National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

Found 1472 cases where Location is Vermont and Vaccination Date on/after '1979-01-01'

Table

   
Year of VaccinationEvent CategoryCountPercent
1989Death10.07%
Recovered10.07%
Not Serious10.07%
total30.2%
1990Emergency Room10.07%
Recovered30.2%
Not Serious90.61%
total130.88%
1991Emergency Room60.41%
Hospitalized10.07%
Recovered100.68%
Not Serious60.41%
total231.56%
1992Permanent Disability10.07%
Emergency Room90.61%
Hospitalized30.2%
Recovered130.88%
Not Serious80.54%
total342.31%
1993Permanent Disability10.07%
Emergency Room90.61%
Hospitalized20.14%
Recovered130.88%
Life Threatening20.14%
Not Serious30.2%
total302.04%
1994Death10.07%
Emergency Room70.48%
Hospitalized20.14%
Recovered120.82%
Not Serious50.34%
total271.83%
1995Emergency Room120.82%
Hospitalized10.07%
Recovered221.49%
Not Serious90.61%
total442.99%
1996Permanent Disability10.07%
Emergency Room130.88%
Hospitalized60.41%
Recovered70.48%
Not Serious20.14%
total291.97%
1997Death10.07%
Emergency Room90.61%
Hospitalized30.2%
Recovered171.15%
Not Serious40.27%
total342.31%
1998Death10.07%
Emergency Room80.54%
Recovered151.02%
Not Serious20.14%
total261.77%
1999Emergency Room181.22%
Hospitalized10.07%
Recovered261.77%
Not Serious40.27%
total493.33%
2000Emergency Room90.61%
Hospitalized20.14%
Recovered281.9%
Not Serious70.48%
total463.13%
2001Emergency Room151.02%
Hospitalized10.07%
Recovered231.56%
Not Serious10.07%
total402.72%
2002Emergency Room80.54%
Hospitalized10.07%
Recovered171.15%
Not Serious30.2%
total291.97%
2003Permanent Disability10.07%
Emergency Room70.48%
Hospitalized20.14%
Recovered130.88%
Not Serious40.27%
total271.83%
2004Permanent Disability10.07%
Emergency Room100.68%
Hospitalized10.07%
Recovered241.63%
Not Serious100.68%
total463.13%
2005Death10.07%
Permanent Disability10.07%
Emergency Room231.56%
Hospitalized40.27%
Recovered352.38%
Not Serious110.75%
total755.1%
2006Permanent Disability10.07%
Emergency Room151.02%
Hospitalized30.2%
Hospitalized, Prolonged10.07%
Recovered332.24%
Life Threatening10.07%
Not Serious100.68%
total644.35%
2007Death10.07%
Permanent Disability20.14%
Emergency Room201.36%
Hospitalized30.2%
Recovered392.65%
Life Threatening10.07%
Not Serious201.36%
total865.84%
2008Permanent Disability10.07%
Emergency Room332.24%
Hospitalized40.27%
Recovered604.08%
Life Threatening20.14%
Not Serious241.63%
total1248.42%
2009Emergency Room382.58%
Hospitalized30.2%
Recovered1389.38%
Not Serious372.51%
total21614.67%
2010Permanent Disability10.07%
Emergency Room231.56%
Hospitalized20.14%
Recovered342.31%
Life Threatening10.07%
Not Serious161.09%
total775.23%
2011Death30.2%
Emergency Room271.83%
Hospitalized60.41%
Recovered412.79%
Life Threatening30.2%
Not Serious201.36%
total1006.79%
2012Office Visit10.07%
Emergency Room221.49%
Emergency Doctor/Room10.07%
Hospitalized20.14%
Recovered442.99%
Life Threatening10.07%
Not Serious171.15%
total885.98%
2013Emergency Room140.95%
Hospitalized30.2%
Hospitalized, Prolonged10.07%
Recovered362.45%
Life Threatening10.07%
Not Serious563.8%
total1117.54%
2014Death20.14%
Permanent Disability20.14%
Office Visit10.07%
Emergency Room271.83%
Emergency Doctor/Room10.07%
Hospitalized20.14%
Recovered493.33%
Not Serious211.43%
total1057.13%
2015Emergency Room291.97%
Hospitalized30.2%
Recovered372.51%
Life Threatening10.07%
Not Serious171.15%
total875.91%
2016Emergency Room261.77%
Hospitalized20.14%
Recovered382.58%
Life Threatening10.07%
Not Serious302.04%
total976.59%
2017Permanent Disability10.07%
Office Visit291.97%
Emergency Room70.48%
Emergency Doctor/Room50.34%
Hospitalized10.07%
Recovered261.77%
Not Serious211.43%
total906.11%
2018Death10.07%
Permanent Disability10.07%
Office Visit30.2%
Emergency Room10.07%
Emergency Doctor/Room20.14%
Hospitalized20.14%
Recovered40.27%
Not Serious40.27%
total181.22%
TOTAL† 1838† 124.86%
† Because some cases have multiple vaccinations and symptoms, a single case can account for multiple entries in this table. This is the reason why the Total Count is greater than 1472 (the number of cases found), and the Total Percentage is greater than 100.

Case Details (Sorted by Vaccination Date)

VAERS ID: 25199 (history)  
Form: Version 1.0  
Age: 51.0  
Gender: Male  
Location: Vermont  
Vaccinated:1989-04-25
Onset:1989-04-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-07-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 229968 / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Arthralgia, Headache, Hyporeflexia, Myelitis, Neuropathy, Paraesthesia, Paralysis
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Arthritis (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: ~ ()~~~In patient
Other Medications: N/A
Current Illness:
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type: 960007921

Write-up: ONE OF FOUR PTS DEVELPD FEVER, CHILLS AND ARTHRALGIAS AND PALPITATIONS WITHIN 24 HRS AFTER IMMUN. NO RESIDUAL EFFECTS NOTED WHEN SEEN BY PHYS 5-1-90.


VAERS ID: 27052 (history)  
Form: Version 1.0  
Age: 38.0  
Gender: Female  
Location: Vermont  
Vaccinated:1989-08-01
Onset:1989-08-05
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 1990-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RUB: RUBELLA (MERUVAX II) / MERCK & CO. INC. 38066 / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Arthropathy, Headache, Malaise, Osteoarthritis, Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Arthritis (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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Allergy environmental; Alleryg , drugs
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES89080607

Write-up: Pt vaccinated with MERUVAX II developed a rash, headache & general malaise. Two days later developed stiffness of the rt & lt knees. Moderately large effusions were noted on both knees.


VAERS ID: 26297 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Vermont  
Vaccinated:1989-12-14
Onset:1990-01-01
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 1990-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256959 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 259943 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Apnoea, Brain oedema, Hypoxia, Infection, Lung disorder, Petechiae, Respiratory disorder, Sudden infant death syndrome
SMQs:, Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Hyponatraemia/SIADH (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Neonatal disorders (narrow), Respiratory failure (narrow), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1990-01-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 9001636.01

Write-up: CDC Reports: 2 mo infant received DTP/OPV on 14DEC89 and died 1JAN90.


VAERS ID: 28233 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Vermont  
Vaccinated:1990-01-03
Onset:1990-01-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1991-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 256959 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0602E / UNK MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site pain, Pyrexia, Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: Previous convuls in pt w/fever of 106.
Allergies:
Diagnostic Lab Data:
CDC Split Type: 900174001

Write-up: CDC reports: 6 yo child developed fever to 105, pain @ inject site & lethargy following DTP/OPV immunization. Duration of illness 2 days.


VAERS ID: 31323 (history)  
Form: Version 1.0  
Age: 36.0  
Gender: Female  
Location: Vermont  
Vaccinated:1990-02-01
Onset:1990-02-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1991-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0183R / 1 - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness:
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type: WAES90110010

Write-up: pt. recvd 1st & 2nd doses Hepatitis B vac & after each inject exp. swollen,achy lymph node. Condition persisted for 2 weeks & resolved w/o treatment.


VAERS ID: 30578 (history)  
Form: Version 1.0  
Age: 42.0  
Gender: Female  
Location: Vermont  
Vaccinated:1990-03-28
Onset:1990-03-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1991-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1772R / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Arthralgia, Arthritis, Nausea, Oedema, Osteoarthritis
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Arthritis (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: ~ ()~~~In patient
Other Medications:
Current Illness: concurrent viral syndrome
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: WAES90060548

Write-up: 28mar90 pt vax hepta b. pt ex joint aching, and nausea which remitted w/i few days. attrib. aches to cocurrent viral syndrome. 07may90 2nd vax. 01jun90 pt devel swelling in ankles and hand joints. also complained of arthritic sx in hip/knee


VAERS ID: 25334 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Vermont  
Vaccinated:1990-04-09
Onset:1990-04-16
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 1990-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 591A4 / UNK - / IM

Administered by: Private       Purchased by: Private
Symptoms: Abdominal pain, Diarrhoea
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: MULTIVITAMINS AND CALCIUM
Current Illness:
Preexisting Conditions: N/A
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type: EBU900140

Write-up: ONE WEEK FOLLOWING 1ST INJECT, PT DEVELPD ABDOMINAL PAIN/CRAMPS, DIARRHEA. A STOOL CULTURE WAS ORDERED. AS OF 4-19-90 NO TREATMENT GIVEN AND ALL SYMPTOMS PERSIST.


VAERS ID: 25335 (history)  
Form: Version 1.0  
Age: 41.0  
Gender: Female  
Location: Vermont  
Vaccinated:1990-04-17
Onset:1990-04-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1990-07-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 591A4 / UNK - / IM

Administered by: Private       Purchased by: Private
Symptoms: Arthralgia, Dizziness, Dyspepsia, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: RECOMBIVAX INOCS UNEVENTFUL~ ()~~~In patient
Other Medications: N/A
Current Illness:
Preexisting Conditions: ALLERGIC TO MOLDS, ZINC, FLEXERIL. INITIAL RECOMBIVAX INOCULATIONS UNEVENTFUL, BUT NEVER PRODUCED ANTIBODIES
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type: EBU900141

Write-up: PT A NON-RESPONDER TO RECOMBIVAX AND RECVD 1ST ADDITIONAL DOSE OF ENGERIX B ON 4-17-90. NEXT DAY PT WAS DIZZY, DEVELPD JOINT PAIN, MUSCLE ACHES, UPSET STOMACH. CURRENTLY IMPROVING. NO SUBSEQUENT INJECTS PLANNED


VAERS ID: 30659 (history)  
Form: Version 1.0  
Age: 49.0  
Gender: Female  
Location: Vermont  
Vaccinated:1990-05-30
Onset:1990-06-03
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 1991-03-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1883R / UNK LA / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Arthralgia, Hypertonia, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: anti HBs positive
CDC Split Type: WAES90070609

Write-up: 30may90 pt vax hepta B. 03jun90 pt devel stiffness in left shoulder and elbow. sx remitted in 3-4 day. lab tests revealed anti-HBs pos and no add vax were admin.


VAERS ID: 25661 (history)  
Form: Version 1.0  
Age: 47.0  
Gender: Male  
Location: Vermont  
Vaccinated:1990-06-27
Onset:1990-06-28
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1990-08-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 586A4 / 3 - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Arthralgia, Arthropathy, Face oedema, Osteoarthritis, Pain, Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Arthritis (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: hepatitis B surfact Antibody done 22-JAN-90 - negative (after 2nd does give)
CDC Split Type:

Write-up: Pt received 3rd dose of Engerix B on 27-JUN-90 and on 28-JUN-90 noted mild arthralgias in hands on 29-JUN-90 rash, causing sellling mainly on rt side of fact & worsened arthralgias in wrists & fingers. Rt knee began to swell, stiff & painfu


VAERS ID: 26577 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Vermont  
Vaccinated:1990-07-01
Onset:1990-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1990-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: EBU900278

Write-up: Non responder /p 3rd dose of vax.


VAERS ID: 37566 (history)  
Form: Version 1.0  
Age: 1.4  
Gender: Male  
Location: Vermont  
Vaccinated:1990-08-15
Onset:1990-10-01
   Days after vaccination:47
Submitted: 0000-00-00
Entered: 1992-06-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1386R / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Cough, Gingival bleeding, Leukopenia, Lung disorder, Otitis media, Pharyngitis, Rash, White blood cell disorder
SMQs:, Anaphylactic reaction (narrow), Agranulocytosis (broad), Haematopoietic leukopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Oropharyngeal infections (narrow), Gingival disorders (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: neutropenia, chronic
Allergies:
Diagnostic Lab Data: DEC1990 WBC Count-4000; Lymphocytes 72 to 91% many atypical; Granulocytes 1%;
CDC Split Type: WAES92010485

Write-up: Pt recvd MMR vax 15AUG90 & OCT90 devel OM, roseola, & a cough which lasted 2 wks; also noted rales; given med for resp infect; DEC90 devel bleeding gums; neutropenia;


VAERS ID: 27986 (history)  
Form: Version 1.0  
Age: 32.0  
Gender: Female  
Location: Vermont  
Vaccinated:1990-08-30
Onset:1990-08-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1991-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 600A4 / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site reaction, Oedema, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: EBU900427

Write-up: W/in 12 hrs of receiving Engerix-B in lt deltoid, experienced pain in arms x 3 days, induration, hot, & swelling; Events resolved


VAERS ID: 28014 (history)  
Form: Version 1.0  
Age: 25.0  
Gender: Female  
Location: Vermont  
Vaccinated:1990-09-07
Onset:1990-09-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1991-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dizziness, Headache, Hyperhidrosis, Nausea
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: EBU900376

Write-up: Events occurred 15 to 30 min p/vaccinee rec''d a 2nd Engerix-B dose 7SEP90; Put under observation ( ? emergency room). sx were still persisting 2 hrs post inject;Diaphoresis;dizziness;nausea;severe headache;


VAERS ID: 26886 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Vermont  
Vaccinated:1990-11-20
Onset:1990-11-20
   Days after vaccination:0
Submitted: 1990-11-26
   Days after onset:6
Entered: 1990-12-03
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 285965 / 2 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 275910 / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Injection site reaction, Screaming
SMQs:, Hostility/aggression (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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt vaccinated with DTP/OPV continuous crying for over 4 hrs following injection, w/redness & swelling of thigh


VAERS ID: 39205 (history)  
Form: Version 1.0  
Age: 33.0  
Gender: Male  
Location: Vermont  
Vaccinated:1990-11-30
Onset:1990-11-30
   Days after vaccination:0
Submitted: 1991-01-23
   Days after onset:54
Entered: 1992-01-28
   Days after submission:370
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (IMOVAX) / PASTEUR MERIEUX INST. D0985 / 4 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Arthralgia, Dizziness, Headache, Myalgia, Pruritus, Pyrexia, Urticaria
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: various pollens
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO3766

Write-up: P/4th dose pt exp generalized itching, fever, muscle aches, joint pains, malaise, h/a, dizziness, abdominal pain & hives; maximum fever 103.4;


VAERS ID: 29856 (history)  
Form: Version 1.0  
Age: 1.3  
Gender: Female  
Location: Vermont  
Vaccinated:1991-01-21
Onset:1991-01-29
   Days after vaccination:8
Submitted: 1991-04-04
   Days after onset:65
Entered: 1991-04-11
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 0A21133 / 1 - / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1502S / 1 - / SC

Administered by: Private       Purchased by: Public
Symptoms: Febrile convulsion
SMQs:, Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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, 5 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: bilat serous otitis media
Preexisting Conditions: 10m, 33 wks gestation, GER, PDA repaired, microcyst,develop-delay
Allergies:
Diagnostic Lab Data: EEG-nl
CDC Split Type:

Write-up: Febrile seizure 29Jan91, hospitalized, did well


VAERS ID: 33786 (history)  
Form: Version 1.0  
Age: 32.0  
Gender: Female  
Location: Vermont  
Vaccinated:1991-03-15
Onset:1991-03-15
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1991-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 631A4 / 3 - / IM A

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: allergies pollen, animal hair
Allergies:
Diagnostic Lab Data:
CDC Split Type: EBU910286

Write-up: Pt recvd 3 doses Engerix-B, 3rd given 15MAR91; About 6 hrs p/3rd inject pt exp itching, swelling @ site, erythema 6in diameter, lt palm red, itching, swollen, throat itching & hives on lt thigh & local induration; Pt went to ER & tx DPH;


VAERS ID: 30331 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Male  
Location: Vermont  
Vaccinated:1991-04-16
Onset:1991-04-16
   Days after vaccination:0
Submitted: 1991-04-18
   Days after onset:2
Entered: 1991-05-07
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1502S / 1 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Bradycardia, Hyperhidrosis, Nausea, Pallor, Somnolence, Urticaria, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: VS-P70, BP100/50-60,;
CDC Split Type: VT91001

Write-up: Approx 5-10min postvax c/o nauseated, had dry heaves & spit up some phlegm; Sat down, was sweating profusely, very pale, hives on his face, became sleepy, en route to ER developed bradycardia;


VAERS ID: 30679 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Female  
Location: Vermont  
Vaccinated:1991-05-14
Onset:1991-05-15
   Days after vaccination:1
Submitted: 1991-05-15
   Days after onset:0
Entered: 1991-05-20
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 298916 / 2 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M17OHR / 2 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 06314 / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Screaming
SMQs:, Hostility/aggression (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: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: prolonged crying ; $g3 hrs


VAERS ID: 31659 (history)  
Form: Version 1.0  
Age: 78.0  
Gender: Female  
Location: Vermont  
Vaccinated:1991-06-05
Onset:1991-06-07
   Days after vaccination:2
Submitted: 1991-06-17
   Days after onset:10
Entered: 1991-06-21
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 2171S / 1 LA / IM
TD: TD ADSORBED (NO BRAND NAME) / SCLAVO 136A1 / UNK RA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site pain, Injection site reaction
SMQs:, Extravasation events (injections, infusions and implants) (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: ~ ()~~~In patient
Other Medications:
Current Illness: UTI
Preexisting Conditions: Drug allergy: Sulfa
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt c/o lump @ site of DT inject in rt arm, aching & itching; on exam 2cm deep nodule rt upper arm; not fluctuant or tender; imp-local allergic rxn to DT; plan-DPH 25mg;


VAERS ID: 40562 (history)  
Form: Version 1.0  
Age: 27.0  
Gender: Male  
Location: Vermont  
Vaccinated:1991-07-30
Onset:1991-08-09
   Days after vaccination:10
Submitted: 1992-02-07
   Days after onset:182
Entered: 1992-03-24
   Days after submission:46
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0851T / 2 LA / -

Administered by: Private       Purchased by: Private
Symptoms: Amblyopia, Diabetes mellitus, Hyperglycaemia, Polyuria, Thirst
SMQs:, Hyperglycaemia/new onset diabetes mellitus (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Optic nerve disorders (broad), Tubulointerstitial diseases (broad), Dehydration (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: NA~ ()~~~In patient
Other Medications: 1st dose MMR given 27JUN91 LA lot # 1731R;
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: Fasting glucose 250, blood sugars ranged in 500+;
CDC Split Type:

Write-up: Pt exp polyuria, inc thirst, blurred vision from 1AUG91 to 9AUG91 exp a twenty pound weight loss; dx of diabetes on 9AUG91;


VAERS ID: 34406 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Vermont  
Vaccinated:1991-08-21
Onset:1991-08-22
   Days after vaccination:1
Submitted: 1991-08-23
   Days after onset:1
Entered: 1991-08-29
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 306924 / 2 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M180HE / 2 - / IM L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0634F / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Hypotonia, Muscle twitching, Pallor, Pyrexia, Stupor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Dyskinesia (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT91002

Write-up: Pt exp fussy all nite, t101, entire body started to jerk, eyes would not focus, pale, went limp for 1 min;


VAERS ID: 38699 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Vermont  
Vaccinated:1991-08-21
Onset:1991-10-21
   Days after vaccination:61
Submitted: 1991-11-19
   Days after onset:29
Entered: 1991-12-23
   Days after submission:34
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 814A4 / 3 - / IM A

Administered by: Public       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: EBU911260

Write-up: 8 people were vaxed w/Engerix-B on 20FEB91, 20MAR91, & 21AUG91 & 2 mos p/3rd dose 21OCT91 titers were tested & 5 of these 8 ptes had neg titer results (non-responders); These pts will receive 2 booster doses;


VAERS ID: 42692 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Vermont  
Vaccinated:1991-08-21
Onset:0000-00-00
Submitted: 1992-02-25
Entered: 1992-04-02
   Days after submission:37
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 814A4 / 3 - / IM A

Administered by: Public       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (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: ~ ()~~~In patient
Other Medications:
Current Illness: UNK
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: EBU920200

Write-up: Pt recvd 3 doses of Engerix-B on 20FEB91, 20MAR91, 21AUG91 & found to have not seroconverted; no tx given;


VAERS ID: 42693 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Vermont  
Vaccinated:1991-08-21
Onset:1991-08-21
   Days after vaccination:0
Submitted: 1992-02-25
   Days after onset:188
Entered: 1992-04-02
   Days after submission:37
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 814A4 / 3 - / IM A

Administered by: Public       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (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: ~ ()~~~In patient
Other Medications:
Current Illness: UNK
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: EBU920201

Write-up: Pt recvd 3 doses of Engerix-B vax 20FEB91, 20MAR91 & 21AUG91 & found to have not seroconverted; no tx was given;


VAERS ID: 34760 (history)  
Form: Version 1.0  
Age: 19.0  
Gender: Female  
Location: Vermont  
Vaccinated:1991-08-23
Onset:1991-08-24
   Days after vaccination:1
Submitted: 1991-09-11
   Days after onset:18
Entered: 1991-09-16
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 0K21146 / UNK LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Chest pain, Dyspnoea, Hepatitis, Influenza, Insomnia, Pain, Pleural disorder, Pyrexia
SMQs:, Hepatitis, non-infectious (narrow), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT91003

Write-up: Pt recvd Td 23AUG91 & c/o feeling of tightness &/or crampy feeling along lower rib cage, same feeling in neck & shoulder area, feeling is emphasized upon taking a deep breath, unable to sleep; dx Pleuritic chest pleural pain & fever;


VAERS ID: 38242 (history)  
Form: Version 1.0  
Age: 64.0  
Gender: Female  
Location: Vermont  
Vaccinated:1991-08-26
Onset:0000-00-00
Submitted: 1991-11-06
Entered: 1991-12-23
   Days after submission:47
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 719A4 / 3 - / IM A

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (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: ~ ()~~~In patient
Other Medications: Pt recvd Engerix-B vax on 7MAY91 lot631A4 & 7JUN91 lot# 715A4;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: EBU910892

Write-up: Pt recvd Engerix-B 7JUN91 & 8JUL91 & exp "negative seroconversion" 26AUG91 recvd a booster;


VAERS ID: 42690 (history)  
Form: Version 1.0  
Age: 0.0  
Gender: Female  
Location: Vermont  
Vaccinated:1991-08-29
Onset:0000-00-00
Submitted: 1992-02-25
Entered: 1992-04-02
   Days after submission:37
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 814A4 / 3 - / IM A

Administered by: Public       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (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: ~ ()~~~In patient
Other Medications:
Current Illness: UNK
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: EBU920198

Write-up: Pt recvd 3 doses of Engerix-B 20FEB91, 20MAR91, & 29AUG91 & found to have not seroconverted; no tx given;


VAERS ID: 42691 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Vermont  
Vaccinated:1991-08-29
Onset:0000-00-00
Submitted: 1992-02-25
Entered: 1992-04-02
   Days after submission:37
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 814A4 / 3 - / IM A

Administered by: Public       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (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: ~ ()~~~In patient
Other Medications:
Current Illness: UNK
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: EBU920199

Write-up: Pt recvd 3 doses of Engerix-B 20FEB91, 20MAR91, 29AUG91 & found to have not seroconverted; no tx given;


VAERS ID: 35691 (history)  
Form: Version 1.0  
Age: 0.1  
Gender: Female  
Location: Vermont  
Vaccinated:1991-10-08
Onset:1991-10-08
   Days after vaccination:0
Submitted: 1991-10-16
   Days after onset:8
Entered: 1991-10-21
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310967 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M615HE / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0641D / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Cyanosis, Dyspnoea, Hypotonia, Pallor, Somnolence, Stupor, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT91004

Write-up: Pt recvd 1st set of shots seemed sleepy all day; 15-30min prior to arrival was noted to turn pale, dusky around lips, w/grunting respirations; Also very limp, eyes open but unresponsive; vomited once; dx hypotonic rxn to immun;


VAERS ID: 38402 (history)  
Form: Version 1.0  
Age: 40.0  
Gender: Female  
Location: Vermont  
Vaccinated:1991-10-10
Onset:1991-10-10
   Days after vaccination:0
Submitted: 1991-12-04
   Days after onset:55
Entered: 1991-12-23
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 814A4 / 2 - / IM A

Administered by: Other       Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site oedema, Pruritus, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: Pollens-hayfever sxs;
Allergies:
Diagnostic Lab Data:
CDC Split Type: EBU911024

Write-up: Pt recvd 2 doses of Engerix-B & the 1st dose was uneventful; On 10OCT91 p/2nd dose pt exp itching @ site of inject, swollen @ site of inject, induration (3x2) @ site of inject & red warm @ site of inject;


VAERS ID: 133301 (history)  
Form: Version 1.0  
Age: 46.0  
Gender: Male  
Location: Vermont  
Vaccinated:1991-10-14
Onset:1999-10-08
   Days after vaccination:2916
Submitted: 1999-12-16
   Days after onset:69
Entered: 2000-01-13
   Days after submission:28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0104AA / 2 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Brain MR scan normal.
CDC Split Type:

Write-up: Tingly numbness rear L sole, heal, & rear arch. Spread 1/2 rear calf, then to include entire L palm, forearm while present in leg. 1 wk later numbness receded. Present only in L foot. Ruled out GBS.


VAERS ID: 37634 (history)  
Form: Version 1.0  
Age: 27.0  
Gender: Female  
Location: Vermont  
Vaccinated:1992-01-01
Onset:1992-01-01
   Days after vaccination:0
Submitted: 1992-01-06
   Days after onset:5
Entered: 1992-07-20
   Days after submission:195
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 120602A / 4 MO / PO

Administered by: Public       Purchased by: Other
Symptoms: Abdominal pain, Diarrhoea, Flatulence, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: ~ ()~~~In patient
Other Medications: inhaler x 2 wks;
Current Illness:
Preexisting Conditions: lactose intolerance maybe asthma;
Allergies:
Diagnostic Lab Data:
CDC Split Type: BER10044

Write-up: diarrhea, fever a lot of gas; stomach aches p/eating;


VAERS ID: 39591 (history)  
Form: Version 1.0  
Age: 0.1  
Gender: Female  
Location: Vermont  
Vaccinated:1992-02-03
Onset:1992-02-03
   Days after vaccination:0
Submitted: 1992-02-12
   Days after onset:9
Entered: 1992-02-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 310967 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M185HF / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 308954 / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Somnolence, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: pts brother exp SIDS @ 2mos w/HIB #1;~ ()~~~In Sibling
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Excessive lethargy w/somnolence & vomiting w/in hrs p/shot; pt admitted to hosp for observation & evaluation of excessive somnolence, irritability w/vomiting;


VAERS ID: 40813 (history)  
Form: Version 1.0  
Age: 27.0  
Gender: Male  
Location: Vermont  
Vaccinated:1992-02-06
Onset:1992-02-07
   Days after vaccination:1
Submitted: 1992-03-23
   Days after onset:45
Entered: 1992-03-31
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1687T / 1 RA / IM
RUB: RUBELLA (MERUVAX II) / MERCK & CO. INC. 1650S / 1 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Abdominal pain, Diarrhoea, Face oedema, Hypersensitivity, Laryngospasm, Nausea, Oedema peripheral, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Dystonia (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: Epididymitis t99.2
Preexisting Conditions: spermatocelectomy 1975, hydrocelectomy 1986, dehydration/hypoglycemia; allergic to ASA, PCN, Compazine;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Awakened 7FEB92 AM w/rt hand swollen, face, t102, stomach cramps, nausea, diarrhea; denied rash, throat tightness; Referred to hosp ER felt throat tightness once there; Impression by ER MD allergic rxn; No edema, redness of inject site;


VAERS ID: 39714 (history)  
Form: Version 1.0  
Age: 44.0  
Gender: Male  
Location: Vermont  
Vaccinated:1992-02-10
Onset:1992-02-10
   Days after vaccination:0
Submitted: 1992-02-12
   Days after onset:2
Entered: 1992-02-27
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / SCLAVO 138A1 / 4 LA / -

Administered by: Private       Purchased by: Public
Symptoms: Abdominal pain, Chest pain, Ear disorder, Hypoaesthesia, Nausea, Rhinitis, Sinusitis
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Retroperitoneal fibrosis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

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

Write-up: c/o lt nasal congestion, & yellow nasal discharge; lt ear pulating; pt recvd vax 10FEB92 & 10-15 min later had tightness in chest w/o SOB followed by queasiness & tightness of stomach;also sl numbness, sl tenderness & edema noted;sinusitis;


VAERS ID: 40812 (history)  
Form: Version 1.0  
Age: 47.0  
Gender: Male  
Location: Vermont  
Vaccinated:1992-02-20
Onset:1992-02-21
   Days after vaccination:1
Submitted: 1992-03-23
   Days after onset:31
Entered: 1992-03-31
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1687T / 2 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Corneal lesion, Herpes zoster
SMQs:, Corneal disorders (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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: smoker 2PPD/60-65db hearing loss @ 4000hz/poor lower dentition;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Rash of shingles rt forehead, eyelid, top of head & around rt ear, few spots on rt cornea; Pt seen by MD; rx''d inflamase eye drops; rash resolving by 4MAR92; t<100.0 for 8-9 days;


VAERS ID: 41481 (history)  
Form: Version 1.0  
Age: 57.0  
Gender: Male  
Location: Vermont  
Vaccinated:1992-03-13
Onset:0000-00-00
Submitted: 1992-04-18
Entered: 1992-04-23
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (IMOVAX) / PASTEUR MERIEUX INST. - / 4 - / IM A

Administered by: Private       Purchased by: Private
Symptoms: Dry mouth, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Dehydration (broad)

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

Write-up: mouth was dry; tongue felt as if it were reacting to something it tingled;


VAERS ID: 50003 (history)  
Form: Version 1.0  
Age: 48.0  
Gender: Female  
Location: Vermont  
Vaccinated:1992-04-01
Onset:1992-04-01
   Days after vaccination:0
Submitted: 1992-04-03
   Days after onset:2
Entered: 1993-01-29
   Days after submission:301
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (IMOVAX) / PASTEUR MERIEUX INST. - / UNK LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: KCL, dyazide, Pepcid, Buspar, COpoten, Lopid
Current Illness:
Preexisting Conditions: HTN, hypercholesteolemia, dyspepsia, depression, asthma, allergic to ATB & Tegartol;
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO4200

Write-up: nausea, h/a p/2nd dose;


VAERS ID: 163437 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Vermont  
Vaccinated:1992-07-30
Onset:0000-00-00
Submitted: 2000-08-22
Entered: 2000-11-14
   Days after submission:84
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 950A4 / 3 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 20000252331

Write-up: Subsequent to receiving three doses of Engerix B, the pt was found to be a non-responder. As of 08/09/2000, the outcome of the event is unknown.


VAERS ID: 163438 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Vermont  
Vaccinated:1992-07-30
Onset:0000-00-00
Submitted: 2000-08-23
Entered: 2000-11-14
   Days after submission:83
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 950A4 / 3 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 20000253311

Write-up: Subsequent to receiving three doses of Engerix B, the pt was found to be a non-responder. As of 08/09/2000 the outcome of the event is unknown.


VAERS ID: 163445 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Vermont  
Vaccinated:1992-07-30
Onset:0000-00-00
Submitted: 2000-08-24
Entered: 2000-11-14
   Days after submission:82
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 9504A4 / 3 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 20000253911

Write-up: Subsequent to receiving three doses of Engerix B, the pt was found to be a non-responder. As of 08/09/2000, the outcome of the event is unknown.


VAERS ID: 163444 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Vermont  
Vaccinated:1992-08-10
Onset:0000-00-00
Submitted: 2000-08-23
Entered: 2000-11-14
   Days after submission:83
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1022A4 / 3 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 20000253701

Write-up: Subsequent to receiving three doses of Engerix B, the pt was found to be a non-responder. As of 08/09/2000, the outcome of the event is unknown.


VAERS ID: 163439 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Vermont  
Vaccinated:1992-08-12
Onset:0000-00-00
Submitted: 2000-08-23
Entered: 2000-11-14
   Days after submission:83
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1022A4 / 3 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 20000253351

Write-up: Subsequent to receiving three doses of Engerix B, the pt was found to be a non-responder. As of 08/09/2000, the outcome of the event is unknown.


VAERS ID: 44578 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Vermont  
Vaccinated:1992-08-18
Onset:1992-08-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1992-08-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (TRI-IMMUNOL) / LEDERLE LABORATORIES 328933 / 3 - / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M575HC / 3 - / IM

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Crying
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: Awoke from nap about 5 hrs p/shot w/high pitched screaming-inconsolable; lasted w/approx 1 1/4 hrs & fell back asleep; APAP given but temp only 97.5 ax;


VAERS ID: 44799 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Vermont  
Vaccinated:1992-09-01
Onset:1992-09-01
   Days after vaccination:0
Submitted: 1992-09-03
   Days after onset:2
Entered: 1992-09-10
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2M31091 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M190HK / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0665C / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Cyanosis, Pallor, Pharyngitis, Pyrexia, Rash
SMQs:, Anaphylactic reaction (narrow), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Acute central respiratory depression (broad), Hypotonic-hyporesponsive episode (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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: minor cough
Preexisting Conditions: downs syndrome, no heart disease
Allergies:
Diagnostic Lab Data: CBC-nl; HCT 29% WNL for 3mos old;
CDC Split Type:

Write-up: Approx 4-5 DTP/OPV/HIB pt found to be cyanotic in crib; was breathing moving but quiet; taken to ER by rescue 02 given in transit; t38.5; observed 2 days in hosp; minor URI, viral-like exanthem; pallor


VAERS ID: 55041 (history)  
Form: Version 1.0  
Age: 62.0  
Gender: Female  
Location: Vermont  
Vaccinated:1992-09-24
Onset:1992-09-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1993-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1301T / 2 - / IM

Administered by: Private       Purchased by: Other
Symptoms: Myalgia, Oedema peripheral, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Premarin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES92090848

Write-up: pt recvd vax 24SEP92 & oon 25SEP92 exp soreness, redness, & moderate swelling which resolved in 48 hrs in the fleshy part of arm; following vax recalled being vaxed w/pneumococcal vax 2DEC91; no further details were provided;


VAERS ID: 59012 (history)  
Form: Version 1.0  
Age: 40.0  
Gender: Female  
Location: Vermont  
Vaccinated:1992-10-01
Onset:1992-10-01
   Days after vaccination:0
Submitted: 1992-12-09
   Days after onset:69
Entered: 1993-11-03
   Days after submission:329
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 1 - / IM A

Administered by: Public       Purchased by: Other
Symptoms: Arthropathy, Malaise, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: EBU922872

Write-up: pt recvd vax & exp general aches & pain, joint stiffness & malaise;


VAERS ID: 48056 (history)  
Form: Version 1.0  
Age: 1.5  
Gender: Female  
Location: Vermont  
Vaccinated:1992-11-25
Onset:1992-11-25
   Days after vaccination:0
Submitted: 1992-12-09
   Days after onset:14
Entered: 1992-12-14
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER 2A41126 / 4 - / L

Administered by: Public       Purchased by: Public
Symptoms: Hypokinesia, Osteoarthritis
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Hypotonic-hyporesponsive episode (broad), Arthritis (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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT92003

Write-up: swollen knee, pt could not walk for 2 wks;


VAERS ID: 48199 (history)  
Form: Version 1.0  
Age: 59.0  
Gender: Female  
Location: Vermont  
Vaccinated:1992-11-27
Onset:1992-12-04
   Days after vaccination:7
Submitted: 1992-12-08
   Days after onset:4
Entered: 1992-12-18
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4928115 / UNK - / IM A

Administered by: Private       Purchased by: Private
Symptoms: Osteoarthritis, Paraesthesia, Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Arthritis (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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: erythromycin/Naprosyn
Allergies:
Diagnostic Lab Data: CBC, lytes, ESR-all nl;
CDC Split Type:

Write-up: joint swellings-hands, itchy feet w/tingling;


VAERS ID: 49685 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Vermont  
Vaccinated:1992-12-07
Onset:1992-12-07
   Days after vaccination:0
Submitted: 1993-02-01
   Days after onset:56
Entered: 1993-02-04
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2D41037 / 1 RL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0661H / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Anaemia, Anorexia, CSF test abnormal, Infection, Pyrexia, Sepsis, Urine analysis abnormal
SMQs:, Agranulocytosis (broad), Haematopoietic erythropenia (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications:
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: CBC revealed Hemoglobin of 11.2 w/repeat 11.5; MCV 87; reticulocyte count was 2.8 w/blood type A+ & neg Coombs'' test;
CDC Split Type: VT93001

Write-up: pt exp t102.5 & urine showed greater than 100 WBCs & bacteria; spinal fluid analysis showed a colorless, clear fluid w/ 70 RBCs, 6 WBCs, 6 Polys & 94 monos; directogen for group B strep was positive; CSF results suggestive for sepsis;


VAERS ID: 62621 (history)  
Form: Version 1.0  
Age: 20.0  
Gender: Female  
Location: Vermont  
Vaccinated:1992-12-09
Onset:1992-12-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1994-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0842V / 2 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Chest pain, Injection site hypersensitivity, Injection site oedema, Injection site pain, Neck pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Arthritis (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: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES93020195

Write-up: Pt recvd vax 9DEC92 & exp pain which radiated down arm to fingers & up arm to neck & across chest; pt exp persistent pain w/sl swelling & redness @ inject site for a few days; 11DEC92 pt exp pain upon lifting lt arm; pt was seen by MD;


VAERS ID: 55979 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Vermont  
Vaccinated:1992-12-20
Onset:1992-12-20
   Days after vaccination:0
Submitted: 1993-07-14
   Days after onset:205
Entered: 1993-09-10
   Days after submission:58
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (IMOVAX) / PASTEUR MERIEUX INST. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dizziness, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO4623

Write-up: dizziness & prickling sensation in legs which travels into buttock, also in hands; states also has dizziness w/begining of menstrual cycle; pt was in contact w/a dog that may have had the saliva of a rabid fox on its fur;


VAERS ID: 52405 (history)  
Form: Version 1.0  
Age: 34.0  
Gender: Female  
Location: Vermont  
Vaccinated:1992-12-28
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1993-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (IMOVAX) / PASTEUR MERIEUX INST. G0330 / 3 - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Asthenia, Chest pain, Myalgia, Myelitis, Neck pain, Neuropathy, Paraesthesia, Paraesthesia oral
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp raxn w/rabies vax #1 & 2 @ 35 y/o;~ ()~~~In patient
Other Medications: Ortho-Novum, Spironolactone
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: lab all neg
CDC Split Type:

Write-up: Pt had severe persistent painful dysesthesias s/p rabies vax; myalgias & paresthesias; some tingling in extremities, devel aching in posterior neck, numbness around lips, soreness, poss neuromuscular toxic reaction; also exhausted, frustrat


VAERS ID: 60210 (history)  
Form: Version 1.0  
Age: 50.0  
Gender: Female  
Location: Vermont  
Vaccinated:1993-01-21
Onset:1993-01-21
   Days after vaccination:0
Submitted: 1993-02-08
   Days after onset:18
Entered: 1993-11-03
   Days after submission:268
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 1 - / IM A

Administered by: Other       Purchased by: Other
Symptoms: Agitation, Anorexia, Chest pain, Dyspnoea, Influenza, Myasthenic syndrome, Paraesthesia, Tachycardia
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Malignancy related conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hostility/aggression (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: sarcodosis, gilberts disease;
Allergies:
Diagnostic Lab Data:
CDC Split Type: EBU930227

Write-up: Pt recvd vax & exp malaise, chills, weakness, tingling in lt hand, flu-like sx, nausea, loss of appetite, aching in arms, loss of strength in arms, irritability, agitation, inc HR, pain & soreness in chest, difficulty breathing & bronchospa


VAERS ID: 65411 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Vermont  
Vaccinated:1993-01-27
Onset:1993-01-27
   Days after vaccination:0
Submitted: 1993-02-01
   Days after onset:5
Entered: 1994-06-02
   Days after submission:485
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 338900 / 1 - / IM A

Administered by: Public       Purchased by: Public
Symptoms: Oedema peripheral, Urticaria
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), 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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: healthy
Preexisting Conditions: allergy to horses
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: 930027101

Write-up: pt recvd vax 27JAN93 AM-by evening, hands & feet were swollen & covered w/hives; seen by nurse 29JAN93; DPH administered; pt recovered; pt has recently devel allergy to horses; no hx of react following prev immun;


VAERS ID: 51265 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Female  
Location: Vermont  
Vaccinated:1993-02-08
Onset:1993-02-08
   Days after vaccination:0
Submitted: 1993-03-25
   Days after onset:45
Entered: 1993-03-29
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2A41126 / 2 LL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M100HP / 2 RL / -

Administered by: Public       Purchased by: Public
Symptoms: Agitation, Anorexia, Ecchymosis, Injection site hypersensitivity, Injection site inflammation, Injection site oedema
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT93002

Write-up: Pt exp lt thigh inject site red & swollen, pt fussy; leg w/minimal local inflammation, mom concerned about red swelling area to lt leg; poor appetite, creis a lot; swelling to lt thigh beginning to turn eccymotic;


VAERS ID: 55990 (history)  
Form: Version 1.0  
Age: 25.0  
Gender: Female  
Location: Vermont  
Vaccinated:1993-02-09
Onset:1993-02-09
   Days after vaccination:0
Submitted: 1993-07-14
   Days after onset:154
Entered: 1993-09-10
   Days after submission:58
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (IMOVAX ID) / PASTEUR MERIEUX INST. - / 1 - / A

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO4671

Write-up: wheal about the size of half dollar;


VAERS ID: 55256 (history)  
Form: Version 1.0  
Age: 55.0  
Gender: Male  
Location: Vermont  
Vaccinated:1993-02-23
Onset:1993-03-23
   Days after vaccination:28
Submitted: 1993-08-05
   Days after onset:134
Entered: 1993-08-16
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1093A2 / 2 - / A

Administered by: Other       Purchased by: Public
Symptoms: Arthritis, Asthenia, Blood lactate dehydrogenase increased, Infection, Myelitis, Neuropathy, Paraesthesia, Quadriplegia
SMQs:, Peripheral neuropathy (narrow), Systemic lupus erythematosus (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Arthritis (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: hx heart disease;
Allergies:
Diagnostic Lab Data: AST (SGOT) 63H; ALT (SGPT) 83 H; LDH 209 H; Sed rate 31 H; subopitimal study flow rates are reduced but fev1/fvc ratio is nl; TLC, RV, & FRC are all reduced suggestion chest restriction; sed rate 26H; CSF protein 50 H; Cholesterol 224H;
CDC Split Type:

Write-up: pt exp pains referable to shoulders & upper arms also quadriparesis; devel some type infectious disease process; malaise, elevated temp, infected tooth; lack of energy, aches & pains in muscles; hypalgesia & paresthesiae; progressive weakne


VAERS ID: 51282 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Vermont  
Vaccinated:1993-03-18
Onset:1993-03-18
   Days after vaccination:0
Submitted: 1993-03-19
   Days after onset:1
Entered: 1993-03-29
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 2E41072 / UNK - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M150JC / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0674B / UNK - / -

Administered by: Private       Purchased by: Public
Symptoms: Hypotonia, Pallor, Screaming
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hostility/aggression (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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: torticollis; mild hydronephrosis; bel''s palsy;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt cried for several hrs following vax then had episode off floppiness & pallor lasting apparently breifly; seen by MD;


VAERS ID: 54877 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Vermont  
Vaccinated:1993-03-26
Onset:1993-03-26
   Days after vaccination:0
Submitted: 1993-07-19
   Days after onset:114
Entered: 1993-07-26
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M040JH / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0670A / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Crying
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax & exp high pitched cry for 2 1/2 hrs;


VAERS ID: 61169 (history)  
Form: Version 1.0  
Age: 21.0  
Gender: Female  
Location: Vermont  
Vaccinated:1993-03-29
Onset:1993-03-29
   Days after vaccination:0
Submitted: 1993-05-13
   Days after onset:44
Entered: 1993-11-03
   Days after submission:174
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / UNK - / IM A

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: EBU930594

Write-up: Pt recvd vax & devel hives; pt was treated w/Antihistamines (DPH); reporting MD indicated pt devel hives on 2 separate occasions unrelated to vax; A thimerosal allergy may exist;


VAERS ID: 61184 (history)  
Form: Version 1.0  
Age: 38.0  
Gender: Female  
Location: Vermont  
Vaccinated:1993-04-01
Onset:1993-04-02
   Days after vaccination:1
Submitted: 1993-05-21
   Days after onset:48
Entered: 1993-11-03
   Days after submission:166
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1070A4 / 3 - / IM A

Administered by: Public       Purchased by: Private
Symptoms: Face oedema, Injection site hypersensitivity, Oedema peripheral, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (narrow), 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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: EBU930648

Write-up: Pt recvd vax & site of inject was itchy & red; pt''s arm swelled 2+ edema down to hand & eye became puffy; treated w/DPh;


VAERS ID: 62916 (history)  
Form: Version 1.0  
Age: 18.0  
Gender: Female  
Location: Vermont  
Vaccinated:1993-04-01
Onset:1993-04-02
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1994-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1301V / 1 - / IM

Administered by: Other       Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site oedema, Pruritus, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: h/a, migraine; allergy nickel;
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES93040195

Write-up: pt recvd vax 1APR93 & 2APR93 a local react consisting of warmth, swelling, pruritus, erythema & induration of 8 1/2 cm by 7 1/2 cm;


VAERS ID: 63487 (history)  
Form: Version 1.0  
Age: 25.0  
Gender: Female  
Location: Vermont  
Vaccinated:1993-04-06
Onset:1993-04-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1994-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1615V / 2 - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: no relevant data;
CDC Split Type: WAES93040264

Write-up: pt recvd vax; pt devel local reaction manifested by swelling, redness & tenderness of her left deltoid;


VAERS ID: 52743 (history)  
Form: Version 1.0  
Age: 1.8  
Gender: Male  
Location: Vermont  
Vaccinated:1993-05-07
Onset:1993-05-11
   Days after vaccination:4
Submitted: 1993-05-12
   Days after onset:1
Entered: 1993-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1648W / 1 - / IM

Administered by: Private       Purchased by: Private
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: ~ ()~~~In patient
Other Medications: Amoxicillin
Current Illness: OM
Preexisting Conditions: OM-on Amoxicillin
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: urticaria, 4 days following Recombivax vax;


VAERS ID: 71688 (history)  
Form: Version 1.0  
Age: 27.0  
Gender: Female  
Location: Vermont  
Vaccinated:1993-05-24
Onset:1993-05-27
   Days after vaccination:3
Submitted: 1993-05-28
   Days after onset:1
Entered: 1994-12-02
   Days after submission:553
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TYP: TYPHOID LIVE ORAL TY21A (VIVOTIF) / BERNA BIOTECH, LTD. 127891A / 2 MO / PO

Administered by: Unknown       Purchased by: Unknown
Symptoms: Abdominal pain, Headache, Nausea
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: might have gastrointestinal
Preexisting Conditions: virus
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: BER10098

Write-up: took 2nd capsule stomache cramping, nausea & h/a;


VAERS ID: 54946 (history)  
Form: Version 1.0  
Age: 57.0  
Gender: Female  
Location: Vermont  
Vaccinated:1993-06-18
Onset:1993-06-23
   Days after vaccination:5
Submitted: 1993-06-24
   Days after onset:1
Entered: 1993-07-30
   Days after submission:36
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4938001 / UNK LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Ecchymosis, Infection, Injection site hypersensitivity
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: burn on fingers
Preexisting Conditions: allergic PCN-meds lithium & dardizem
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt noted redness around lt deltoid @ site of DT given 18JUn site is also ecchymotic which occured shortly p/DT given; dx infected lt arm;


VAERS ID: 54872 (history)  
Form: Version 1.0  
Age: 7.0  
Gender: Female  
Location: Vermont  
Vaccinated:1993-07-12
Onset:1993-07-12
   Days after vaccination:0
Submitted: 1993-07-16
   Days after onset:4
Entered: 1993-07-26
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (IMOVAX) / PASTEUR MERIEUX INST. - / 1 - / IM

Administered by: Private       Purchased by: Private
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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: RIG 12JUL93;
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: onset 20-33mm p/recvd RIG & vax pt devel hives in trunk; no resp distress or other sx;


VAERS ID: 55934 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Vermont  
Vaccinated:1993-08-30
Onset:1993-08-30
   Days after vaccination:0
Submitted: 1993-09-02
   Days after onset:3
Entered: 1993-09-09
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3M41111 / 1 RL / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH M460JP / 1 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0685D / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Crying, Screaming
SMQs:, Hostility/aggression (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: ~ ()~~~In patient
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: VT93003

Write-up: high pitched cry for 2-3 hrs noc following vax;


VAERS ID: 64200 (history)  
Form: Version 1.0  
Age: 4.0  
Gender: Female  
Location: Vermont  
Vaccinated:1993-09-16
Onset:1993-09-17
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1994-03-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0460W / UNK - / IM

Administered by: Private       Purchased by: Private
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: ~ ()~~~In patient
Other Medications: recombivax of msd;
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: no relevant data;
CDC Split Type: WAES93090738

Write-up: pt recvd vax; pt devel hives;


VAERS ID: 58134 (history)  
Form: Version 1.0  
Age: 46.0  
Gender: Female  
Location: Vermont  
Vaccinated:1993-10-18
Onset:1993-11-08
   Days after vaccination:21
Submitted: 1993-11-22
   Days after onset:14
Entered: 1993-12-13
   Days after submission:21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / PFIZER/WYETH 4938089 / 1 RA / IM

Administered by: Public       Purchased by: Other
Symptoms: CSF test abnormal, Guillain-Barre syndrome, Laboratory test abnormal, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Clinoril
Current Illness: UNKNOWN
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 893333003J

Write-up: 2 wks p/vax pt devel numbness of legs below knees & numbness in fingers; admitted to hosp to rule out GBS;


VAERS ID: 57615 (history)  
Form: Version 1.0  
Age: 28.0  
Gender: Female  
Location: Vermont  
Vaccinated:1993-10-19
Onset:1993-10-20
   Days after vaccination:1
Submitted: 1993-11-10
   Days after onset:21
Entered: 1993-11-22
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Nausea, Palpitations, Tachycardia, Vasodilatation
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Dehydration (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: ~ ()~~~In patient
Other Medications: BCP''s;
Current Illness: NONE
Preexisting Conditions: endometrosis
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: nausea, flushed, palpitats/tachycardia;


VAERS ID: 57449 (history)  
Form: Version 1.0  
Age: 17.0  
Gender: Male  
Location: Vermont  
Vaccinated:1993-10-28
Onset:1993-10-28
   Days after vaccination:0
Submitted: 1993-11-11
   Days after onset:14
Entered: 1993-11-16
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Anxiety, Arrhythmia, Cardiac arrest, Cardiovascular disorder, Dizziness, Hyperhidrosis, Myocardial ischaemia, Tachycardia
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Other ischaemic heart disease (narrow), Vestibular disorders (broad), Respiratory failure (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES93110107

Write-up: pt recvd vax on 28OCT93 & 2 hrs later exp lightheadedness & an irregular pulse which was over 200; upon transport to hosp pt ex 2 cardiac arrests; dx Wolff-parkinson-White synd felt not vax related;


VAERS ID: 58192 (history)  
Form: Version 1.0  
Age: 60.0  
Gender: Female  
Location: Vermont  
Vaccinated:1993-11-29
Onset:1993-11-29
   Days after vaccination:0
Submitted: 1993-12-06
   Days after onset:7
Entered: 1993-12-13
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 3G51129 / 2 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: Zantac, Advil;
Current Illness: NONE
Preexisting Conditions: esophagitis;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: upper lt amr red & swollen area w/papules (8cm x 21cm); c/o urticara wrist pain; area warm to touch;


VAERS ID: 73480 (history)  
Form: Version 1.0  
Age: 37.0  
Gender: Female  
Location: Vermont  
Vaccinated:1994-02-09
Onset:1994-02-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 1995-03-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1405W / 1 - / IM

Administered by: Public       Purchased by: Other
Symptoms: Hypertonia, Pain
SMQs:, Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (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: ~ ()~~~In patient
Other Medications: Insulin-NPH; Lopid; Glucatrol; Vitamin E; Multivitamin;
Current Illness:
Preexisting Conditions: pancreatitis; diabetes, insulin dependent;
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES94030362

Write-up: pt recv vax 09FEB94 & 11FEB94 devel pain & stiffness in lt shoulder & lt thumb & was seen by MD; APR94 pt recovered; No further details were provided;


VAERS ID: 61103 (history)  
Form: Version 1.0  
Age: 50.0  
Gender: Female  
Location: Vermont  
Vaccinated:1994-03-08
Onset:1994-03-19
   Days after vaccination:11
Submitted: 1994-03-24
   Days after onset:5
Entered: 1994-03-29
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 3L51092 / UNK LA / -

Administered by: Private       Purchased by: Other
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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: large local react 16 cm circle firm;


VAERS ID: 61535 (history)  
Form: Version 1.0  
Age: 30.0  
Gender: Male  
Location: Vermont  
Vaccinated:1994-03-16
Onset:1994-03-25
   Days after vaccination:9
Submitted: 1994-03-30
   Days after onset:5
Entered: 1994-04-04
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4938228 / UNK RA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Cellulitis, Fibrosis tendinous, Injection site hypersensitivity, Injection site oedema, Injection site pain, Tenosynovitis
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Tendinopathies and ligament disorders (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, 3 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: crush injury lt lower leg;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC, Sed rate 11, Blood cult; CPK (73); WBC 7.0, Neut 44.3, Lymph 43.1, Mono 8.6, EOS 3.2, Baso 0.7;
CDC Split Type:

Write-up: pt''s rt upper arm became reddened, swollen, & tender 9 days p/DT inject; adm to hosp dx cellulitis, ?myositis/fascitis;


VAERS ID: 61686 (history)  
Form: Version 1.0  
Age: 48.0  
Gender: Female  
Location: Vermont  
Vaccinated:1994-03-24
Onset:1994-03-25
   Days after vaccination:1
Submitted: 1994-04-01
   Days after onset:7
Entered: 1994-04-08
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 3L51092 / 1 LA / IM

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

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

Write-up: redness, swelling lt detloid 27 hrs p/vax;


VAERS ID: 61875 (history)  
Form: Version 1.0  
Age: 45.0  
Gender: Female  
Location: Vermont  
Vaccinated:1994-04-06
Onset:1994-04-06
   Days after vaccination:0
Submitted: 1994-04-14
   Days after onset:8
Entered: 1994-04-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1290A4 / UNK - / -

Administered by: Unknown       Purchased by: Private
Symptoms: Arthralgia, Pruritus, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT94001

Write-up: Wed nite-itching on arms & legs; Thursday night worse; Friday still had redness on Arms & legs; MOnday felt joint pain;


VAERS ID: 62999 (history)  
Form: Version 1.0  
Age: 57.0  
Gender: Female  
Location: Vermont  
Vaccinated:1994-04-14
Onset:0000-00-00
Submitted: 1994-05-13
Entered: 1994-05-19
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 3L51092 / 1 - / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Dermatitis bullous, Oedema peripheral, Vasodilatation
SMQs:, Cardiac failure (broad), Severe cutaneous adverse reactions (narrow), Angioedema (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: ~ ()~~~In patient
Other Medications: Premarin, Lopressor
Current Illness: NONE
Preexisting Conditions: hypotension, allergy PCN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax & devel redness, swelling & blisters formation of entire upper lt arm; pt was seen by MD & rx w/Pred for 12 days;


VAERS ID: 62089 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Vermont  
Vaccinated:1994-04-18
Onset:1994-04-19
   Days after vaccination:1
Submitted: 1994-04-19
   Days after onset:0
Entered: 1994-04-25
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3E51112 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M675KN / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0691L / 1 MO / PO

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

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1994-04-19
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: hx of fetal tachycardia; s/p neonatal jaundice, s/p neg r/o sepsis;
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt had physical & 2 mo immun on 18APR; pt died on 19APR94-was sleeping on mattress between parents on back w/pillow under head;


VAERS ID: 66817 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Vermont  
Vaccinated:1994-07-01
Onset:1994-07-01
   Days after vaccination:0
Submitted: 1994-09-12
   Days after onset:73
Entered: 1994-09-19
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 3F51124 / 1 LL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M520LA / 1 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0696E / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Anorexia, Asthenia, Hypotonia, Screaming
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

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

Write-up: pt very fussy w/prolonged crying 3-4 hrs (?) p/vax; pt was overly tired & limp for the subsequent 12-16 hrs & did not feed for $g 18 hrs;


VAERS ID: 66851 (history)  
Form: Version 1.0  
Age: 1.4  
Gender: Male  
Location: Vermont  
Vaccinated:1994-08-11
Onset:1994-08-11
   Days after vaccination:0
Submitted: 1994-09-12
   Days after onset:32
Entered: 1994-09-22
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51057 / 4 RA / IM

Administered by: Private       Purchased by: Public
Symptoms: Convulsion, Hypotonia, Pyrexia, Somnolence, Stupor, Vomiting
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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: ~ ()~~~In patient
Other Medications:
Current Illness: conjunctivitis, serous otitis media
Preexisting Conditions: recurrent otitis;
Allergies:
Diagnostic Lab Data: WBC 7000; HCT 33%; Blooc culture-no growth; HGB 11.2; Platelets 181,000;
CDC Split Type:

Write-up: fever first noted 5 hrs p/vax; fever rose to 103.6 3 hrs later; pt floppy & unresponsive @ that time; 10 mins later parents noted generalized sz lasting 2-3 mins; pt remained sleepy for 3-4 hrs & then improved; also emesis x 3


VAERS ID: 67589 (history)  
Form: Version 1.0  
Age: 35.0  
Gender: Female  
Location: Vermont  
Vaccinated:1994-08-29
Onset:1994-08-29
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1994-10-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4B61052 / UNK LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Hypertonia, Injection site pain, Myalgia, Neck pain, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp incapacitated arm @ 20 w/Td booster~ ()~~~In patient
Other Medications: NA
Current Illness: puncture wound (cat bite);
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NA
CDC Split Type:

Write-up: 29AUG94 pt had Td shot lt delotid pt had sensation of zing; pt devel tightness & ache lt neck, lt shoulder & lt upper arm; soreness of lt upper arm has persisted;


VAERS ID: 69400 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Female  
Location: Vermont  
Vaccinated:1994-09-15
Onset:1994-09-15
   Days after vaccination:0
Submitted: 1994-12-02
   Days after onset:78
Entered: 1994-12-08
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51120 / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES - / UNK - / -

Administered by: Private       Purchased by: Other
Symptoms: Screaming
SMQs:, Hostility/aggression (broad)

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

Write-up: pt recvd vax; unconsolable crying for 3 hrs;


VAERS ID: 74015 (history)  
Form: Version 1.0  
Age: 25.0  
Gender: Female  
Location: Vermont  
Vaccinated:1994-09-16
Onset:1994-09-20
   Days after vaccination:4
Submitted: 1995-03-24
   Days after onset:185
Entered: 1995-05-12
   Days after submission:48
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1393A4 / 1 - / IM A

Administered by: Other       Purchased by: Private
Symptoms: Arthralgia, Conjunctivitis, Dizziness, Headache, Myalgia
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Conjunctival disorders (narrow), Ocular infections (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: VT95003

Write-up: h/a, discharge of eyes R/L (a few wk) dizziness episodes, aching, hip discomfort;


VAERS ID: 67062 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Vermont  
Vaccinated:1994-09-20
Onset:1994-09-20
   Days after vaccination:0
Submitted: 1994-09-28
   Days after onset:8
Entered: 1994-10-03
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4M51115 / UNK RL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4M51115 / UNK - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 376938 / UNK MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Crying, Pyrexia, Screaming
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hostility/aggression (broad), 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: ~ ()~~~In patient
Other Medications: none;
Current Illness: none;
Preexisting Conditions: none;
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT94002

Write-up: pt recvd vax & had high pitched cry for 7 hrs; t 101.5;


VAERS ID: 67666 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Male  
Location: Vermont  
Vaccinated:1994-10-21
Onset:1994-10-22
   Days after vaccination:1
Submitted: 1994-10-24
   Days after onset:2
Entered: 1994-10-27
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4G61080 / 5 RA / -

Administered by: Public       Purchased by: Public
Symptoms: Pyrexia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none;
Current Illness: none;
Preexisting Conditions: none;
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT94003

Write-up: pt recvd vax & 24 hrs later had t 101 & passed out;


VAERS ID: 68945 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Female  
Location: Vermont  
Vaccinated:1994-11-11
Onset:1994-11-11
   Days after vaccination:0
Submitted: 1994-11-16
   Days after onset:5
Entered: 1994-11-25
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0706A / 1 RL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1340 / 1 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: APAP
Current Illness: mild URI
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: PO4, CBC, CT Scan, CA++, electrolytes, glucose, MG all nl
CDC Split Type:

Write-up: sz < 15 mins, probably focal, stopped spontaneously, not associated w/fever;


VAERS ID: 69651 (history)  
Form: Version 1.0  
Age: 56.0  
Gender: Male  
Location: Vermont  
Vaccinated:1994-11-14
Onset:1994-11-14
   Days after vaccination:0
Submitted: 1994-12-02
   Days after onset:18
Entered: 1994-12-16
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Agitation, Asthenia, Central nervous system stimulation, Condition aggravated, Hypersensitivity, Hypothermia, Malaise
SMQs:, Angioedema (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: in pt,same event occured last yr,pt thought it was flu vax;lasted 1 day;~ ()~~~In patient
Other Medications: none;
Current Illness:
Preexisting Conditions: allergic to mercury, since early 1980''s;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax in pm;noc,began feeling bad & by next am was sick,t 97.7;agitation & fatigue,called "erethism";inc in sinus/nasal allergy sxs;allergic rxn to thimerosal;pt allergic to mercury & flu vax contained mercury preservatives;


VAERS ID: 163440 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Vermont  
Vaccinated:1994-11-15
Onset:0000-00-00
Submitted: 2000-08-23
Entered: 2000-11-14
   Days after submission:83
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1407A4 / 3 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 20000253431

Write-up: Subsequent to receiving three doses of Engerix B, the pt was found to be a non-responder. As of 08/09/2000, the outcome of the event is unknown.


VAERS ID: 69286 (history)  
Form: Version 1.0  
Age: 35.0  
Gender: Female  
Location: Vermont  
Vaccinated:1994-11-23
Onset:1994-11-28
   Days after vaccination:5
Submitted: 1994-11-29
   Days after onset:1
Entered: 1994-12-05
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4948029 / 1 LA / -

Administered by: Military       Purchased by: Unknown
Symptoms: Injection site mass, Skin nodule
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: ~ ()~~~In patient
Other Medications: bcp;
Current Illness: none;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recvd vax; lump under lt arm; inject site hard;


VAERS ID: 69717 (history)  
Form: Version 1.0  
Age: 1.9  
Gender: Male  
Location: Vermont  
Vaccinated:1994-12-06
Onset:1994-12-07
   Days after vaccination:1
Submitted: 1994-12-16
   Days after onset:9
Entered: 1994-12-19
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51032 / 4 LA / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES - / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0543W / 1 RA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 382943 / UNK MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Erythema multiforme
SMQs:, Severe cutaneous adverse reactions (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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: (viral synd 2-3 wks fore immun)
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: erythema multiforme-onset 24 hrs following vax;


VAERS ID: 69719 (history)  
Form: Version 1.0  
Age: 2.0  
Gender: Female  
Location: Vermont  
Vaccinated:1994-12-13
Onset:1994-12-13
   Days after vaccination:0
Submitted: 1994-12-15
   Days after onset:2
Entered: 1994-12-19
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0594A / 2 LL / IM

Administered by: Private       Purchased by: Private
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: pt exp 3 hrs crying @ 2mos w/DTP #1;~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: urticaria


VAERS ID: 70734 (history)  
Form: Version 1.0  
Age: 2.0  
Gender: Female  
Location: Vermont  
Vaccinated:1995-01-09
Onset:1995-01-10
   Days after vaccination:1
Submitted: 1995-01-17
   Days after onset:7
Entered: 1995-01-23
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51058 / 4 - / L
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0858A / 3 - / L
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 382943 / 3 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Condition aggravated, Convulsion
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: phenobarbital
Current Illness: none
Preexisting Conditions: sz disorder-afebrile
Allergies:
Diagnostic Lab Data: phenobarbital level - 21.7(therapeutic)
CDC Split Type:

Write-up: pt recvd vax;on phenobarbital for afebrile szs;no sz since start of phenobarbital in apr94;had afebrile sz 24 hrs p/ vax; no fever,no local rxn;


VAERS ID: 72716 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Vermont  
Vaccinated:1995-01-09
Onset:1995-01-09
   Days after vaccination:0
Submitted: 1995-03-23
   Days after onset:73
Entered: 1995-03-31
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4A61040 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES - / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0711C / 1 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Agitation, Crying
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 2 hrs of high pitched, peculiar, inconsolable crying despite APAP;


VAERS ID: 71432 (history)  
Form: Version 1.0  
Age: 33.0  
Gender: Female  
Location: Vermont  
Vaccinated:1995-01-10
Onset:0000-00-00
Submitted: 1995-02-07
Entered: 1995-02-13
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H6118 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site hypersensitivity, Injection site mass
SMQs:, Extravasation events (injections, infusions and implants) (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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 8x8cm area of induration/erythema @ inject site;


VAERS ID: 82216 (history)  
Form: Version 1.0  
Age: 42.0  
Gender: Male  
Location: Vermont  
Vaccinated:1995-01-12
Onset:1995-01-22
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 1995-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RUB: RUBELLA (MERUVAX II) / MERCK & CO. INC. 0694A / 1 - / SC

Administered by: Private       Purchased by: Other
Symptoms: Arthralgia, Arthritis, Oedema peripheral, Osteoarthritis, Pain, Pyrexia, Tenosynovitis
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (narrow), Tendinopathies and ligament disorders (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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data
CDC Split Type: WAES95020617

Write-up: pt recvd vax 12JAN95 & 23JAN95 pt exp a fever of 103 to 104;fever lasted x 2 days;also exp arthritic sx in both knees,rt hip,both wrists;exp gen joint swelling & pain,exp in wrists;both hands were swollen & painful;had carpal tunnel


VAERS ID: 71562 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Vermont  
Vaccinated:1995-01-18
Onset:1995-01-18
   Days after vaccination:0
Submitted: 1995-02-03
   Days after onset:16
Entered: 1995-02-21
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H51120 / 2 - / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4H51120 / 2 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 376942 / UNK - / -

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Screaming
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), 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: pt recvd vax & was irritable;~ ()~~~In patient
Other Medications:
Current Illness: mild URI, rhinorrhea;
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT95001

Write-up: pt recvd vax 18JAN95 & cried steadily for approx 5 hrs; mom states there wasn''t a period of even 30 seconds where pt didn''t cry through the rest of the noc; pt irritable;


VAERS ID: 82119 (history)  
Form: Version 1.0  
Age: 40.0  
Gender: Female  
Location: Vermont  
Vaccinated:1995-01-24
Onset:1995-01-24
   Days after vaccination:0
Submitted: 1995-02-01
   Days after onset:8
Entered: 1995-11-14
   Days after submission:286
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1437A4 / 1 - / IM A

Administered by: Private       Purchased by: Private
Symptoms: Injection site hypersensitivity, Pyrexia, Rash
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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Aerobid;Albuterol
Current Illness:
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data:
CDC Split Type: 950007921

Write-up: pt recvd vax & post vax exp a low grade temp & rash around the inj site extending across thorax & up neck;these symptoms were treated w/DPH;


VAERS ID: 82258 (history)  
Form: Version 1.0  
Age: 25.0  
Gender: Female  
Location: Vermont  
Vaccinated:1995-02-10
Onset:1995-02-24
   Days after vaccination:14
Submitted: 1995-03-31
   Days after onset:35
Entered: 1995-11-14
   Days after submission:228
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1411A4 / 1 - / -

Administered by: Other       Purchased by: Private
Symptoms: Dermatitis bullous, Face oedema, Injection site hypersensitivity, Injection site mass, Injection site oedema, Pruritus, Urticaria, Vasodilatation
SMQs:, Severe cutaneous adverse reactions (narrow), 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: ?runny nose
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC Split Type: 950019451

Write-up: pt recvd vax & exp dime sized knot (inj site);lump dec over 1 month is now gone; seen by MD @ ER;tx warm compresses;swelling, redness & warmth (inj site);2wks post vax devel hives, swollen face & pox on hands & arms w/itching;


VAERS ID: 74477 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Male  
Location: Vermont  
Vaccinated:1995-02-28
Onset:1995-02-28
   Days after vaccination:0
Submitted: 1995-05-26
   Days after onset:86
Entered: 1995-06-02
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4L51032 / 2 - / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4L51032 / UNK - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0711C / 2 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Crying, Oedema peripheral, Screaming, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Hostility/aggression (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: none~ ()~~~In patient
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT95004

Write-up: pt recv vax; not consolable for 4 hr, screamed, leg swollen fr knee to hip, also red;


VAERS ID: 73056 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Male  
Location: Vermont  
Vaccinated:1995-03-22
Onset:1995-03-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1995-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER 1050A / UNK - / -
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER 4H61118 / UNK - / -

Administered by: Other       Purchased by: Public
Symptoms: Cellulitis, Face oedema, Headache, Nausea, Pain
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: NA~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT95002

Write-up: pain down both arms; h/a; "nausis"; facial edema; treated for cellulitis w/Keflex


VAERS ID: 89059 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Female  
Location: Vermont  
Vaccinated:1995-04-04
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1996-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1541A / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Infection, Injection site oedema, 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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES95061189

Write-up: pt recv vax 4APR95 & exp severe swelling @ the inj site;the area which was 3 inches by 5 inches, became infected;also exp t104 & was treated w/ATB;no further details were provided;


VAERS ID: 89060 (history)  
Form: Version 1.0  
Age: 20.0  
Gender: Female  
Location: Vermont  
Vaccinated:1995-04-04
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1996-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1541A / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Injection site pain, Skin discolouration
SMQs:, Extravasation events (injections, infusions and implants) (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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES95061190

Write-up: pt recv vax 4APR95 & pt exp a large painful, discolored area @ inj site;It was present for approx 10 days;


VAERS ID: 89061 (history)  
Form: Version 1.0  
Age: 40.0  
Gender: Female  
Location: Vermont  
Vaccinated:1995-04-04
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1996-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1541A / UNK - / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES95061191

Write-up: pt recv vax 4APR95 & exp significant pain @ the inj site radiating to axilla;no further details were provided;


VAERS ID: 89062 (history)  
Form: Version 1.0  
Age: 50.0  
Gender: Male  
Location: Vermont  
Vaccinated:1995-04-04
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1996-08-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 1541A / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Asthenia, Dizziness
SMQs:, Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES95061192

Write-up: pt recv vax 4APR95 & pt exp lightheadedness & weakness sometime p/vax;the exp resolved in 1hr;


VAERS ID: 73626 (history)  
Form: Version 1.0  
Age: 52.0  
Gender: Female  
Location: Vermont  
Vaccinated:1995-04-18
Onset:1995-04-25
   Days after vaccination:7
Submitted: 1995-04-25
   Days after onset:0
Entered: 1995-05-01
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H61118 / 2 LA / IM

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

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: ~ ()~~~In patient
Other Medications: Premarin
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax 18APR; On 25APR pt devel large red swollen, itchy area around inj site & other red raised areas distant to upper arm;


VAERS ID: 74478 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Female  
Location: Vermont  
Vaccinated:1995-05-09
Onset:0000-00-00
Submitted: 1995-05-29
Entered: 1995-06-02
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0972A / 2 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT95005

Write-up: pt recv vax; saw MD; hives, red face, eyes swollen shut; tx w/ dph & 5 days prednisone therapy;


VAERS ID: 74177 (history)  
Form: Version 1.0  
Age: 11.0  
Gender: Male  
Location: Vermont  
Vaccinated:1995-05-10
Onset:1995-05-10
   Days after vaccination:0
Submitted: 1995-05-12
   Days after onset:2
Entered: 1995-05-18
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1050A / 2 LA / -

Administered by: Public       Purchased by: Public
Symptoms: Convulsion, Dizziness, Hypertonia, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT95006

Write-up: pt became faint, rigid, sz lasting about 20-30 sec-fainted again; immed bolted upright & asked if had fallen asleep; event lasting under 2 mins;


VAERS ID: 74558 (history)  
Form: Version 1.0  
Age: 51.0  
Gender: Female  
Location: Vermont  
Vaccinated:1995-05-25
Onset:1995-05-31
   Days after vaccination:6
Submitted: 1995-06-01
   Days after onset:1
Entered: 1995-06-06
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4H61156 / UNK LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 394960 / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: diabetes, HTN, smoker, aortic stenosis
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 3" area of redness swelling; hard to touch, warmth; tx w/ATB


VAERS ID: 75975 (history)  
Form: Version 1.0  
Age: 0.1  
Gender: Male  
Location: Vermont  
Vaccinated:1995-06-06
Onset:1995-06-06
   Days after vaccination:0
Submitted: 1995-07-11
   Days after onset:35
Entered: 1995-07-18
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTP: DTP (NO BRAND NAME) / CONNAUGHT LABORATORIES 4E61017 / 1 LL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES 4E61017 / 1 LL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0721F / 1 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Muscle spasms, Myoclonus, Pallor, Pyrexia, Somnolence, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CBC, BUN cr glucose; electrolytes, MG Ca, WNL
CDC Split Type:

Write-up: noted by mom & staff pale, gray appearance & briefly shaking one leg; remained pale & lethargic for 3-4 hr; t36.6-37.8 BP 110/50; myoclonic spasm observed;


VAERS ID: 90914 (history)  
Form: Version 1.0  
Age: 26.0  
Gender: Male  
Location: Vermont  
Vaccinated:1995-06-15
Onset:1996-06-25
   Days after vaccination:376
Submitted: 0000-00-00
Entered: 1996-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 2 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 25JUN96 varicella antibody 0.8;
CDC Split Type: WAES96070291

Write-up: pt recv vax 15JUN95 & 25JUN96 IgG antibody titer was 0.8 (greater than 1.0 immunity);


VAERS ID: 78130 (history)  
Form: Version 1.0  
Age: 72.0  
Gender: Female  
Location: Vermont  
Vaccinated:1995-06-30
Onset:1995-07-21
   Days after vaccination:21
Submitted: 1995-09-22
   Days after onset:63
Entered: 1995-10-17
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 4G61080 / UNK LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Asthenia, Guillain-Barre syndrome, Hyporeflexia
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: EMG
CDC Split Type: VT95007

Write-up: pt recvd vax & exp muscle weakness & diminished reflexes


VAERS ID: 103796 (history)  
Form: Version 1.0  
Age: 30.0  
Gender: Female  
Location: Vermont  
Vaccinated:1995-07-06
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1997-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 2 - / -

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES97090335

Write-up: pt recv vax & pt failed to seroconvert;


VAERS ID: 76602 (history)  
Form: Version 1.0  
Age: 1.3  
Gender: Female  
Location: Vermont  
Vaccinated:1995-08-10
Onset:1995-08-10
   Days after vaccination:0
Submitted: 1995-08-10
   Days after onset:0
Entered: 1995-08-14
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (ACEL-IMUNE) / PFIZER/WYETH 378909 / 3 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M520LA / 3 LL / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp inc crying & inc T 14 hrs @ 2mos w/DTP/HIB dose 1~ ()~~~In patient
Other Medications: Tempra
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: onset of diffuse erythema & urticaria w/in 30 mins of DTAP & HIB vax; rx Epi & DPH;


VAERS ID: 86993 (history)  
Form: Version 1.0  
Age:   
Gender: Male  
Location: Vermont  
Vaccinated:1995-09-20
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1996-06-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: no relevant data;
CDC Split Type: WAES95100301

Write-up: pt recv vax 20SEP95 & 3OCT95 pt devel hives all over body;no further details were provided;


VAERS ID: 78152 (history)  
Form: Version 1.0  
Age: 1.3  
Gender: Male  
Location: Vermont  
Vaccinated:1995-09-22
Onset:1995-09-27
   Days after vaccination:5
Submitted: 1995-09-28
   Days after onset:1
Entered: 1995-10-16
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1337W / 1 RL / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: NH95024

Write-up: insidious onset, rash, called on 27SEP; rash on trunk & neck fussy, no fever, MMR rash, sxs MMR rash; seen 28SEP rash on extremities, welts in places like hives, NAD, multi-form, erithematous, no vesicles, mouth clear, afeb


VAERS ID: 78111 (history)  
Form: Version 1.0  
Age: 56.0  
Gender: Female  
Location: Vermont  
Vaccinated:1995-10-05
Onset:1995-10-05
   Days after vaccination:0
Submitted: 1995-10-09
   Days after onset:4
Entered: 1995-10-13
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 5H71142 / UNK LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Pain, Vasodilatation
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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: inflammed upper arm 70% tender


VAERS ID: 90858 (history)  
Form: Version 1.0  
Age: 28.0  
Gender: Female  
Location: Vermont  
Vaccinated:1995-10-13
Onset:1996-01-12
   Days after vaccination:91
Submitted: 0000-00-00
Entered: 1996-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 2 - / -

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 12JAN96 varicella antibody negative
CDC Split Type: WAES96061848

Write-up: pt recv vax & became pregnant (LMP 12DEC95);estimated delivery date is 18SEP96;12JAN96 lab eval revealed a negative varicella antibody titer;@ time of report, pt @ 27wk gestation no other adverse exp,no pregnancy complications;nl delivery;


VAERS ID: 83943 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Vermont  
Vaccinated:1995-10-17
Onset:1995-10-18
   Days after vaccination:1
Submitted: 1995-10-20
   Days after onset:2
Entered: 1996-02-26
   Days after submission:129
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4958138 / 2 - / IM A

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 895304005L

Write-up: pt recv vax 17OCT95 & 18OCT95 devel a diffuse rash characterized as red,punctate & w/a halo around it;pt was tx w/DPH;addtl info recv 30NOV95: pt was dx w/pseudomonas rash


VAERS ID: 78528 (history)  
Form: Version 1.0  
Age: 78.0  
Gender: Female  
Location: Vermont  
Vaccinated:1995-10-25
Onset:1995-10-25
   Days after vaccination:0
Submitted: 1995-10-25
   Days after onset:0
Entered: 1995-10-31
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 5F61127 / UNK LA / -

Administered by: Public       Purchased by: Other
Symptoms: Chills, Cough, Nausea, Pharyngitis, Pyrexia, Rhinitis
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Gly burde, chlorthazidine, APAP
Current Illness: Otitis Media
Preexisting Conditions: HTN DM
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: sudden onset fever, chill, coryza, nausea, scratching throat, coughing


VAERS ID: 79723 (history)  
Form: Version 1.0  
Age: 63.0  
Gender: Female  
Location: Vermont  
Vaccinated:1995-10-25
Onset:1995-10-29
   Days after vaccination:4
Submitted: 1995-11-18
   Days after onset:20
Entered: 1995-11-27
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Public       Purchased by: Unknown
Symptoms: Asthenia, Chills, Diarrhoea, Headache, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: "start of virus"
Preexisting Conditions: low immunity
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: feel very tired on 29OCT-30OCT fever, chills, h/a, diarrhea had it 10-12 days; fever 100-101;flu shot given 25OCT95 still feel tired;nurse told pt that she had ''start of virus'' when vaxed, made it ''twice as diff''


VAERS ID: 79507 (history)  
Form: Version 1.0  
Age: 42.0  
Gender: Female  
Location: Vermont  
Vaccinated:1995-11-07
Onset:1995-11-09
   Days after vaccination:2
Submitted: 1995-11-11
   Days after onset:2
Entered: 1995-11-20
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4958036 / UNK LA / -

Administered by: Private       Purchased by: Other
Symptoms: Oedema peripheral, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: injury
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: inc redness, swelling hand size area-no palp abscess lt deltoid


VAERS ID: 90390 (history)  
Form: Version 1.0  
Age: 65.0  
Gender: Female  
Location: Vermont  
Vaccinated:1995-11-09
Onset:1995-11-09
   Days after vaccination:0
Submitted: 1995-11-16
   Days after onset:7
Entered: 1996-09-11
   Days after submission:299
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH - / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 895340017L

Write-up: a few hr p/vax pt exp paresthesia & pain in the inj arm;pt was treated w/codeine w/o results;by the next day pt exp paresthesia across the entire injected arm, including the fingers;pt has recovered;


VAERS ID: 98771 (history)  
Form: Version 1.0  
Age: 47.0  
Gender: Female  
Location: Vermont  
Vaccinated:1995-11-09
Onset:1995-11-09
   Days after vaccination:0
Submitted: 1997-02-06
   Days after onset:455
Entered: 1997-04-18
   Days after submission:70
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 5F61024 / 1 - / IM A

Administered by: Other       Purchased by: Other
Symptoms: Conjunctivitis, Cough, Dry mouth, Lacrimal disorder, Laryngospasm, Myalgia, Pruritus, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Eosinophilic pneumonia (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: allergy to tetracycline
Allergies:
Diagnostic Lab Data:
CDC Split Type: CO6327

Write-up: eyes very red, itchy & watery;dry mouth, felt like object in throat 1hr p/vax;persistent cough;BP fine, P=fine;called MD who sent to ER;tx w/DPH;throat better;6PM devel temp 100.6 & was achy;nothing unusual to eat or drink;


VAERS ID: 80953 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Vermont  
Vaccinated:1995-12-19
Onset:1995-12-19
   Days after vaccination:0
Submitted: 1996-01-10
   Days after onset:22
Entered: 1996-01-18
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 429968 / 1 LL / IM
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0523B / 2 RL / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0733H / 1 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Anorexia, Crying, Muscle twitching, Personality disorder, Screaming, Stupor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (broad), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: VT96001

Write-up: pt recvd vax 19DEC95 2PM started very intense high pitched crying 330PM-lasting to MN;consoled only few minutes intermittently;eyes glazed;not aware mom was there;would not breast feed during this time;had jerking legs;called MD office;


VAERS ID: 81271 (history)  
Form: Version 1.0  
Age: 67.0  
Gender: Female  
Location: Vermont  
Vaccinated:1996-01-07
Onset:0000-00-00
Submitted: 1995-01-16
Entered: 1996-01-24
   Days after submission:373
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4958036 / UNK RA / -

Administered by: Public       Purchased by: Other
Symptoms: Cellulitis, Injection site hypersensitivity, Injection site pain, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (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: ~ ()~~~In patient
Other Medications: LTS CAl;Maxide;Votaire
Current Illness: lt middle finger injury
Preexisting Conditions: DJD, MI 1982
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: red, painful, warm area about arm p/td on 7JAN96; consistent w/cellulitis


VAERS ID: 85418 (history)  
Form: Version 1.0  
Age: 28.0  
Gender: Female  
Location: Vermont  
Vaccinated:1996-02-01
Onset:0000-00-00
Submitted: 1996-04-26
Entered: 1996-04-30
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 2 - / -

Administered by: Other       Purchased by: Other
Symptoms: Abortion, Haemorrhage, Ovarian disorder
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Termination of pregnancy and risk of abortion (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Varicella antibody neg;
CDC Split Type: WAES96041842

Write-up: pt recv vax 1FEB96&5wks p/vax became pregnant;in seventh wk of pregnancy,on 2APR96 pt began to bleed&presented to OB/GYN-dx w/blighted ovum;subsequently,pt had a miscarriage;19APR96 dilation&curettage was performed


VAERS ID: 82579 (history)  
Form: Version 1.0  
Age: 31.0  
Gender: Male  
Location: Vermont  
Vaccinated:1996-02-06
Onset:1996-02-07
   Days after vaccination:1
Submitted: 1996-02-08
   Days after onset:1
Entered: 1996-02-15
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DT: DT ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 430109 / UNK LA / IM

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

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

Write-up: 4cm red swelling @ site of inj w/red streaks running toward axilla;


VAERS ID: 83136 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Vermont  
Vaccinated:1996-02-12
Onset:1996-02-13
   Days after vaccination:1
Submitted: 1996-02-19
   Days after onset:6
Entered: 1996-02-27
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 429310 / UNK LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? 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: pt recvd vax;local rxn at site prolonged w/ swelling & redness;


VAERS ID: 88435 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Vermont  
Vaccinated:1996-06-18
Onset:1996-06-18
   Days after vaccination:0
Submitted: 1996-07-17
   Days after onset:29
Entered: 1996-08-02
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 433567 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1722A2 / 2 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Pallor
SMQs:, Acute central respiratory depression (narrow), Hypotonic-hyporesponsive episode (broad), Respiratory failure (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: ~ ()~~~In patient
Other Medications: APAP
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: transient pale color possible brief apnea-observed by parents;


VAERS ID: 163442 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Vermont  
Vaccinated:1996-07-05
Onset:0000-00-00
Submitted: 2000-08-23
Entered: 2000-11-14
   Days after submission:83
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1814A4 / 3 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (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:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 20000253531

Write-up: Subsequent to receiving three doses of Engerix B, the pt was found to be a non-responder. As of 08/09/2000, the outcome of the event is unknown.


VAERS ID: 90434 (history)  
Form: Version 1.0  
Age: 40.0  
Gender: Female  
Location: Vermont  
Vaccinated:1996-08-01
Onset:1996-08-01
   Days after vaccination:0
Submitted: 1996-09-27
   Days after onset:57
Entered: 1996-10-01
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Colitis, Diarrhoea, Gastrointestinal haemorrhage, Petechiae, Purpura, Pyrexia, Thrombocytopenic purpura, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal haemorrhage (narrow), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Pred, Glucotrol, Insulin
Current Illness:
Preexisting Conditions: diabetes
Allergies:
Diagnostic Lab Data: SEP96 platelet count 12 THS/MM#;13SEP96 platelet count 15 THS/MM3;SEP96 Guaiac stool-positive;
CDC Split Type: WAES96091129

Write-up: pt recv vax AUG96 & 2wk p/ vax pt devel low fever, abd discomfort & some loose stools;pt treated for poss diverticulitis for 1wk;6SEP96 pt became more ill w/worsening sx & hosp;devel n/v, petechiae & purpura;dx thrombocytopenia;tx w/med


VAERS ID: 101973 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Vermont  
Vaccinated:1996-08-01
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1997-07-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Other       Purchased by: Other
Symptoms: Thrombocytopenia
SMQs:, Haematopoietic thrombocytopenia (narrow), Systemic lupus erythematosus (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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES96091214

Write-up: pt recv vax AUG96 & pt exp a very low platelet count;pt condition was improving @ the time of the report, but had not yet recovered;


VAERS ID: 89368 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Vermont  
Vaccinated:1996-08-15
Onset:1996-08-15
   Days after vaccination:0
Submitted: 1996-08-16
   Days after onset:1
Entered: 1996-08-29
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 427840 / 3 - / IM
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 740K3 / 3 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Chills, Convulsion, Pallor, Somnolence, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: EEG-results pending
CDC Split Type:

Write-up: pt recv vax 15AUG96 430PM & about 8PM pt was nursing & mom noticed was shaking & shivering all over x 1min;pt became pale, lethargic;mom called MD & was seen in the office then transported to ER;


VAERS ID: 89384 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Vermont  
Vaccinated:1996-08-21
Onset:1996-08-22
   Days after vaccination:1
Submitted: 1996-08-23
   Days after onset:1
Entered: 1996-08-29
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 0742B / 1 RA / -
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 6E81148 / 5 LA / -

Administered by: Private       Purchased by: Public
Symptoms: Arthralgia, Headache, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NA~ ()~~~In patient
Other Medications: NA
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT96003

Write-up: aches all over, joint pain, h/a, nausea;


VAERS ID: 89544 (history)  
Form: Version 1.0  
Age: 0.6  
Gender: Female  
Location: Vermont  
Vaccinated:1996-08-23
Onset:1996-08-23
   Days after vaccination:0
Submitted: 1996-08-26
   Days after onset:3
Entered: 1996-09-03
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 434810 / 3 LL / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0740K / 3 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Dyspnoea, Hyperventilation, Pyrexia, Rhinitis, Skin discolouration
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NOE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: CXR-nl;oxymetry-nl
CDC Split Type:

Write-up: several hr p/vax mottled appearance, fever, grunting rapid resp, clear nasal discharge;


VAERS ID: 99636 (history)  
Form: Version 1.0  
Age: 84.0  
Gender: Male  
Location: Vermont  
Vaccinated:1996-09-01
Onset:1996-11-01
   Days after vaccination:61
Submitted: 1996-12-19
   Days after onset:48
Entered: 1997-05-29
   Days after submission:160
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS - / 1 - / IM A

Administered by: Private       Purchased by: Private
Symptoms: Anorexia, Back pain, Diarrhoea, Myalgia, Pain
SMQs:, Rhabdomyolysis/myopathy (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Noninfectious diarrhoea (narrow), 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: ~ ()~~~In patient
Other Medications: vitamins
Current Illness: UNK
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: profile 6 & CXR negative;
CDC Split Type: 010150970038000

Write-up: pt recv vax SEP96 & NOV96 pt exp loss of appetite, aches, & pains, backache, diarrhea;pt examined by MD;CXR & profile 6 were both negative;pt has not yet recovered;pt recv vax w/one of the recalled lots, unable to ID specific lot#:


VAERS ID: 93538 (history)  
Form: Version 1.0  
Age: 58.0  
Gender: Female  
Location: Vermont  
Vaccinated:1996-10-15
Onset:1996-10-18
   Days after vaccination:3
Submitted: 1996-12-02
   Days after onset:45
Entered: 1997-01-03
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / MEDEVA PHARMA, LTD. E3036GA / UNK LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Asthenia, Guillain-Barre syndrome, Hypokinesia, Myasthenic syndrome, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Malignancy related conditions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Hypotonic-hyporesponsive episode (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, 29 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: since 11oct96 biaxin for bronchitis/ pneumonia
Current Illness: recovering from pneumonia/bronchitis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: GBS
CDC Split Type: VT96005

Write-up: 18oct96 woke w/ tingling in legs, weakness, worked all day. 20oct96 went to MD w/ above complaints "legs going on me" 21oct96 went to ER-admitted. 22oct96 transferred to diff hosp. Dx: GBS


VAERS ID: 93537 (history)  
Form: Version 1.0  
Age: 71.0  
Gender: Female  
Location: Vermont  
Vaccinated:1996-10-18
Onset:1996-10-19
   Days after vaccination:1
Submitted: 1996-12-04
   Days after onset:46
Entered: 1997-01-03
   Days after submission:30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4968170 / UNK RA / IM

Administered by: Private       Purchased by: Other
Symptoms: Laboratory test abnormal, Myasthenic syndrome, Myelitis, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Malignancy related conditions (narrow), Guillain-Barre syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: MRI of entire spine; CT scan head WNL. LP-high protein, al IgG. EMG WNL
CDC Split Type: VT96004

Write-up: ascending paresthesias, left leg weakness w/ transverse myelitis: hosp for 5 days sudomedrol. sx occurred w. 36 hr of influenza vax; no other expandable cause for sx.


VAERS ID: 93539 (history)  
Form: Version 1.0  
Age: 54.0  
Gender: Female  
Location: Vermont  
Vaccinated:1996-11-08
Onset:1996-11-18
   Days after vaccination:10
Submitted: 1996-12-02
   Days after onset:14
Entered: 1997-01-03
   Days after submission:32
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4968170 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Back pain, Guillain-Barre syndrome, Headache, Hypokinesia, Myasthenic syndrome, Pain
SMQs:, Peripheral neuropathy (narrow), Retroperitoneal fibrosis (broad), Malignancy related conditions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Hypotonic-hyporesponsive episode (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, 10 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: GBS
CDC Split Type: VT96006

Write-up: 18nov96- headache, legs and back ache;20dec96- went to MD for complaints; 22nov96- again went to MD for same complaints & weakness in legs-using walker; 23nov96-went to ER, unable to walk at all; pt admitted; still in ICU 02dec96; GBS


VAERS ID: 93540 (history)  
Form: Version 1.0  
Age: 59.0  
Gender: Female  
Location: Vermont  
Vaccinated:1996-11-15
Onset:1996-11-29
   Days after vaccination:14
Submitted: 1996-12-24
   Days after onset:25
Entered: 1997-01-03
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 6F71221 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Guillain-Barre syndrome, Hypokinesia, Myasthenic syndrome, Paraesthesia
SMQs:, Peripheral neuropathy (narrow), Malignancy related conditions (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Hypotonic-hyporesponsive episode (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, 25 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: albuterol, alupent, calan premarin, theophylline
Current Illness: none
Preexisting Conditions: chronic obstructive pulmonary disease; hypertension
Allergies:
Diagnostic Lab Data: GBS
CDC Split Type: VT96007

Write-up: 29nov96- woke up feeling fine, w/in hr felt picky numbness, muscle weakness & eventually could not stand;went to med outpatient ctr; 30nov96- sx worse- went to ER admitted & still hospitalized; GBS


VAERS ID: 93313 (history)  
Form: Version 1.0  
Age: 38.0  
Gender: Male  
Location: Vermont  
Vaccinated:1996-11-25
Onset:1996-12-08
   Days after vaccination:13
Submitted: 1996-12-27
   Days after onset:19
Entered: 1996-12-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1478D / UNK - / -

Administered by: Private       Purchased by: Unknown
Symptoms: Pruritus, Rash maculo-papular, 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: ~ ()~~~In patient
Other Medications: proventil, aeroboclin inhaler;
Current Illness:
Preexisting Conditions: asthma; allergic rhinitis, recurrent sinusitis;
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax; itchy rash on shoulders, back, arms; started as fine red rash; welt type rash;


VAERS ID: 98613 (history)  
Form: Version 1.0  
Age: 1.3  
Gender: Female  
Location: Vermont  
Vaccinated:1997-01-14
Onset:1997-01-16
   Days after vaccination:2
Submitted: 1997-05-28
   Days after onset:131
Entered: 1997-06-03
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 441099 / 4 RA / -

Administered by: Private       Purchased by: Public
Symptoms: Febrile convulsion, Injection site hypersensitivity, Injection site oedema, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Generalised convulsive seizures following immunisation (narrow), 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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT97004

Write-up: Febrile seizure, t103.8, red swollen arm;


VAERS ID: 96519 (history)  
Form: Version 1.0  
Age: 35.0  
Gender: Female  
Location: Vermont  
Vaccinated:1997-01-15
Onset:1997-01-27
   Days after vaccination:12
Submitted: 1997-03-21
   Days after onset:53
Entered: 1997-03-28
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1130B / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Dermatitis bullous, Mouth ulceration, Pruritus
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Systemic lupus erythematosus (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: PCN0env. allergy-hayfever
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 28JAN97 pt devel pustules on forehead, chin, lower throat & rt arm;29JAN97 devel cold sore on rt lower lip;30JAN97 3x3 patch pustules x 5 or rt lower abd;27JAN97 gen pruritus lasting x 1wk;


VAERS ID: 96318 (history)  
Form: Version 1.0  
Age: 68.0  
Gender: Male  
Location: Vermont  
Vaccinated:1997-02-04
Onset:1997-02-05
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1997-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 438673 / 1 RA / IM
TD: TD ADSORBED (NO BRAND NAME) / UNKNOWN MANUFACTURER 6K81364 / UNK LA / -

Administered by: Private       Purchased by: Private
Symptoms: Hyperhidrosis, Injection site hypersensitivity, Injection site reaction, Myalgia, Pruritus, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT97002

Write-up: huge local rxn rt arm fever, joint aches, noc sweats;itching @ site;


VAERS ID: 95194 (history)  
Form: Version 1.0  
Age: 1.5  
Gender: Male  
Location: Vermont  
Vaccinated:1997-02-11
Onset:1997-02-11
   Days after vaccination:0
Submitted: 1997-02-14
   Days after onset:3
Entered: 1997-02-19
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 441099 / 4 - / A

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT97001

Write-up: shaking spell, elevated temp was taken to Er & evaluated & sent home w/APAP;


VAERS ID: 97794 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Male  
Location: Vermont  
Vaccinated:1997-02-12
Onset:1997-02-20
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 1997-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1356D / 1 - / SC

Administered by: Private       Purchased by: Public
Symptoms: Rash maculo-papular
SMQs:, 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: ~ ()~~~In patient
Other Medications: Ceclor
Current Illness: infect, resp, upper;OM
Preexisting Conditions: allergy, PCN;
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES97022293

Write-up: pt recv vax 12FEB97 & 20FEB97 pt devel a raised, red, papular rash on stomach which spread to back, chest, neck & face;there was no no pruritus;rash occurred for one day & resolved;pt then exp new outbreaks for 5 days;


VAERS ID: 98166 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Vermont  
Vaccinated:1997-05-05
Onset:1997-05-07
   Days after vaccination:2
Submitted: 1997-05-15
   Days after onset:8
Entered: 1997-05-21
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (TETRAMUNE) / PFIZER/WYETH 438621 / 5 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0097D / 3 RA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 0756M / 4 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Injection site oedema, Injection site pain
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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT97003

Write-up: local rxn of lt upper arm swelling & pain;


VAERS ID: 98351 (history)  
Form: Version 1.0  
Age: 1.5  
Gender: Male  
Location: Vermont  
Vaccinated:1997-05-12
Onset:1997-05-15
   Days after vaccination:3
Submitted: 1997-05-20
   Days after onset:5
Entered: 1997-05-28
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0180E / 1 RA / SC

Administered by: Private       Purchased by: Public
Symptoms: Convulsion, Gastrointestinal disorder, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), 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? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt recv vax 12MAY97 & devel gastroenteritis 15MAY97 & fever up to 103.5;had 2-3 sz & was adm to hosp 17MAY97;


VAERS ID: 98691 (history)  
Form: Version 1.0  
Age: 45.0  
Gender: Female  
Location: Vermont  
Vaccinated:1997-05-14
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1997-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1692D / 1 - / -

Administered by: Private       Purchased by: Private
Symptoms: Influenza, Myalgia, Oedema peripheral
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Infective pneumonia (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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT97005

Write-up: systemic flu sx;aches;swelling in feet;


VAERS ID: 99351 (history)  
Form: Version 1.0  
Age: 13.0  
Gender: Female  
Location: Vermont  
Vaccinated:1997-05-22
Onset:1997-05-22
   Days after vaccination:0
Submitted: 1997-06-17
   Days after onset:26
Entered: 1997-06-27
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1469D / 3 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Facial palsy, Myasthenic syndrome, Pharyngitis
SMQs:, Agranulocytosis (broad), Malignancy related conditions (narrow), Oropharyngeal infections (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: c/o tongue felt smoothe & funny-unable to whistle
Preexisting Conditions: allergic to PCN & bee stings;
Allergies:
Diagnostic Lab Data: NA
CDC Split Type: VT97007

Write-up: pt recv vax & next day woke up w/marked weakness lt side of face unable to completely close lt eye & side of mouth;Bells palsy but pt actually in because of URI & pharynx inflammed;


VAERS ID: 238794 (history)  
Form: Version 1.0  
Age: 1.53  
Gender: Female  
Location: Vermont  
Vaccinated:1997-05-27
Onset:2005-01-10
   Days after vaccination:2785
Submitted: 2005-05-16
   Days after onset:125
Entered: 2005-06-01
   Days after submission:16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / SANOFI PASTEUR 6D81396 / 4 - / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 622757 / 1 - / SC

Administered by: Private       Purchased by: Private
Symptoms: Pruritus, Skin ulcer
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:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES0502USA00325

Write-up: Information has been received from a woman in a physician''s office concerning a 9 year old female with no medical history who on 27 MAY 1997 was vaccinated SC with first dose of Varicella. Concomitant vaccinations on that same day included an IM fourth dose of TRIPEDIA. There was no illness at teh time of vaccination. It was reported that on 10 JAN 2005 the patient''s mother called the physician''s office indicating that her daughter developed slightly itchy leasions on her chest, legs and back and subsequenlty developed more. As of Feb 2005 the patient was noted to be recovering as her lesions were in the process of scabbing. Subsequently the patient''s slightly itchy lesions resolved. Additional information is not expected.


VAERS ID: 99183 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Vermont  
Vaccinated:1997-06-11
Onset:1997-06-11
   Days after vaccination:0
Submitted: 1997-06-11
   Days after onset:0
Entered: 1997-06-19
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (TRIPEDIA) / CONNAUGHT LABORATORIES 6D81396 / 5 LA / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 440728 / 4 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Dyspnoea, Oedema genital, Pruritus, Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: ~ ()~~~In patient
Other Medications:
Current Illness: NA
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT97006

Write-up: hives-itchy, SOB, genital swelling;


VAERS ID: 103518 (history)  
Form: Version 1.0  
Age: 21.0  
Gender: Female  
Location: Vermont  
Vaccinated:1997-06-12
Onset:1997-06-27
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 1997-10-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1539D / 1 - / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: exposure, varicella;
Preexisting Conditions: exposure, varicella;
Allergies:
Diagnostic Lab Data: No relevant data;
CDC Split Type: WAES97062516

Write-up: pt recv vax 12JUN97 & 27JUN97 pt devel a full-blown case of varicella;by 7JUN97 had recovered;


VAERS ID: 101832 (history)  
Form: Version 1.0  
Age: 21.0  
Gender: Female  
Location: Vermont  
Vaccinated:1997-07-15
Onset:1997-07-20
   Days after vaccination:5
Submitted: 1997-08-18
   Days after onset:29
Entered: 1997-08-26
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 1613A1 / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Coagulopathy, Ecchymosis, Oedema peripheral, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (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? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT97008

Write-up: 20JUL97 sudden onset arms 2xnl size, red, purple, hot-went to ER said not vaccine rx;did ultrasound & sent home;21JUL pt to MD adm to hosp had hugh blood clot that had to be dissolved-surgery;f/u 6wk remove rib;MD felt rxn not r/t vax;


VAERS ID: 104879 (history)  
Form: Version 1.0  
Age: 25.0  
Gender: Female  
Location: Vermont  
Vaccinated:1997-10-09
Onset:1997-10-30
   Days after vaccination:21
Submitted: 1997-11-02
   Days after onset:3
Entered: 1997-11-20
   Days after submission:18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dermatitis bullous, Skin disorder
SMQs:, Severe cutaneous adverse reactions (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt adm to ER 2 blisters loose abd & chest & thigh;no itching, one blister broken;described as varicella-like rash by MD;pt had vax on 9OCT for low titer;4NOV97 re-admit to ER w/many more blisters (20+);given rx for Vorivax;


VAERS ID: 123616 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Vermont  
Vaccinated:1997-10-09
Onset:1997-10-28
   Days after vaccination:19
Submitted: 1999-05-14
   Days after onset:562
Entered: 1999-05-21
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 1 - / -

Administered by: Public       Purchased by: Other
Symptoms: Dermatitis bullous, Infection
SMQs:, Severe cutaneous adverse reactions (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: no relevant data~ ()~~~In patient
Other Medications: unk
Current Illness:
Preexisting Conditions: unk
Allergies:
Diagnostic Lab Data: lab tests: 10/?/98, pos varicella titers
CDC Split Type: WAES98070547

Write-up: p/ pt recv vax approx 17 days later pt devel a ``varicella rash w/approx 50 lesions''''. in 7/98 pt devel a 2nd case of varicella w/40-50 ``varicella-like lesions'''' rpt MD felt both cases were not related to therapy w/varivax. tests done.


VAERS ID: 104039 (history)  
Form: Version 1.0  
Age: 42.0  
Gender: Female  
Location: Vermont  
Vaccinated:1997-10-17
Onset:1997-10-17
   Days after vaccination:0
Submitted: 1997-10-21
   Days after onset:4
Entered: 1997-10-29
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81754 / 1 LA / -

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: oral contraceptive;Loestrin
Current Illness: NONE
Preexisting Conditions: endometriosis
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: 8 1/2hr p/vax pt devel sl nausea, followed by uncontrollable shaking & teeth chattering;p/a period of rest pt devel a fever;T max 102 orally;had one other episode of violent shaking w/in the next 12hr;temp remained elevated for 36hr;


VAERS ID: 104296 (history)  
Form: Version 1.0  
Age: 47.0  
Gender: Female  
Location: Vermont  
Vaccinated:1997-10-17
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 1997-11-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK RA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 5/8" needle provided by Wyeth for IM flu vax;
CDC Split Type:

Write-up: pt states arm turned red, swelling up, itching, burn; reporter states 5/8" needle provided by Wyeth for IM flu vax;


VAERS ID: 104297 (history)  
Form: Version 1.0  
Age: 43.0  
Gender: Female  
Location: Vermont  
Vaccinated:1997-10-17
Onset:1997-10-18
   Days after vaccination:1
Submitted: 1997-10-28
   Days after onset:10
Entered: 1997-11-03
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4978193 / UNK LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: allergies-colitis (ulcerative)
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: large reddened, raised area on deltoid, heat filled;ice applied;lasted 4+ days then resolved;spot was also very itchy during rxn;reporter feels the vax was given SC instead of IM because 5/8" needle provided by Wyeth;


VAERS ID: 104298 (history)  
Form: Version 1.0  
Age: 29.0  
Gender: Female  
Location: Vermont  
Vaccinated:1997-10-17
Onset:1997-10-18
   Days after vaccination:1
Submitted: 1997-10-28
   Days after onset:10
Entered: 1997-11-03
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK - / -

Administered by: Other       Purchased by: Private
Symptoms: Oedema peripheral, Vasodilatation
SMQs:, Cardiac failure (broad), Angioedema (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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: pt arm swelled up turned very hot & red;pt put ice on it;it took 4 days to go back to nl;3 by 4 in wide raised;reporter states pt has large arms there fore 5/8" needle provided on tubex did not go IM;


VAERS ID: 104299 (history)  
Form: Version 1.0  
Age: 43.0  
Gender: Female  
Location: Vermont  
Vaccinated:1997-10-17
Onset:1997-10-18
   Days after vaccination:1
Submitted: 1997-10-23
   Days after onset:5
Entered: 1997-11-03
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK LA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site mass, Injection site pain, Pruritus
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp itchy, hard, red wheal w/flu vax in 1996;~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: PCN
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: devel a 4inch x 2inch itchy, hard, red wheal @ site of the inj-varied between locally sore & locally very itchy till today 23OCt97;pt has recv vax other yr including last year w/rxn;reporter states 5/8" needle went SC not IM;


VAERS ID: 104300 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Vermont  
Vaccinated:1997-10-17
Onset:1997-10-17
   Days after vaccination:0
Submitted: 1997-10-28
   Days after onset:11
Entered: 1997-11-03
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK LA / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site hypersensitivity, Injection site mass, Injection site oedema, Oedema peripheral, Pruritus, Rash, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (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: NONE~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: large red rash/swelling/itching/hot & was a hard ball where it was given;d/t 5/8" needle provided by Wyeth this inj probably went SC;


VAERS ID: 104301 (history)  
Form: Version 1.0  
Age: 53.0  
Gender: Female  
Location: Vermont  
Vaccinated:1997-10-17
Onset:1997-10-18
   Days after vaccination:1
Submitted: 1997-10-28
   Days after onset:10
Entered: 1997-11-03
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / UNK LA / -

Administered by: Other       Purchased by: Unknown
Symptoms: Oedema, Pain, Skin nodule, Vasodilatation
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad)

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

Write-up: area about size of a tennis ball that was swollen very red & hot very sore for 3 days;flu vax recv in individual doses from wyeth w/ 5/8" needle;


VAERS ID: 106438 (history)  
Form: Version 1.0  
Age: 53.0  
Gender: Female  
Location: Vermont  
Vaccinated:1997-10-17
Onset:0000-00-00
Submitted: 1998-01-12
Entered: 1998-01-16
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81788 / UNK LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Pain, Tendon disorder
SMQs:, Tendinopathies and ligament disorders (narrow)

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

Write-up: pt reported persistent soreness in lt arm & devel of tendonitis since flu shot;feels nurse gave shot too far back in arm;pt has been seen by MD & can not find cause for tendonitis-? flu shot only started since recv vax;


VAERS ID: 106439 (history)  
Form: Version 1.0  
Age: 33.0  
Gender: Female  
Location: Vermont  
Vaccinated:1997-10-17
Onset:0000-00-00
Submitted: 1998-01-12
Entered: 1998-01-16
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 7F81894 / UNK RA / IM

Administered by: Other       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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: pt exp abscess p/vax;~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC Split Type:

Write-up: pt reported persistent lump about the size of walnut from flu shot;


VAERS ID: 104302 (history)  
Form: Version 1.0  
Age: 40.0  
Gender: Female  
Location: Vermont  
Vaccinated:1997-10-20
Onset:1997-10-20
   Days after vaccination:0
Submitted: 1997-10-24
   Days after onset:4
Entered: 1997-11-03
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH - / 1 RA / SC

Administered by: Other       Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site mass, Pain, Vasodilatation
SMQs:, Extravasation events (injections, infusions and implants) (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: NA~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: rt upper arm, deltoid area became hot to touch w/tenderness, along w/a hard raised rash of 3" inches in circumference around the inj site;reporter states flu vax provided by Wyeth tubex prepared w/ 5/8" for Im shot;


VAERS ID: 207692 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Male  
Location: Vermont  
Vaccinated:1997-10-22
Onset:0000-00-00
Submitted: 2003-08-02
Entered: 2003-08-12
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. - / 2 - / -
HIBV: HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 - / -

Administered by: Unknown       Purchased by: Other
Symptoms: Convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-03-05
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: At 2 months of age, 8/27/97, HIB #1, Hep B #1, IVP #2, DTaP #1; 10/22/97 HIB #2, Hep B #2, IPV #2, DTaP #2. Reacted to immunization with fever then several hours later convulsions. Seizures not present prior. No improvement over several weeks. Took child to hospital and doctor gave 10/27/97 shots; I said no. She did them anyway. Child died a few months later. 8/12/03: Information received from corrections facility where the reporter is an inmate, indicates that he may not receive outside phone calls but letters are permitted. A letter of request for ER and inpatient record was faxed for the admission on 11/22/03. 8/14/03 This record was received and includes: the ER evaluation; the H&P and the Discharge Summary w/ an addendum that includes the findings from the transfer hospital where child was hospitalized for more extensive evaluation of abnormal head CT. The discharge diagnosis on 11/25/97 was Failure To Thrive. The addendum which was added after the child''s transfer and evaluation at the higher level of care facility was a diagnosis of Krabbe Disease, an autosomal recessive genetic disorder leading to progressive demyelination of the nervous system. As a result of this evaluation, it was also determined that the mother''s father was also the child''s father and this man was later arrested and arraigned on sexual assault charges. There was no autopsy done on this patient per Office of Chief Medical Examiner. 8/13/03 Call to PMD for this child from birth to the time of his death, to request immunization and relevant OV records. Since it has been 5 yrs since the death of this patient, they have placed the records in storage. She has agreed to locate the records and send them to VAERS 9/3/03 Official Certificate of Death received which confirms the cause of death as Krabbe''s Disease. A copy of the 5 pp. Discharge Summary from hospital is received for the admission from 11/25/97-12/02/97. The discharge diagnosis is listed as progressive leukodystrophy, probable Krabbe Disease. It is not clear if or when the immunization records with lot#s will be received. That information will be added when available. Follow-up is otherwise complete.


VAERS ID: 104538 (history)  
Form: Version 1.0  
Age: 1.2  
Gender: Female  
Location: Vermont  
Vaccinated:1997-10-23
Onset:1997-11-02
   Days after vaccination:10
Submitted: 1997-11-02
   Days after onset:0
Entered: 1997-11-07
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPHIB: DTP + HIB (NO BRAND NAME) / UNKNOWN MANUFACTURER 44101 / 4 LL / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0103E / 1 RL / SC

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

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

Write-up: rash-red blanching lesions occipital adenopathy;fever to 100; APAP given;


VAERS ID: 105813 (history)  
Form: Version 1.0  
Age: 45.0  
Gender: Female  
Location: Vermont  
Vaccinated:1997-11-19
Onset:1997-11-19
   Days after vaccination:0
Submitted: 1997-12-11
   Days after onset:22
Entered: 1997-12-22
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / CONNAUGHT LABORATORIES 7E91672 / UNK LA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Hypokinesia, Injection site pain, Pain
SMQs:, Parkinson-like events (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Hypotonic-hyporesponsive episode (broad)

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: ~ ()~~~In patient
Other Medications:
Current Illness: unk
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT97009

Write-up: pt c/o pain @ vax site & down lt arm immed;12 days later stated pain cont & had been noting some limits in some ROM in lt arm;pt saw MD p/that time frame;


VAERS ID: 105946 (history)  
Form: Version 1.0  
Age: 1.7  
Gender: Male  
Location: Vermont  
Vaccinated:1997-12-01
Onset:1997-12-22
   Days after vaccination:21
Submitted: 1997-12-26
   Days after onset:4
Entered: 1998-01-02
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 826A2 / 4 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M350PN / 4 RA / IM

Administered by: Private       Purchased by: Public
Symptoms: Abscess
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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: sterile abscess lt shoulder;


VAERS ID: 111339 (history)  
Form: Version 1.0  
Age: 0.6  
Gender: Female  
Location: Vermont  
Vaccinated:1998-03-16
Onset:1998-03-16
   Days after vaccination:0
Submitted: 1998-05-22
   Days after onset:66
Entered: 1998-06-01
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 841A2 / 3 - / IM

Administered by: Private       Purchased by: Public
Symptoms: Crying, Ecchymosis, Injection site hypersensitivity, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Depression (excl suicide and self injury) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 19980111011

Write-up: Several hr p/vax pt devel screaming,ecchymosis @inj site & fever 101.4.


VAERS ID: 111338 (history)  
Form: Version 1.0  
Age: 0.4  
Gender: Female  
Location: Vermont  
Vaccinated:1998-03-18
Onset:1998-03-28
   Days after vaccination:10
Submitted: 1998-05-22
   Days after onset:54
Entered: 1998-06-01
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 841A2 / 2 - / IM

Administered by: Private       Purchased by: Public
Symptoms: Injection site mass, 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? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: bronchiolitis, upper resp infect. NKA
Allergies:
Diagnostic Lab Data:
CDC Split Type: 19980090171

Write-up: Pt recvd vax & devel 3cm area of induration @inj site & fever lasting 1 wk.


VAERS ID: 111340 (history)  
Form: Version 1.0  
Age: 1.4  
Gender: Male  
Location: Vermont  
Vaccinated:1998-03-25
Onset:1998-03-29
   Days after vaccination:4
Submitted: 1998-05-22
   Days after onset:53
Entered: 1998-06-01
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 841A2 / 1 - / IM

Administered by: Private       Purchased by: Public
Symptoms: Abnormal dreams, Agitation, Ecchymosis, Injection site hypersensitivity, Injection site mass, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: bronchiolitis,conjunctivitis,otitis media,poss allergy amoxicillin,upper resp infect
Allergies:
Diagnostic Lab Data:
CDC Split Type: 19980111111

Write-up: Approx 4 day p/vax pt devel walnut size purple area @inj site,fussiness & fever of 99.9. 12April98 pt devel nightmares. Pea sized lump @inj site still remains


VAERS ID: 111341 (history)  
Form: Version 1.0  
Age: 1.5  
Gender: Male  
Location: Vermont  
Vaccinated:1998-03-30
Onset:1998-03-30
   Days after vaccination:0
Submitted: 1998-05-22
   Days after onset:52
Entered: 1998-06-01
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 841A2 / 1 - / IM

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

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: Actigall (Ursodiol)
Current Illness: Poss upper resp infect/chest congestion
Preexisting Conditions: myotubular myopathy, upper resp infect; NKA
Allergies:
Diagnostic Lab Data:
CDC Split Type: 19980111121

Write-up: Approx 2 hr p/vax pt devel fever 101.3. Also redness & firmness @inj site.


VAERS ID: 115882 (history)  
Form: Version 1.0  
Age: 22.0  
Gender: Female  
Location: Vermont  
Vaccinated:1998-04-04
Onset:1998-04-08
   Days after vaccination:4
Submitted: 1998-10-26
   Days after onset:201
Entered: 1998-11-02
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 1 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Arthralgia, Neck pain, Pruritus, Pyrexia, Rash, Urticaria, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: 19980105871

Write-up: pt recv vax 4APR98 & 8APR98 pt devel a fever & sore neck;13APR exp joint pain;14APR broke out in a red itchy, confluent rash described as hive/urticaria on chin, neck, stomach, area, inner elbow, upper thighs & wrist;


VAERS ID: 110769 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Vermont  
Vaccinated:1998-05-04
Onset:1998-05-06
   Days after vaccination:2
Submitted: 1998-05-06
   Days after onset:0
Entered: 1998-05-11
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 840A2 / 1 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 1234E / 2 LA / SC
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH 446716 / 4 MO / PO

Administered by: Private       Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site oedema, Oedema peripheral, Rash
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: erythema, edema entire arm & shoulder-elbow w/extensive erythema to chest & forearm approx 36hr p/vax;


VAERS ID: 114725 (history)  
Form: Version 1.0  
Age: 30.0  
Gender: Female  
Location: Vermont  
Vaccinated:1998-07-14
Onset:1998-07-16
   Days after vaccination:2
Submitted: 1998-09-30
   Days after onset:76
Entered: 1998-10-05
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2632A2 / 2 RA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0034H / 2 LA / -

Administered by: Private       Purchased by: Private
Symptoms: Influenza, Injection site hypersensitivity, Injection site pain, Malaise, Myalgia, Vasodilatation
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (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: ~ ()~~~In patient
Other Medications: Ventolin Rotocaps;Vanceril
Current Illness: Asthma-chronic
Preexisting Conditions: possible PCN allergy
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt recv vax 14JUL98 & had local redness, warmth & tenderness;had flu like synd w/malaise, h/a;


VAERS ID: 113696 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Vermont  
Vaccinated:1998-08-03
Onset:1998-08-04
   Days after vaccination:1
Submitted: 1998-08-24
   Days after onset:20
Entered: 1998-08-28
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM A847A2 / 1 - / IM L
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1308D / 2 - / IM L
HIBV: HIB (HIBTITER) / PFIZER/WYETH M285RJ / 1 - / IM L
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. L1112 / 1 - / SC L

Administered by: Private       Purchased by: Public
Symptoms: Condition aggravated, Gaze palsy, Hyporeflexia, Tongue disorder
SMQs:, Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Ocular motility disorders (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: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: 38wk c/s for placental insufficiency;similar episode of apnea @ 3wk;
Allergies:
Diagnostic Lab Data: CBC-nl
CDC Split Type:

Write-up: pt was falling asleep & mom went to place in bussinet, noticed pt was not breathing, eyes rolled back, tongue out of mouth lasted 15sec;mom shouted & shook child-child responded seconds later repeat of similar episode;brought to ER;


VAERS ID: 115159 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Unknown  
Location: Vermont  
Vaccinated:1998-08-12
Onset:1998-08-13
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 1998-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 451463 / UNK - / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Laryngospasm, Myalgia, Oedema peripheral
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Dystonia (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT98003

Write-up: gen myalgia w/o trouble breathing;tightness in throat;swollen arm;


VAERS ID: 115160 (history)  
Form: Version 1.0  
Age: 15.0  
Gender: Female  
Location: Vermont  
Vaccinated:1998-08-31
Onset:1998-09-01
   Days after vaccination:1
Submitted: 1998-10-14
   Days after onset:43
Entered: 1998-10-21
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / LEDERLE LABORATORIES 451463 / 6 LA / -

Administered by: Private       Purchased by: Public
Symptoms: Influenza, Injection site oedema, Injection site pain, Nuchal rigidity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), 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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT98001

Write-up: sore & swollen @ site of inj;flu sx;stiff neck;


VAERS ID: 116182 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Vermont  
Vaccinated:1998-09-02
Onset:1998-09-02
   Days after vaccination:0
Submitted: 1998-11-01
   Days after onset:60
Entered: 1998-11-10
   Days after submission:9
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1372E / 1 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Rash maculo-papular
SMQs:, 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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: w/in a few hr of vax pt broke out in a raised, red, papular rash which extended over entire body & lasted 4wk;pt was examined by 2 MD who confirmed that this was not varicella or poison ivy;neither MD could dx cause;


VAERS ID: 157106 (history)  
Form: Version 1.0  
Age: 20.0  
Gender: Male  
Location: Vermont  
Vaccinated:1998-09-15
Onset:1999-05-20
   Days after vaccination:247
Submitted: 2000-05-16
   Days after onset:362
Entered: 2000-07-18
   Days after submission:63
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. - / 2 - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Drug ineffective
SMQs:, Lack of efficacy/effect (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness:
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: Serum Varicella Zoster Neg. No detectable antibodies
CDC Split Type: WAES99060678

Write-up: Lack of response after receiving 1st and 2nd doses of varicella.


VAERS ID: 242386 (history)  
Form: Version 1.0  
Age: 51.0  
Gender: Female  
Location: Vermont  
Vaccinated:1998-10-01
Onset:2004-11-09
   Days after vaccination:2231
Submitted: 2005-07-29
   Days after onset:261
Entered: 2005-08-04
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. 0986N / 2 UN / -

Administered by: Other       Purchased by: Other
Symptoms: Chills, Erythema, Oedema, Pain, Pyrexia
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: aspirin, Lipitor, Celebrex, cyanocobalamin, Neurontin, Lantus,Humalog,Prinivil,Aciphex, vitamins (unspecified)
Current Illness:
Preexisting Conditions: Liver function test abnormal, Osteoarthritis, Diabetes mellitus, Hypertension, Gastroesophageal reflux disease, Smoker, Drug Hypersensitivity
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: WAES0411USA01997

Write-up: Information has been received from a physician concerning a 57 year old white female with osteoarthritis, diabetes mellitus, hypertension, gastroesophageal reflux disease, smoker and ACTO''s causing increased LFT''s who in October 1988 was vaccinated with a second dose of pneumococcal 23v polysaccharide vaccine (lot 0986N), in the right deltoid. Concomitant therapy included. rabeprazole sodium (Aciphex), atorvastatin calcium (Lipitor), gabapentin (Neurontin), lisinopril (manufacturer unk), celecoxib (Celebrex), insulin lispro (Humalog), insulin glargine (Lantus), aspirin, vitamins (unspecified) and cyanocobalamin, On Nov 09 2004, in the afternoon, the patient experienced right upper arm pain, erythema, swelling, fever and chills. Subsequently, the patient recovered. There were no relevant diagnostic tests or laboratory data. The patient had no adverse events following prior vaccinations. No further information is available.


VAERS ID: 115161 (history)  
Form: Version 1.0  
Age: 61.0  
Gender: Male  
Location: Vermont  
Vaccinated:1998-10-07
Onset:1998-10-08
   Days after vaccination:1
Submitted: 1998-10-14
   Days after onset:6
Entered: 1998-10-21
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4988203 / UNK RA / -

Administered by: Private       Purchased by: Private
Symptoms: Malaise, Pharyngitis, Pyrexia, Tinnitus
SMQs:, Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Hearing impairment (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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT98002

Write-up: ringing ears, sore throat, malaise, elevated temp;


VAERS ID: 116616 (history)  
Form: Version 1.0  
Age: 1.2  
Gender: Male  
Location: Vermont  
Vaccinated:1998-10-07
Onset:1998-10-16
   Days after vaccination:9
Submitted: 1998-11-16
   Days after onset:31
Entered: 1998-11-23
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0785H / 1 RL / -
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0644H / 1 LL / -

Administered by: Private       Purchased by: Public
Symptoms: Convulsion, Hydronephrosis, Hypoxia, Pericardial effusion, Pulmonary oedema, Renal impairment, Rhinitis
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Asthma/bronchospasm (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (narrow), Convulsions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Generalised convulsive seizures following immunisation (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 1998-10-16
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Ibuprofen
Current Illness: NONE
Preexisting Conditions: adopted child-birth parents siblings;hydronephrosis & renal insuff on autopsy
Allergies:
Diagnostic Lab Data: autopsy unrevealing of COD
CDC Split Type:

Write-up: unexplained infant death;autopsy finding of hydronephrosis & renal insufficiency not felt to be r/t pt death;


VAERS ID: 116306 (history)  
Form: Version 1.0  
Age: 56.0  
Gender: Female  
Location: Vermont  
Vaccinated:1998-10-13
Onset:1998-10-13
   Days after vaccination:0
Submitted: 1998-10-15
   Days after onset:2
Entered: 1998-11-09
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKDALE PHARMACEUTICALS 02298P / 1 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Chest pain, Conjunctivitis, Cough, Dyspnoea, Face oedema
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Angioedema (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Conjunctival disorders (narrow), Ocular infections (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: UNK~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: FLU88121098

Write-up: Pt recv vax on 10/13/98; post vax pt exp increased cough, tight chest, red/puffy eyes & difficulty breathing


VAERS ID: 117349 (history)  
Form: Version 1.0  
Age: 10.0  
Gender: Male  
Location: Vermont  
Vaccinated:1998-10-13
Onset:1998-10-15
   Days after vaccination:2
Submitted: 1998-12-09
   Days after onset:55
Entered: 1998-12-14
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER 1229H / 1 LA / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0785H / 2 - / -

Administered by: Public       Purchased by: Public
Symptoms: Arthralgia, Arthritis, Hypertonia, Osteoarthritis
SMQs:, Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Parkinson-like events (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Arthritis (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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: MA98004

Write-up: diagnosed/reactive arthritis: joint pain, swelling & stiffness in hands & knees;taking high doses of advil;


VAERS ID: 116307 (history)  
Form: Version 1.0  
Age: 37.0  
Gender: Female  
Location: Vermont  
Vaccinated:1998-10-14
Onset:1998-10-14
   Days after vaccination:0
Submitted: 1998-10-15
   Days after onset:1
Entered: 1998-11-09
   Days after submission:25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKDALE PHARMACEUTICALS 02298P / 2 - / IM

Administered by: Private       Purchased by: Private
Symptoms: Dysphonia, Laryngospasm, Rash maculo-papular
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Parkinson-like events (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: UNK~ ()~~~In patient
Other Medications: UNK
Current Illness: UNK
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: FLU88131098

Write-up: Pt recv vax on 10/14/98; post vax pt exp tight throat, hoarse, red blotches on neck & chest


VAERS ID: 115379 (history)  
Form: Version 1.0  
Age: 72.0  
Gender: Female  
Location: Vermont  
Vaccinated:1998-10-15
Onset:1998-10-15
   Days after vaccination:0
Submitted: 1998-10-21
   Days after onset:6
Entered: 1998-10-27
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4988203 / 2 LA / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 445637 / 1 LA / IM

Administered by: Private       Purchased by: Other
Symptoms: Injection site hypersensitivity, Injection site oedema, Injection site pain, Oedema peripheral, Pruritus
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (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: ~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions: HTN
Allergies:
Diagnostic Lab Data: NOEN
CDC Split Type:

Write-up: pt reports 4 days p/vax c/o tenderness, swelling, red, itchy arms, moving from site to elbow;slowly improving using ice & elevation as needed;denies fever but will cont to f/u daily as needed;


VAERS ID: 118282 (history)  
Form: Version 1.0  
Age: 48.0  
Gender: Male  
Location: Vermont  
Vaccinated:1998-11-05
Onset:0000-00-00
Submitted: 1998-12-12
Entered: 1999-01-22
   Days after submission:41
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES 0984550 / UNK LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Diarrhoea, Headache, Nausea
SMQs:, Acute pancreatitis (broad), 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? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: unk
CDC Split Type:

Write-up: pt reported a month p/vax has been sick w/diarrhea, nausea & h/a since inj;has not seen a MD;states there as few other @ office who were sick;encouraged pt to see MD;


VAERS ID: 117696 (history)  
Form: Version 1.0  
Age: 1.0  
Gender: Male  
Location: Vermont  
Vaccinated:1998-12-15
Onset:1998-12-16
   Days after vaccination:1
Submitted: 1998-12-18
   Days after onset:2
Entered: 1998-12-28
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 860A2 / 4 LA / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH M010RN / 4 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. 0515H / 1 RA / SC
OPV: POLIO VIRUS, ORAL (NO BRAND NAME) / UNKNOWN MANUFACTURER 0792C / 1 MO / PO

Administered by: Private       Purchased by: Other
Symptoms: Febrile convulsion, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type:

Write-up: Pt recv vax on 12/15/98; on 12/16/98 pt exp fever (104.5), febrile seizure


VAERS ID: 388159 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Vermont  
Vaccinated:1999-01-27
Onset:1999-01-27
   Days after vaccination:0
Submitted: 2010-05-14
   Days after onset:4124
Entered: 2010-05-18
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 1262H / 1 UN / SC

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: serum varicella zoster, 09/01?/09, negative
CDC Split Type: WAES0909USA00222

Write-up: Information has been received from a registered nurse concerning a 5 year old female with no pertinent medical history and no known drug allergies who on 27-JAN-1999 was vaccinated with the first 0.5ml dose of VARIVAX (Merck) (subcutaneous injection, lot # 628147/1262H). There was no concomitant medication. The nurse was reporting that on 05-FEB-1999 the patient developed itchy rash on face, ears, nose, and hands after receiving her first dose of VARIVAX (Merck). On approximately 01-SEP-2009, the patient had the titer done, but it came back as negative for varicella immunity. On unspecified date, the patient recovered. On unspecified date, the patient saw the physician. Follow up information has been received from a healthcare professional indicated that a 6 year old (previously reported as 5 year old) patient experienced rash on 27-JAN-1999 (previously reported as 05-FEB-1999). Additional information is not expected.


VAERS ID: 121189 (history)  
Form: Version 1.0  
Age: 48.0  
Gender: Female  
Location: Vermont  
Vaccinated:1999-02-08
Onset:0000-00-00
Submitted: 1999-02-09
Entered: 1999-04-13
   Days after submission:62
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2795A2 / 2 LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Pruritus
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: NONE
Preexisting Conditions: h/o breast cancer w/chemotherapy
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: pt recv vax 8FEB99 & pt was given DPH 35min p/vax (pt stayed in clinic) started itching chest & neck DPH given w/relief of sx;


VAERS ID: 133594 (history)  
Form: Version 1.0  
Age: 12.0  
Gender: Male  
Location: Vermont  
Vaccinated:1999-04-02
Onset:0000-00-00
Submitted: 2000-01-31
Entered: 2000-02-01
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 2934A2 / 1 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Arthralgia, Arthritis
SMQs:, Systemic lupus erythematosus (broad), Arthritis (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: ANA, ESR 67, CRP 2.1
CDC Split Type:

Write-up: In late April, within 3 weeks following HEP-B, pt developed arthralgia and eventually arthritis in his right knee.


VAERS ID: 121471 (history)  
Form: Version 1.0  
Age: 1.4  
Gender: Male  
Location: Vermont  
Vaccinated:1999-04-20
Onset:1999-04-20
   Days after vaccination:0
Submitted: 1999-04-20
   Days after onset:0
Entered: 1999-04-26
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 890A2 / 2 LL / IM
HIBV: HIB (PROHIBIT) / CONNAUGHT LABORATORIES 788AA / 2 RL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. 4911 / 2 LL / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR I) / MERCK & CO. INC. 1649H / 1 RL / SC

Administered by: Public       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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT99001

Write-up: Pt recv vax on 4/20/99; 15 min post vax pt exp large hives on back of neck, shoulders & chest; pt to E.R.; tx=Benadryl


VAERS ID: 122198 (history)  
Form: Version 1.0  
Age: 14.0  
Gender: Female  
Location: Vermont  
Vaccinated:1999-04-27
Onset:1999-04-28
   Days after vaccination:1
Submitted: 1999-05-12
   Days after onset:14
Entered: 1999-05-17
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (RECOMBIVAX HB) / MERCK & CO. INC. 1604H / 2 LA / -

Administered by: Private       Purchased by: Public
Symptoms: Purpura
SMQs:, Haemorrhage terms (excl laboratory terms) (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: ~ ()~~~In patient
Other Medications:
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type: VT99002

Write-up: Pt recv vax on 4/27/99; on 4/28/99 pt exp hemorrhagic rash on upper chest &around neck&chin


VAERS ID: 281862 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Vermont  
Vaccinated:1999-05-03
Onset:2003-07-28
   Days after vaccination:1547
Submitted: 2007-05-16
   Days after onset:1388
Entered: 2007-05-24
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0290J / 1 UN / SC

Administered by: Private       Purchased by: Public
Symptoms: Herpes zoster
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: Cleft palate repair; Chickenpox
Preexisting Conditions: Drug hypersensitivity
Allergies:
Diagnostic Lab Data: None
CDC Split Type: WAES0701USA01049

Write-up: Information has been received from a registered nurse concerning a 9-year-old female with drug hypersensitivity to diphenhydramine (Benadryl) and a history of chicken pox in June 1994 and cleft palate repair who on 03-MAY-1999 was vaccinated subsequently with a 0.5 mL first dose of Varivax (Lot # 630037/0290J). There was no concomitant medication. There was no illness at the time of vaccination. There were no adverse events following prior vaccinations. On 28-JUL-2003, the patient experienced shingles and was seen in the emergency room. She was told to rest. No diagnostic studies were performed. Subsequently, the patient recovered from shingles. No additional information to report. There was no product quality complaint. No additional information is expected.


VAERS ID: 123258 (history)  
Form: Version 1.0  
Age: 70.0  
Gender: Female  
Location: Vermont  
Vaccinated:1999-05-24
Onset:1999-05-25
   Days after vaccination:1
Submitted: 1999-05-27
   Days after onset:2
Entered: 1999-06-02
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TD: TD ADSORBED (NO BRAND NAME) / PFIZER/WYETH 4998027 / UNK - / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: mitral regeug acoustic neuroma
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: p/vax pt exp firm mass around site 5 cm, inflamed & warm to elbow, heat & anti inflammation recommended


VAERS ID: 123364 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Vermont  
Vaccinated:1999-06-02
Onset:1999-06-03
   Days after vaccination:1
Submitted: 1999-06-04
   Days after onset:1
Entered: 1999-06-07
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 9862A2 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH 361453 / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N0651 / 1 LL / IM

Administered by: Private       Purchased by: Public
Symptoms: Insomnia, Screaming, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), 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: ~ ()~~~In patient
Other Medications:
Current Illness: no
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: none
CDC Split Type:

Write-up: after vax pt exp very sleepy for about 24 hr, screamed inconsolably 2pm-12 mn, slept fitfully until morn


VAERS ID: 125300 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Vermont  
Vaccinated:1999-06-04
Onset:1999-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 1999-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 903A2 / 1 RL / IM
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM 3068A2 / 2 LL / -
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES N0788AA / 1 RL / -
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N04911 / 1 LL / -

Administered by: Private       Purchased by: Public
Symptoms: Apnoea, Convulsion, Electroencephalogram abnormal, Gaze palsy, Muscle twitching, Somnolence
SMQs:, Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Dementia (broad), Convulsions (narrow), Dyskinesia (broad), Dystonia (broad), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ocular motility disorders (narrow), Generalised convulsive seizures following immunisation (narrow), Respiratory failure (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NA
Current Illness:
Preexisting Conditions: premature @ 33wks gestation-currently 9lb, 5oz @ 2mo & devel nicely
Allergies:
Diagnostic Lab Data: EEG= discharges in lt temporal area; head CT=nl;
CDC Split Type: VT99003

Write-up: afebrile sz;8hr p/vax parents noticed 3 sz;described-jerking all over, not breathing, upward rolling of eyes, for about 20 seconds;then drowsiness for several hr;adm to hosp-no further sz; had 1 sz, a week later; tx w/ phenobarbitol Annual follow-up received 9/5/00 states that the pt has recovered.


VAERS ID: 154372 (history)  
Form: Version 1.0  
Age: 44.0  
Gender: Male  
Location: Vermont  
Vaccinated:1999-06-24
Onset:1999-06-25
   Days after vaccination:1
Submitted: 1999-09-29
   Days after onset:96
Entered: 2000-06-15
   Days after submission:260
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
LYME: LYME (LYMERIX) / SMITHKLINE BEECHAM 104B2 / 2 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Arthralgia, Dizziness, Headache, Influenza like illness, Nausea, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Arthritis (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:
Preexisting Conditions: Environmental allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type: 19990167441

Write-up: This is a spontaneous report from a nurse referring to a 44 year old male pt who on 5/27/99, received his 1st Lymerix, with no ill effects. On 6/24/1999, he received the 2nd dose and 1 day later, experienced nausea, dizziness, headache, aching joints, flu-like symptoms and a tingling left arm at injection site. The pt was advised to take Tylenol or ibuprofen as treatment, and the pt has not decided to receive the 3rd Lymerix injection. The most recent information received on 8/5/99, reports the symptoms resolved, 3 days later on 6/28/1999.


VAERS ID: 128412 (history)  
Form: Version 1.0  
Age: 31.0  
Gender: Male  
Location: Vermont  
Vaccinated:1999-07-01
Onset:1999-07-22
   Days after vaccination:21
Submitted: 1999-09-16
   Days after onset:56
Entered: 1999-09-21
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (RABAVERT) / NOVARTIS VACCINES AND DIAGNOSTICS 208011 / UNK - / IM

Administered by: Other       Purchased by: Other
Symptoms: Arthralgia, Headache, Hyperhidrosis, Myalgia, Nausea, Pelvic pain, Pharyngitis, Pyrexia, Weight decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Agranulocytosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), 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: ~ ()~~~In patient
Other Medications: Bayrab Human Raibes Immune Globulin
Current Illness:
Preexisting Conditions: bit by bat 7/1/99 & bit by sting ray on 7/18/99
Allergies:
Diagnostic Lab Data: CBC, erythrocyte sedimentation rate (ESR) & comprehensive metabolite profile were nl on 7/23/99
CDC Split Type: 4201

Write-up: p/vax pt exp severe groin pain, fever of101, sore throat, h/a, pharyngitis, weight loss, nausea, noc sweats, arthralgia, myalgia;pt was not adm to hosp tx as an outpatient;


VAERS ID: 130002 (history)  
Form: Version 1.0  
Age: 1.1  
Gender: Female  
Location: Vermont  
Vaccinated:1999-08-04
Onset:1999-08-14
   Days after vaccination:10
Submitted: 1999-10-22
   Days after onset:69
Entered: 1999-10-28
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / 1 LL / -

Administered by: Private       Purchased by: Public
Symptoms: Hypertonia, Hypoventilation, Pallor, Pyrexia, Stupor
SMQs:, Neuroleptic malignant syndrome (narrow), Anticholinergic syndrome (broad), Parkinson-like events (narrow), Acute central respiratory depression (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

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

Write-up: seen in ER for episode of lifelessness;went suddenly pale & limp w/slow breathing;responsive to name only lasted 30-45min w/return of color & activity suddenly while in ER;associated w/T101 & no obvious source on exam;


VAERS ID: 159592 (history)  
Form: Version 1.0  
Age: 45.0  
Gender: Female  
Location: Vermont  
Vaccinated:1999-08-12
Onset:1999-08-12
   Days after vaccination:0
Submitted: 1999-08-31
   Days after onset:19
Entered: 2000-09-08
   Days after submission:374
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
RAB: RABIES (IMOVAX) / PASTEUR MERIEUX INST. - / 2 - / IM

Administered by: Other       Purchased by: Other
Symptoms: Headache, Injection site erythema, Pain, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: U1999006120

Write-up: It was reported that a 45 year old female received Imovax IM on 8/12/99. The pt experienced redness at the injection site and 15-20 minutes, post vax, she felt pain and tingling in her fingers, from her hand to her elbow and also pain in the left side of her face. 12 days, post vax, she felt pain and tingling down the left arm. The pt was seen by HCP.


VAERS ID: 130003 (history)  
Form: Version 1.0  
Age: 1.2  
Gender: Female  
Location: Vermont  
Vaccinated:1999-09-29
Onset:1999-09-29
   Days after vaccination:0
Submitted: 1999-10-13
   Days after onset:14
Entered: 1999-10-28
   Days after submission:15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM - / 3 - / -
HEP: HEP B (ENGERIX-B) / SMITHKLINE BEECHAM - / 3 - / -
HIBV: HIB (HIBTITER) / PFIZER/WYETH - / 3 - / -
OPV: POLIO VIRUS, ORAL (ORIMUNE) / PFIZER/WYETH - / 3 - / -

Administered by: Private       Purchased by: Public
Symptoms: Erythema multiforme
SMQs:, Severe cutaneous adverse reactions (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: ~ ()~~~In patient
Other Medications:
Current Illness: WRI/Croup
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: erythema multiforme rash began several hours p/vax, spread over next day, resolved w/in a week;


VAERS ID: 133867 (history)  
Form: Version 1.0  
Age: 33.0  
Gender: Female  
Location: Vermont  
Vaccinated:1999-10-08
Onset:1999-10-16
   Days after vaccination:8
Submitted: 1999-12-28
   Days after onset:73
Entered: 2000-02-10
   Days after submission:44
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / SMITHKLINE BEECHAM 57286 / 1 RA / IM
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES 7372AA / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Clariton
Current Illness: NO
Preexisting Conditions: Environ allergies: dust, pollen, mold, poison ivy, bees
Allergies:
Diagnostic Lab Data: NO
CDC Split Type: VT99009

Write-up: Pt had 2 vax at 2 diff providers. 8 days post vax, rash covering body, itchy, swollen. Treated at ER twice and DO once. For Yellow Fever vax provider consult original documentation.


VAERS ID: 159711 (history)  
Form: Version 1.0  
Age:   
Gender: Female  
Location: Vermont  
Vaccinated:1999-10-08
Onset:1999-10-16
   Days after vaccination:8
Submitted: 1999-10-26
   Days after onset:10
Entered: 2000-09-08
   Days after submission:318
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM
YF: YELLOW FEVER (YF-VAX) / CONNAUGHT LABORATORIES - / UNK - / SC

Administered by: Unknown       Purchased by: Unknown
Symptoms: Hypersensitivity, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: U1999007600

Write-up: It was reported, that a female pt received a Yellow Fever and a Hepatitis A (unspecified) vaccination on October 8, 1999. Reportedly, on 10/16/1999, the pt developed urticaria and was evaluated by physician, and dermatologist. Pt was treated with Prednisone and Benadryl. Reportedly, the dermatologist feels it is an allergic reaction to a preservative. Pt stated, the only thing I did differently was eat sheeps cheese the day before I broke out in hives. Pt denies egg allergy.


VAERS ID: 162053 (history)  
Form: Version 1.0  
Age: 56.0  
Gender: Male  
Location: Vermont  
Vaccinated:1999-10-13
Onset:1999-10-13
   Days after vaccination:0
Submitted: 1999-12-14
   Days after onset:62
Entered: 2000-10-06
   Days after submission:296
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4998212 / UNK - / IM
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 461144 / UNK - / IM

Administered by: Private       Purchased by: Other
Symptoms: Injection site haemorrhage, Injection site oedema, Injection site pain
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), 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: UNK
Current Illness: NONE
Preexisting Conditions: UNK
Allergies:
Diagnostic Lab Data: UNK
CDC Split Type: HQ8314513DEC1999

Write-up: On the same day of vax, the pt developed an injection site reaction in the right arm characterized by swelling which extended over the upper arm and pain. The pt also developed ecchymotic areas in the upper arm and forearm. The pt recovered.


VAERS ID: 162348 (history)  
Form: Version 1.0  
Age: 56.0  
Gender: Male  
Location: Vermont  
Vaccinated:1999-10-14
Onset:1999-10-31
   Days after vaccination:17
Submitted: 1999-12-29
   Days after onset:59
Entered: 2000-10-13
   Days after submission:288
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES - / UNK - / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre 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: MRI scan of right brain-nml
CDC Split Type: U1999010150

Write-up: It was reported that a 56 year old male pt received a Fluzone UNSP ''99-''00 vaccination on 10/14/99. Reportedly, on 10/31/99, the pt developed paresthesia from sole of left foot with gradual increase to left leg, left side of body and left arm to the forearm. The paresthesia has faded in the same pattern it progressed. No right side involvement, pt''s reflexes were normal. Pt also developed paresthesia below right ankle at this time and is fading. The doctor has not confirmed dx with spinal tap or nerve conduction studies due to symptoms resolving at this time. No additional information was provided from correspondence returned on 12/17/99.


VAERS ID: 130172 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Vermont  
Vaccinated:1999-10-18
Onset:1999-10-19
   Days after vaccination:1
Submitted: 1999-10-20
   Days after onset:1
Entered: 1999-11-02
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 911A2 / 1 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES P1113AA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N08262 / 1 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Injection site hypersensitivity, Injection site mass
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Hypersensitivity (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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: VT99007

Write-up: local rxn in rt leg;red, hard lump, size of dime;no fever;very fussy 24hr p/vax;call to MD given APAP;seen in MD office;


VAERS ID: 130173 (history)  
Form: Version 1.0  
Age: 0.5  
Gender: Male  
Location: Vermont  
Vaccinated:1999-10-19
Onset:1999-10-20
   Days after vaccination:1
Submitted: 1999-10-20
   Days after onset:0
Entered: 1999-11-02
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 911A2 / 2 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES P1113AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N08262 / 2 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Injection site hypersensitivity, Injection site pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: heart disease, congental-single ventrical
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: VT99006

Write-up: local rxn, very fussy;pain @ site, remarkable tenderness, erythema;temp this AM 102 ax @ home;seen in MD office 10/20/99 3PM;rt leg reaction;


VAERS ID: 130174 (history)  
Form: Version 1.0  
Age: 0.2  
Gender: Female  
Location: Vermont  
Vaccinated:1999-10-19
Onset:1999-10-19
   Days after vaccination:0
Submitted: 1999-10-19
   Days after onset:0
Entered: 1999-11-02
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 911A2 / 1 RL / IM
HIBV: HIB (ACTHIB) / CONNAUGHT LABORATORIES P1113AA / 1 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N08262 / 1 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Agitation, Injection site hypersensitivity, Injection site pain
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Hypersensitivity (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: NONE~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: VT99005

Write-up: 3hr p/vax pt has been crying since vax;remarkably tender site rxn, erythema, pain in lt leg;given APAP & sent home;


VAERS ID: 130175 (history)  
Form: Version 1.0  
Age: 0.3  
Gender: Male  
Location: Vermont  
Vaccinated:1999-10-19
Onset:1999-10-19
   Days after vaccination:0
Submitted: 1999-10-19
   Days after onset:0
Entered: 1999-11-02
   Days after submission:14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (INFANRIX) / SMITHKLINE BEECHAM 911A1 / 2 RL / IM
FLU3: INFLUENZA (SEASONAL) (FLUSHIELD) / PFIZER/WYETH 4998225 / 1 RL / IM
HIBV: HIB (HIBTITER) / PFIZER/WYETH P1113AA / 2 LL / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / CONNAUGHT LTD. N08262 / 2 LL / SC

Administered by: Private       Purchased by: Public
Symptoms: Injection site hypersensitivity, Injection site pain
SMQs:, Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (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: NONE~ ()~~~In patient
Other Medications: Digixon;Lasix;
Current Illness: NONE
Preexisting Conditions: pre-mature, heart conditon;aeortic stenosis
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: VT99004

Write-up: 5hr p/vax pt to MD office;has been crying since vax;remarkably tender, site rxn, erythema, pain in rt leg;


VAERS ID: 132100 (history)  
Form: Version 1.0  
Age: 53.0  
Gender: Female  
Location: Vermont  
Vaccinated:1999-10-19
Onset:1999-10-19
   Days after vaccination:0
Submitted: 1999-11-01
   Days after onset:13
Entered: 1999-12-28
   Days after submission:57
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKDALE PHARMACEUTICALS 03179P / 1 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Asthma, Back pain, Chills, Dysphonia, Injection site hypersensitivity, Injection site mass, Neck pain, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (narrow), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Extravasation events (injections, infusions and implants) (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Lipitor,albuterol,Xanax,prednisone,Ambien
Current Illness: NONE
Preexisting Conditions: asthma,hypertension,elevated cholestrol,MVP,osteoarthritis
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: By 4p on 10/19/99, pt had a raised,bright red welt approx 2" x 3" in diam;hot to the touch at inj. site,neck,shoulder, & lower back pain w/ accompying chills.The next day,sx worsened.Tx w/ Benadryl & cephalexin.


VAERS ID: 132261 (history)  
Form: Version 1.0  
Age: 23.0  
Gender: Female  
Location: Vermont  
Vaccinated:1999-11-03
Onset:1999-11-03
   Days after vaccination:0
Submitted: 1999-11-05
   Days after onset:2
Entered: 1999-12-28
   Days after submission:53
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / CONNAUGHT LABORATORIES U0104AA / 1 LA / IM

Administered by: Other       Purchased by: Private
Symptoms: Hypertonia, Injection site hypersensitivity, Injection site pain, Laryngospasm, Tongue oedema, Vasodilatation
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Dystonia (broad), Parkinson-like events (narrow), Oropharyngeal allergic conditions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Allergy to tea tree oil, Asthma
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type: VT99008

Write-up: Vax. at worksite, continued at job, 3 1/2 hrs. later felt like throat had something stuck in it, felt constricted. Tongue felt tingly and thick. Felt flush, skin on chest, legs & arms was mottled, but not described as hives. Left arm at


VAERS ID: 161809 (history)  
Form: Version 1.0  
Age: 76.0  
Gender: Male  
Location: Vermont  
Vaccinated:1999-11-04
Onset:1999-11-04
   Days after vaccination:0
Submitted: 1999-12-21
   Days after onset:47
Entered: 2000-10-06
   Days after submission:289
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNU-IMUNE) / PFIZER/WYETH 461144 / UNK - / IM

Administered by: Private       Purchased by: Other
Symptoms: Cellulitis,