
Location: Idaho  
Vaccinated:2010-04-28
Onset:2010-04-28
   Days after vaccination:0
Submitted: 2010-04-29
   Days after onset:1
Entered: 2010-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF739AA / 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E45349 / 2 RL / IM

Administered by: Unknown       Purchased by: Public
Symptoms: Abasia, Induration, Injection site pain, Screaming, Skin warm
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad)

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

Write-up: Parent stated S/Sx started on the evening of the vaccine. Pt C/o not being able to walk d/t pain in R leg where vaccine given. Screaming in pain today 4/29 and can''t walk. Injection site is painful, no redness, warm to touch, and hard where vaccine was given on R leg.


VAERS ID: 386282 (history)  
Form: Version 1.0  
Age: 0.53  
Sex: Female  
Location: Utah  
Vaccinated:2010-04-28
Onset:2010-04-28
   Days after vaccination:0
Submitted: 2010-04-29
   Days after onset:1
Entered: 2010-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44527 / 1 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Crying, Injection site nodule, No reaction on previous exposure to drug
SMQs:, Extravasation events (injections, infusions and implants) (broad), Depression (excl suicide and self injury) (broad)

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

Write-up: Crying, knot in muscle of leg where injection given. Did not have previous persistent crying with 2 and 4mo imms.


VAERS ID: 386286 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: Idaho  
Vaccinated:2010-04-28
Onset:2010-04-29
   Days after vaccination:1
Submitted: 2010-04-29
   Days after onset:0
Entered: 2010-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E45349 / 2 RL / IM

Administered by: Private       Purchased by: Public
Symptoms: Gait disturbance, Injection site pain, Irritability
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Hypoglycaemia (broad)

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

Write-up: Parent called nurse triage line patient''s R leg is very sore and limping. Patient is very upset about the pain. Parent will watch if S/sx of cellulitis to come in. To treat with Tylenol/ice PRN.


VAERS ID: 386294 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: Washington  
Vaccinated:2010-04-27
Onset:2010-04-28
   Days after vaccination:1
Submitted: 2010-04-29
   Days after onset:1
Entered: 2010-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E45349 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Redness at site of injection~Pneumo (Prevnar13)~5~2.00~Patient
Other Medications: No meds
Current Illness: None - healthy child
Preexisting Conditions: h/o hives - cause unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness at site of injection site about 2 cm X 3 cm.


VAERS ID: 386376 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2010-04-29
Onset:2010-04-29
   Days after vaccination:0
Submitted: 2010-04-30
   Days after onset:1
Entered: 2010-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E47472 / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Cough, Full blood count normal, Lethargy, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: LETHARGY, FEVER, COUGH DEVELOPED WITHIN 24 HOURS.


VAERS ID: 386389 (history)  
Form: Version 1.0  
Age: 5.0  
Sex: Female  
Location: Colorado  
Vaccinated:2010-04-27
Onset:2010-04-28
   Days after vaccination:1
Submitted: 2010-04-30
   Days after onset:2
Entered: 2010-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP033CA / 1 RA / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44519 / 1 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Induration, Skin warm, Tenderness
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Obesity; astigmatism; apnea of newborn due to reflux
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: PCV 13 administered on 4/27 in L arm. Mom returned to clinic 4/30 to have labs drawn. L arm noted to have large, red area around where PCV 13 was given ~ 3 1/2" wide x 3" tall - tender, warm and induration. H1N1 administered on 4/27 in R arm. Small red area ~ 1/2"x1/2" with 2 or 3 pinpoint raised bumps in center. No tenderness or itching. Not warm or tender today (was yesterday).


VAERS ID: 386408 (history)  
Form: Version 1.0  
Age: 0.36  
Sex: Male  
Location: California  
Vaccinated:2010-03-29
Onset:2010-03-30
   Days after vaccination:1
Submitted: 2010-04-30
   Days after onset:31
Entered: 2010-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3534AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44527 / 1 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1521Y / 2 MO / PO

Administered by: Public       Purchased by: Public
Symptoms: Diarrhoea
SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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

Write-up: Diarrhea for 10 days. No other notable signs. No fever. No fussiness. Appetite/intake normal.


VAERS ID: 386411 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Female  
Location: California  
Vaccinated:2010-04-29
Onset:2010-04-29
   Days after vaccination:0
Submitted: 2010-04-30
   Days after onset:1
Entered: 2010-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E45350 / 4 LL / -

Administered by: Public       Purchased by: Other
Symptoms: Arthralgia, Joint swelling
SMQs:, Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Patient awaiting CBC and X-ray if no improvement by tomorrow
CDC Split Type:

Write-up: Per mom, patient went home, start complaining of left knee pain and then notices swelling of left knee (no swelling/tenderness of thigh where Iz was given).


VAERS ID: 386467 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Female  
Location: Utah  
Vaccinated:2010-04-13
Onset:2010-04-15
   Days after vaccination:2
Submitted: 2010-04-22
   Days after onset:7
Entered: 2010-05-03
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF976AA / 4 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E47472 / 1 RL / IM

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

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

Write-up: Redness, swelling. Concern of cellulitis. Pt to ER - given IV antibiotic - Rt thigh swelling/redness


VAERS ID: 386485 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Female  
Location: Utah  
Vaccinated:2010-04-13
Onset:2010-04-13
   Days after vaccination:0
Submitted: 2010-04-22
   Days after onset:9
Entered: 2010-05-03
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / UNK UN / UN
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Rash~Vaccine not specified (no brand name)~UN~1.00~Patient
Other Medications: FLOVENT; SINGULAIR; DEPAKOTE
Current Illness: None
Preexisting Conditions: Extreme Prematurity; CP; Tracheostomy; Asthma; Seizure
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Allergic Rxn - started on same day to have rash all over body, itch, red some hives. Also, with redness directly at the site of vaccination in left leg.


VAERS ID: 386555 (history)  
Form: Version 1.0  
Age: 1.04  
Sex: Male  
Location: South Dakota  
Vaccinated:2010-04-22
Onset:2010-04-22
   Days after vaccination:0
Submitted: 2010-05-03
   Days after onset:11
Entered: 2010-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR U3040AA / 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E06427 / 1 LL / IM

Administered by: Private       Purchased by: Other
Symptoms: Cough, Decreased appetite, Dehydration, Ear infection, Pyrexia, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No. Doctor reported child was healthy during well baby visit. Ears were 100% clear and healthy.
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever of 101.8 which led to runny nose, cough, loss of appetite and hospitalization for severe dehydration and ear infection.


VAERS ID: 386563 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Arizona  
Vaccinated:2010-04-29
Onset:2010-04-29
   Days after vaccination:0
Submitted: 2010-05-03
   Days after onset:4
Entered: 2010-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF725AA / 4 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0840Y / 1 LL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E45350 / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1215Y / 1 RL / SC

Administered by: Private       Purchased by: Public
Symptoms: Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)

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

Write-up: Hives at site of injection.


VAERS ID: 386564 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2010-04-16
Onset:2010-04-16
   Days after vaccination:0
Submitted: 2010-05-03
   Days after onset:17
Entered: 2010-05-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 RL / IJ
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / 1 LL / IJ

Administered by: Private       Purchased by: Private
Symptoms: Blood test abnormal, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: None.
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: blood test showed high cell count. advised it was similar to mono.
CDC Split Type:

Write-up: Very high fever ran for four days. Reached 104.1 with Tylenol in system for an hour.


VAERS ID: 386601 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: Maryland  
Vaccinated:2010-04-27
Onset:2010-04-27
   Days after vaccination:0
Submitted: 2010-04-29
   Days after onset:2
Entered: 2010-05-04
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E47472 / 1 LL / IM

Administered by: Other       Purchased by: Private
Symptoms: Cough, Irritability, Pain in extremity, Pyrexia, Rhinorrhoea
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: PCV 13 given 4/27/10. Mom reports that he had fever - dry cough & runny nose. Fussy & sore leg. Difficulty walking AM 4/28/10. In pm. 4/28/10 - walking normally, no erythema or tenderness at injection site.


VAERS ID: 386603 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: Maryland  
Vaccinated:2010-04-27
Onset:2010-04-27
   Days after vaccination:0
Submitted: 2010-04-29
   Days after onset:2
Entered: 2010-05-04
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E47472 / 1 LL / ID

Administered by: Other       Purchased by: Private
Symptoms: Gait disturbance, Injection site erythema, Injection site swelling, Pain in extremity, Tenderness
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

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

Write-up: Pt. received PCV 13 4/27/10. Per mom leg was sore and child was unable to walk that evening. Starting 4/28/10 in PM mom noticed redness and swelling at injection site. Today 4x6 cm non tender erythema slightly swollen area on leg.


VAERS ID: 386631 (history)  
Form: Version 1.0  
Age: 0.34  
Sex: Female  
Location: Texas  
Vaccinated:2010-05-03
Onset:2010-05-03
   Days after vaccination:0
Submitted: 2010-05-04
   Days after onset:1
Entered: 2010-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3607AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44520 / 2 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0148Z / 2 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Decreased activity, Diarrhoea, Irritability, Lethargy, Pallor, Vomiting
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

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

Write-up: Child had episode of diarrhea at 5:30pm, was a little cranky. Then at 9:15pm, patient noted to get very pale, threw up and had watery explosive stool. At this time child was very lethargic to parents, taken immediately to ER where child was responsive but decreased activity. IV fluids given as well as steroid. Uncertain about labs or other testing done.


VAERS ID: 386633 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: California  
Vaccinated:2010-04-27
Onset:2010-04-29
   Days after vaccination:2
Submitted: 2010-04-29
   Days after onset:0
Entered: 2010-05-04
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR SPUF776AC / 4 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH WYE45349 / 1 LL / IM

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

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

Write-up: Swelling and redness injection site.


VAERS ID: 386639 (history)  
Form: Version 1.0  
Age: 0.52  
Sex: Male  
Location: Arizona  
Vaccinated:2010-04-27
Onset:2010-04-27
   Days after vaccination:0
Submitted: 2010-04-27
   Days after onset:0
Entered: 2010-05-04
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS AC14B166CA / 3 UN / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF8164B / 3 UN / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0532 / 3 UN / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E45350 / 3 UN / IM

Administered by: Private       Purchased by: Public
Symptoms: Crying
SMQs:, Depression (excl suicide and self injury) (broad)

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

Write-up: Constant crying; started approx 90 min. after vaccines given. Did not respond to TYLENOL. Seen in office at 1500 - quiet, consolable; cries if not being held.


VAERS ID: 386652 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: Iowa  
Vaccinated:2010-04-26
Onset:2010-04-27
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2010-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH AC14B088BA / 1 RL / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Injection site cellulitis
SMQs:

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

Write-up: Cellulitis at site.


VAERS ID: 386661 (history)  
Form: Version 1.0  
Age: 1.51  
Sex: Female  
Location: Maryland  
Vaccinated:2010-05-03
Onset:2010-05-03
   Days after vaccination:0
Submitted: 2010-05-04
   Days after onset:1
Entered: 2010-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 02457 / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E49135 / 5 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site rash, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Rash behind site of injection on day of administering & fever 102 day after injection. TX of TYLENOL.


VAERS ID: 386687 (history)  
Form: Version 1.0  
Age: 0.34  
Sex: Male  
Location: North Carolina  
Vaccinated:2010-04-22
Onset:2010-04-25
   Days after vaccination:3
Submitted: 2010-05-04
   Days after onset:9
Entered: 2010-05-05
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3469AA / 2 UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44520 / UNK UN / UN
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1523Y / 2 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Emotional distress, Haematochezia, Intussusception, Mucous stools
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Ischaemic colitis (broad), Depression (excl suicide and self injury) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES1004USA04530

Write-up: Initial and follow-up information has been received from a physician and a front office employee concerning an 18 weeks old male with no pertinent medical history or allergies who on 22-APR-2010 was vaccinated orally with the first dose of ROTATEQ (lot# 664883/1523Y). Concomitant therapy included PENTACEL (lot# SPC#3469AA) and PREVNAR (lot# E44520) which were both vaccinated on 22-APR-2010. On 25-APR-2010 the patient had an inconsolable episode for 3-4 hours in the early afternoon. Then at 1:00 am the patient''s mother opened the patient''s diaper and there was a string of mucus with blood. The physician believed the patient may have had intussusception episode on the afternoon of 25-APR-2010 that self resolved by the time the patient''s mother contacted him around 1:00 am through phone call. It was reported that the patient was not experiencing any known symptoms. The physician also reported that no testing were done, so it was unknown if the patient experienced intussusception. Based on symptoms of the child being inconsolable along with the tiny amount of bloody mucus in diaper, the physician suspected that it was self-resolving intussusception. These adverse events were not considered to be disabling or life threatening by the physician. Upon internal review, intussusception was determined to be an other important medical event. No further information is available.


VAERS ID: 386730 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Female  
Location: New York  
Vaccinated:2010-04-30
Onset:2010-05-01
   Days after vaccination:1
Submitted: 2010-05-05
   Days after onset:4
Entered: 2010-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44526 / UNK LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:

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

Write-up: None stated.


VAERS ID: 386731 (history)  
Form: Version 1.0  
Age: 0.6  
Sex: Female  
Location: New York  
Vaccinated:2010-05-03
Onset:2010-05-04
   Days after vaccination:1
Submitted: 2010-05-05
   Days after onset:1
Entered: 2010-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44526 / 1 UN / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Unevaluable event
SMQs:

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

Write-up: None Stated


VAERS ID: 386741 (history)  
Form: Version 1.0  
Age: 1.27  
Sex: Female  
Location: Ohio  
Vaccinated:2010-05-03
Onset:2010-05-03
   Days after vaccination:0
Submitted: 2010-05-05
   Days after onset:2
Entered: 2010-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3607AA / 1 RA / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E45349 / 1 RA / IM

Administered by: Private       Purchased by: Public
Symptoms: Body temperature increased, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Amoxicillin; Hemangioma on 4th digit on right
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Despite mom giving ibuprofen at the visit and 6 hrs. later, patient still developed at temp of 102.8F and has continued to be febrile with


VAERS ID: 386745 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2010-04-30
Onset:2010-05-01
   Days after vaccination:1
Submitted: 2010-05-03
   Days after onset:2
Entered: 2010-05-05
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR 942400 / 4 LA / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1301Y / 2 RA / SC

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

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

Write-up: Approximately 12 x 12 cm warm, red area left deltoid. Child OK looks fully healthy. On 5/4/10 pm symptoms almost completely recovered.


VAERS ID: 386750 (history)  
Form: Version 1.0  
Age: 1.09  
Sex: Female  
Location: Kansas  
Vaccinated:2010-04-15
Onset:2010-04-29
   Days after vaccination:14
Submitted: 2010-05-05
   Days after onset:6
Entered: 2010-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3082AA / 4 LL / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB431AA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1273Y / 1 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44520 / 4 LL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1295Y / 1 RL / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site erythema, Injection site rash, Injection site swelling, Injection site warmth, Skin lesion, Varicella
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prevacid 15mg ODT once daily
Current Illness: No acute illnesses
Preexisting Conditions: (stable Gastroesophageal reflux on Prevacid)
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Swelling, warmth and erythema in the left thigh that resolved the next day. "Wavy" rash on both legs on 4/30/2010 that resolved within a few hours. Varicella lesions on the face that began on 5/5/10.


VAERS ID: 386818 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Male  
Location: Virginia  
Vaccinated:2010-05-04
Onset:2010-05-05
   Days after vaccination:1
Submitted: 2010-05-06
   Days after onset:1
Entered: 2010-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3380AA / 5 LA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D0413 / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1357Y / 2 LA / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E47472 / 1 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1446Y / 2 RA / SC

Administered by: Private       Purchased by: Private
Symptoms: Cellulitis
SMQs:

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

Write-up: Cellulitis to left arm. Keflex 250/5 1.5 tsp BID x10 days.


VAERS ID: 386859 (history)  
Form: Version 1.0  
Age: 0.4  
Sex: Female  
Location: Georgia  
Vaccinated:2010-05-04
Onset:2010-05-05
   Days after vaccination:1
Submitted: 2010-05-06
   Days after onset:1
Entered: 2010-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B209CA / 2 LL / IM
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF749AA / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44526 / 2 RL / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NONE
Preexisting Conditions: Acid reflux and constipation
Allergies:
Diagnostic Lab Data: Patient placed on Allegra 1/2 tsp bid
CDC Split Type:

Write-up: Right upper vastus lateralis with slightly raised quarter sized red area at injection site.


VAERS ID: 386889 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Female  
Location: Virginia  
Vaccinated:2010-04-16
Onset:2010-04-28
   Days after vaccination:12
Submitted: 2010-04-29
   Days after onset:1
Entered: 2010-05-06
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 0095Z / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E47472 / 1 RL / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1405Y / 1 RL / SC

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

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

Write-up: Large raised/swollen area at VARIVAX vaccine site - 12 days post vaccine. No fever, no redness. Resolved w/in.


VAERS ID: 386900 (history)  
Form: Version 1.0  
Age: 1.44  
Sex: Male  
Location: Florida  
Vaccinated:2010-05-05
Onset:2010-05-05
   Days after vaccination:0
Submitted: 2010-05-06
   Days after onset:1
Entered: 2010-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS SKB14B085BA / 4 LA / -
HIBV: HIB (HIBERIX) / GLAXOSMITHKLINE BIOLOGICALS SKB245BA / 4 RA / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR PMCD4801 / 3 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. MSD1269Y / 1 RA / -
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH WALE44521 / 4 RA / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. MSD1450Y / 1 LA / -

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

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

Write-up: Fever 102F the night that child received the 6 vaccines. Tylenol given by mom Q4h. It only worked for 20 minutes. The baby had shaking episode every 2 hours last about 2 minutes. Only consumed yogurt and unable to tolerate baby milk.


VAERS ID: 386908 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Male  
Location: California  
Vaccinated:2010-04-14
Onset:2010-04-15
   Days after vaccination:1
Submitted: 2010-05-06
   Days after onset:21
Entered: 2010-05-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E47472 / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site reaction, Injection site swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: 1. Injection site reaction-red and raised, approx. 1 inch in diameter. 2. Mild case of hives-head-to-toe, equal to or less than 12 at any given time that came and went-lasted approx. 24hr.


VAERS ID: 386928 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Texas  
Vaccinated:2010-05-05
Onset:2010-05-05
   Days after vaccination:0
Submitted: 2010-05-06
   Days after onset:1
Entered: 2010-05-07
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3606AA / 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E49135 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 01482 / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Bottle feeding, Erythema, Swelling face, Tremor
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VANICREAM qid; ACLOVATE 0.05%
Current Illness: None Well 6 month old
Preexisting Conditions: Eczema; Pruritis; Plagiocephaly; Head banging
Allergies:
Diagnostic Lab Data: Vital signs, exam & observation at ER. Discharged to home.
CDC Split Type: TX20100026PR

Write-up: Approximately 2 PM, 5-5-10, pt was being bottle fed by his nanny. Both his hands started shaking & this persisted 4-5 minutes. Went to sleep after this. At 4:25 PM, 5-5-10, mother called to report that pt''s face was swollen. Cheeks and one ear bright red. Sent to ER. This is in follow-up to report(s) previously submitted on 05/06/2010: provided Mfr/imm. proj. reort no.


VAERS ID: 386973 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2010-05-05
Onset:2010-05-05
   Days after vaccination:0
Submitted: 2010-05-07
   Days after onset:2
Entered: 2010-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B141BA / 1 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1607Y / 2 RL / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44520 / 1 LL / ID
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1238Y / 2 RL / SC

Administered by: Unknown       Purchased by: Private
Symptoms: Gait disturbance, Injection site induration
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypoglycaemia (broad)

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

Write-up: Firm area to left thigh with pain for the last 2 days. Refusing to walk.


VAERS ID: 387018 (history)  
Form: Version 1.0  
Age: 0.12  
Sex: Male  
Location: Nevada  
Vaccinated:2010-05-06
Onset:2010-05-06
   Days after vaccination:0
Submitted: 2010-05-07
   Days after onset:1
Entered: 2010-05-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B248BA / UNK LL / IM
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. 1122Y / UNK LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E47472 / UNK RL / IM

Administered by: Private       Purchased by: Private
Symptoms: Crying, Cyanosis, Oxygen saturation normal, Pallor
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None - well check
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Pulse ox 100%
CDC Split Type:

Write-up: Following PEDIARIX vaccine he cries briefly, turned cyanotic, then pale. He was quiet briefly, then fully recovered. Pulse ox always was 100%.


VAERS ID: 387031 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Male  
Location: Florida  
Vaccinated:2010-05-06
Onset:2010-05-09
   Days after vaccination:3
Submitted: 2010-05-10
   Days after onset:1
Entered: 2010-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B207BA / 1 RL / IM
HIBV: HIB (HIBERIX) / GLAXOSMITHKLINE BIOLOGICALS AHIBC252CB / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44526 / 1 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: PPD Test done 05/07/2010 with non reactive result.
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Rash like hives.


VAERS ID: 387046 (history)  
Form: Version 1.0  
Age: 0.57  
Sex: Female  
Location: Hawaii  
Vaccinated:2010-04-30
Onset:2010-04-30
   Days after vaccination:0
Submitted: 2010-04-30
   Days after onset:0
Entered: 2010-05-10
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3544AA / 3 RL / IM
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3263CA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB731AA / 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E45350 / 3 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 0573Y / 3 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Differential white blood cell count, Full blood count, Irritability, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: ? low grade fever on day of vaccination
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC w/diff ok
CDC Split Type:

Write-up: Fever to 103 F, not responding to antipyretics, increase fussiness for about 24 hr.


VAERS ID: 387067 (history)  
Form: Version 1.0  
Age: 0.51  
Sex: Female  
Location: Nebraska  
Vaccinated:2010-05-07
Onset:2010-05-07
   Days after vaccination:0
Submitted: 2010-05-10
   Days after onset:3
Entered: 2010-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3607AA / 3 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E49135 / 3 RL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 00217 / 3 MO / PO

Administered by: Private       Purchased by: Private
Symptoms: Nasopharyngitis, Otitis media, Pyrexia, Upper respiratory tract infection
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cold symptoms for 2-3 days. no fever
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever started Friday evening. Cold symptoms. Went to ER on Sunday at 9 pm with a fever of 103.3. Diagnosis at ER was URI and otitis media.


VAERS ID: 387124 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2010-05-04
Onset:2010-05-06
   Days after vaccination:2
Submitted: 2010-05-10
   Days after onset:4
Entered: 2010-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44526 / 1 RA / IM

Administered by: Private       Purchased by: Public
Symptoms: Culture throat negative, Hypersomnia, Hypotonia, Pallor, Staring, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)

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

Write-up: 2 days after PREVNAR 13 she slept late (14 1/2 hrs). Mom woke her, she looked pale and vomited. When mom stood her she looked pale body went limp and starred for a couple of seconds. Vomited 5-6 xs in 1-2 hrs. Seen @ office - normal exam and was better by the pm.


VAERS ID: 387143 (history)  
Form: Version 1.0  
Age: 0.5  
Sex: Male  
Location: Tennessee  
Vaccinated:2010-05-07
Onset:2010-05-07
   Days after vaccination:0
Submitted: 2010-05-10
   Days after onset:3
Entered: 2010-05-11
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3450AA / 3 RL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 LL / UN

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2010-05-07
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: None stated.


VAERS ID: 387149 (history)  
Form: Version 1.0  
Age: 1.26  
Sex: Male  
Location: Georgia  
Vaccinated:2010-05-05
Onset:2010-05-06
   Days after vaccination:1
Submitted: 2010-05-11
   Days after onset:5
Entered: 2010-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF733AB / 4 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44520 / 1 RL / UN

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

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

Write-up: Quarter size annular area with erythema: blanches to right anterior thigh with firm center at injection site (PREVNAR 13).


VAERS ID: 387166 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: New York  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 2010-05-11
Entered: 2010-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E47472 / 5 AR / IM

Administered by: Private       Purchased by: Private
Symptoms: Erythema multiforme, Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Mild URI
Preexisting Conditions: Down''s syndrome; hypothyroidism
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Administered PREVNAR 13 on 5/7/10, woke up on 5/10/10 with hive like rash, which progressed to erythema multiforme.


VAERS ID: 387190 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Female  
Location: Michigan  
Vaccinated:2010-05-10
Onset:2010-05-10
   Days after vaccination:0
Submitted: 2010-05-11
   Days after onset:1
Entered: 2010-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E46123 / 5 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Gait disturbance, Injected limb mobility decreased, Injection site pain
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypoglycaemia (broad)

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

Write-up: Pt had pain in left leg and stopped moving the leg around 6-8 hours after the vaccine shot in left leg. Now in clinic she is walking with a limp No h/o seizures, hives, shortness of breath. No neurological deficit on exam. Recommend - MOTRIN, TYLENOL.


VAERS ID: 387194 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2010-04-13
Onset:2010-04-15
   Days after vaccination:2
Submitted: 2010-05-11
   Days after onset:26
Entered: 2010-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UP073AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44520 / 1 LL / IM

Administered by: Private       Purchased by: Other
Symptoms: Injection site erythema, Vaccination complication
SMQs:, Extravasation events (injections, infusions and implants) (broad)

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

Write-up: Mom returned to clinic with complaint of redness to injection site. MD evaluated and was diagnosed with "Local vaccine reaction versus a possible early cellulitis." Was started on Keflex to treat.


VAERS ID: 387200 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Female  
Location: Georgia  
Vaccinated:2010-05-05
Onset:2010-05-06
   Days after vaccination:1
Submitted: 2010-05-06
   Days after onset:0
Entered: 2010-05-11
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR C3380AA / 6 RL / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 13344 / 2 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44520 / 1 RL / UN

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

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

Write-up: Local reaction 2" X 1 3/4 inch. Fever of 100.5.


VAERS ID: 387222 (history)  
Form: Version 1.0  
Age: 3.0  
Sex: Male  
Location: Michigan  
Vaccinated:2010-05-05
Onset:2010-05-06
   Days after vaccination:1
Submitted: 2010-05-11
   Days after onset:5
Entered: 2010-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44433 / 1 UN / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Penicillin reaction - body rash
Allergies:
Diagnostic Lab Data: Shot reaction; injection shot Rx
CDC Split Type:

Write-up: On 5-6-10, 2" X 2" red rash at injection site, mild, swelling and warm to touch. Low grade fever.


VAERS ID: 387226 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2010-05-05
Onset:2010-05-08
   Days after vaccination:3
Submitted: 2010-05-11
   Days after onset:3
Entered: 2010-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44521 / 1 LL / IM

Administered by: Unknown       Purchased by: Other
Symptoms:
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol HFA, Pulmicort, Flovent
Current Illness: Asthma
Preexisting Conditions: Eczema, asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Given vaccination on 6May10 and on 8May10 mother brought child to Hospital ER for evaul. Was admitted with cellulitis and d/c from hospital on 10May10.


VAERS ID: 387227 (history)  
Form: Version 1.0  
Age: 1.1  
Sex: Male  
Location: New York  
Vaccinated:2010-05-11
Onset:2010-05-11
   Days after vaccination:0
Submitted: 2010-05-11
   Days after onset:0
Entered: 2010-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1397Y / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER D911Y / 1 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44519 / 4 RL / IM
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER 14327 / 1 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Inappropriate schedule of drug administration, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Medication errors (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: no
Preexisting Conditions: recent occurrence of hives 2 months earlier with diagnosis of viral upper respiratory illness
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Occurrence of localized raised urticaria on the right hand 15 minutes after the vaccines were given.


VAERS ID: 387291 (history)  
Form: Version 1.0  
Age: 0.2  
Sex: Male  
Location: New York  
Vaccinated:2010-05-10
Onset:2010-05-11
   Days after vaccination:1
Submitted: 2010-05-12
   Days after onset:1
Entered: 2010-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3599AA / 1 RL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1275Y / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44521 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1632Y / 1 MO / PO

Administered by: Other       Purchased by: Public
Symptoms: Blood culture, Full blood count normal, Pyrexia, Rash generalised
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Fever 102.7, rash on trunk and extremities.


VAERS ID: 387295 (history)  
Form: Version 1.0  
Age: 0.18  
Sex: Male  
Location: Idaho  
Vaccinated:2010-05-11
Onset:2010-05-11
   Days after vaccination:0
Submitted: 2010-05-12
   Days after onset:1
Entered: 2010-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3572AA / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1024Y / 2 RL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E46122 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1527Y / 1 MO / PO

Administered by: Other       Purchased by: Other
Symptoms: Crying, Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Depression (excl suicide and self injury) (broad)

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

Write-up: Rt thigh swollen, warm to touch & very red. Pt crying and mom had not been able to calm him. Mom already gave Tylenol. Patient given 1cc Benadryl per request of Dr. Mom instructed to give Tylenol q4h prn & Benadryl q6h prn.


VAERS ID: 387308 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Male  
Location: California  
Vaccinated:2010-04-29
Onset:2010-05-01
   Days after vaccination:2
Submitted: 2010-05-04
   Days after onset:3
Entered: 2010-05-12
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK RA / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / UNK RA / UN

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

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

Write-up: Redness, swelling, tenderness


VAERS ID: 387309 (history)  
Form: Version 1.0  
Age: 0.59  
Sex: Male  
Location: Virginia  
Vaccinated:2010-05-06
Onset:2010-05-06
   Days after vaccination:0
Submitted: 2010-05-12
   Days after onset:6
Entered: 2010-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS AC21B210BA / 3 RL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF975AA / 3 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44519 / 3 LL / UN

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

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

Write-up: Child received DTaP, Hep B, IPV, (PEDIARIX) HIB, PCV on 5/6/10. Mother stated that child had hives on the night of 5/6/10. Next morning he had a fever of 101 axilliary. He was seen at physician tx center and tied to increase fluids.


VAERS ID: 387321 (history)  
Form: Version 1.0  
Age: 4.0  
Sex: Female  
Location: California  
Vaccinated:2010-05-11
Onset:2010-05-12
   Days after vaccination:1
Submitted: 2010-05-12
   Days after onset:0
Entered: 2010-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E45349 / 5 LA / IM

Administered by: Unknown       Purchased by: Public
Symptoms: Pain, Skin warm, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: SWOLLEN PAIN IT WARMNESS 3CM X 3CM.


VAERS ID: 387329 (history)  
Form: Version 1.0  
Age: 1.17  
Sex: Male  
Location: California  
Vaccinated:2010-05-05
Onset:0000-00-00
Submitted: 2010-05-10
Entered: 2010-05-12
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB362AA / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0967Y / 1 RA / SC
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44527 / UNK RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1132Y / 1 LA / SC

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

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

Write-up: Right upper ext. warm, red, slight induration 18 X 20 cm at vaccine site 2 days after vaccine.


VAERS ID: 387341 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Female  
Location: Illinois  
Vaccinated:2010-05-01
Onset:2010-05-02
   Days after vaccination:1
Submitted: 2010-05-12
   Days after onset:10
Entered: 2010-05-13
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Apparent death, Endotracheal intubation, Extubation, Speech disorder, Status epilepticus
SMQs:, Angioedema (broad), Systemic lupus erythematosus (broad), Dementia (broad), Convulsions (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 0 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Concomitant medications were not reported.
Current Illness: Unknown
Preexisting Conditions: Relevant medical history was not provided.
Allergies:
Diagnostic Lab Data: Unknown
CDC Split Type: USWYEH14965210

Write-up: This case was considered medically important. Information regarding PREVNAR 13 was received from a healthcare professional regarding a 29-month-old female patient who experienced status epilepticus, almost died and struggled to speak. At 29 months of age, the patient received a dose on 01-May-2010. The patient also received a dose of Hepatitis A Vaccine (manufacturer unknown) on 01-May-2010. The patient experienced status epilepticus on 02-May-2010 as described by her mother as seizing for about one hour and almost died. The patient was hospitalized and had to be intubated. That evening, the patient was extubated. The following day, the patient struggled to speak, however some words were coming back. Outcome was reported as recovering. No additional information was available at the time of this report.


VAERS ID: 387345 (history)  
Form: Version 1.0  
Age: 2.0  
Sex: Male  
Location: Michigan  
Vaccinated:2010-05-11
Onset:0000-00-00
Submitted: 2010-05-13
Entered: 2010-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)) / SANOFI PASTEUR UF836AA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44526 / 1 RL / IM

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

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

Write-up: Mother states child developed a large red area on right leg where PCV13 shot was given. And that is spread down his leg and up toward his back. She states he has never had a reaction to a vaccine in the past.


VAERS ID: 387352 (history)  
Form: Version 1.0  
Age: 1.0  
Sex: Male  
Location: Iowa  
Vaccinated:2010-05-03
Onset:2010-05-05
   Days after vaccination:2
Submitted: 2010-05-06
   Days after onset:1
Entered: 2010-05-13
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. 1538Y / 1 LL / UN
HIBV: HIB (ACTHIB) / SANOFI PASTEUR UF732AC / 4 LL / UN
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44521 / 1 RL / UN

Administered by: Private       Purchased by: Unknown
Symptoms: Chest X-ray abnormal, Pneumonia, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CXR
CDC Split Type:

Write-up: Patient had acute onset of wheezing approx 18 hrs after vaccines. Was diagnosed with pneumonia by CXR overnight (approx 4 hr) hospitalization for O2, antibiotic and bronchodilators.


VAERS ID: 387354 (history)  
Form: Version 1.0  
Age: 0.18  
Sex: Male  
Location: North Carolina  
Vaccinated:2010-05-04
Onset:2010-05-05
   Days after vaccination:1
Submitted: 2010-05-07
   Days after onset:2
Entered: 2010-05-13
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPVHIB: DTAP + IPV + HIB (PENTACEL) / SANOFI PASTEUR C3588AA / 1 RL / IM
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS AHBVB818BA / 2 LL / IM
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH E44521 / 1 LL / IM
RV5: ROTAVIRUS (ROTATEQ) / MERCK & CO. INC. 1523Y / 1 MO / PO

Administered by: Private       Purchased by: Unknown
Symptoms: Irritability, Screaming
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypoglycaemia (broad)

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

Write-up: Child very fussy. Screams for 20 mins. inconsolable.


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