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Case Details (Sorted by Age)

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VAERS ID: 403556 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Kentucky  
Vaccinated:2010-10-10
Onset:2010-10-10
   Days after vaccination:0
Submitted: 2010-10-11
   Days after onset:1
Entered: 2010-10-15
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3652AA / UNK RA / IM

Administered by: Other       Purchased by: Other
Symptoms: Rash generalised, Vaccine positive rechallenge
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: rash~Influenza (H1N1) (H1N1 (MONOVALENT) (UNKNOWN))~1~4.00~Patient
Other Medications: Albuterol and Atrovent PRN; Pulmicort; Claritin and Nasonex PRN
Current Illness: Had just recovered from sinus infection
Preexisting Conditions: Asthma; allergies to: sunscreens; environmental; acidic foods cause eczema
Allergies:
Diagnostic Lab Data: None at this time
CDC Split Type:

Write-up: Tx with BENADRYL head to toe rash one hour following vaccination - patient got a rash that was not as severe last year to the H1N1 vaccine, but mom did not report that on administration form.


VAERS ID: 403559 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Connecticut  
Vaccinated:2010-10-04
Onset:2010-10-05
   Days after vaccination:1
Submitted: 2010-10-08
   Days after onset:3
Entered: 2010-10-15
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAP: DTAP (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 LG / UN
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501017P / 1 NS / IN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS AHAVB441AA / 1 UN / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0156Z / 2 UN / SC

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

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

Write-up: Leg redness and swelling following 4th dose of DTaP.


VAERS ID: 403848 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Kansas  
Vaccinated:2010-10-16
Onset:2010-10-16
   Days after vaccination:0
Submitted: 2010-10-18
   Days after onset:2
Entered: 2010-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 LA / -

Administered by: Unknown       Purchased by: Unknown
Symptoms: Injection site erythema, Injection site warmth, Musculoskeletal stiffness, Pain in extremity
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: please note pt received the flu vaccine and it was suppose to be a combinattion of the seasonal flu vaccine and the H1N1
Current Illness: no illness
Preexisting Conditions: none. good health
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Stiffness, soreness of arm. Redness of the arm from the shoulder to the elbow & hot to touch. Swelling of the arm from the shoulder to the elbow (2x bigger than other arm). Gave Ibuprofen q 6 hours and a dose of Benadryl. Saw MD today and started Zyrtec and continue w/ ibuprofen.


VAERS ID: 403857 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Maryland  
Vaccinated:2010-10-16
Onset:2010-10-16
   Days after vaccination:0
Submitted: 2010-10-18
   Days after onset:2
Entered: 2010-10-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR - / 2 LA / IJ

Administered by: Other       Purchased by: Unknown
Symptoms: Abdominal discomfort, Headache, Malaise, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Developed bad headache and upset stomach at 8:00pm, then went to sleep. Woke up at 12:00am and had a fever of 101 and felt very sick, vomited once. She went back to sleep after this. Felt better the next day.


VAERS ID: 403989 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: California  
Vaccinated:2010-09-28
Onset:2010-09-30
   Days after vaccination:2
Submitted: 2010-10-15
   Days after onset:15
Entered: 2010-10-18
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PNC13: PNEUMO (PREVNAR13) / PFIZER/WYETH 913965 / 2 LL / UN

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

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

Write-up: Local pain, swollen, erythema, warm 10 x 20 cms.


VAERS ID: 404021 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Illinois  
Vaccinated:2010-10-12
Onset:2010-10-15
   Days after vaccination:3
Submitted: 2010-10-19
   Days after onset:4
Entered: 2010-10-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B164CA / 1 RL / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0186Z / 1 LL / SC

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

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

Write-up: LEFT THIGH AREA 10X8 LOCALIZIED REACTION, RED SWOLLEN AND WARM TX BENADRYL, WENT TO ER 10/15, IM BENADRYL 20MG., SENT HOME P.O. BACTRIM QID X 10 DAYS. SEEN AT FACILITY 10/18/10. AREA PINK SLIGHTLY DECREASED IN SIZE, DECREASED SWELLING, NO PAIN, NO FEVER.


VAERS ID: 404337 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Tennessee  
Vaccinated:2010-10-07
Onset:2010-10-08
   Days after vaccination:1
Submitted: 2010-10-11
   Days after onset:3
Entered: 2010-10-19
   Days after submission:8
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3568AA / 1 RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0441Z / 2 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Blood creatinine normal, Carbon dioxide decreased, Full blood count, Laboratory test, Lymphocyte count normal, Nausea, Neutrophil count increased, Pyrexia, Rash generalised, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CBC-Neut-88.4; Lymph 2.2; M Neut -85; M Lymph 1; Creatinine 0.5; CO2 -19.9; AGPKK 22.9000; AGPK 19
CDC Split Type:

Write-up: Had MMR and flu vaccine on 10-7-10. On 10-8-10 developed full body rash and N and V. Developed fever on 10-10-10 of 101. Taken to ER and had to have fluid replacement. Cont with full body rash on 10-11-10.


VAERS ID: 404629 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Arkansas  
Vaccinated:2010-10-20
Onset:2010-10-21
   Days after vaccination:1
Submitted: 2010-10-21
   Days after onset:0
Entered: 2010-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 501049P / UNK NS / IN

Administered by: Public       Purchased by: Public
Symptoms: Erythema
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: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mom called office on 10/21/10 asking if redness to face & neck is common after flu vaccine. Informed to call MD & let him know about this & see if he suggest BENADRYL.


VAERS ID: 404744 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Maryland  
Vaccinated:2010-10-18
Onset:2010-10-18
   Days after vaccination:0
Submitted: 2010-10-21
   Days after onset:3
Entered: 2010-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN3: INFLUENZA (SEASONAL) (FLUMIST) / MEDIMMUNE VACCINES, INC. 5010069 / 1 NS / IN

Administered by: Other       Purchased by: Other
Symptoms: Chest discomfort, Chest pain, Rash macular
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: At 10:20 student came to the health room. c/o chest pressure and pain in mid-chest color pink. No sob, no difficulty breathing, red blotches on face and nose, red and hard ear lobes, temp=98.6 HR=92, resp=20 BP=88/62.


VAERS ID: 404748 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: North Carolina  
Vaccinated:2010-10-05
Onset:2010-10-06
   Days after vaccination:1
Submitted: 2010-10-21
   Days after onset:15
Entered: 2010-10-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3570CA / 7+ LL / IM

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

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

Write-up: 10-6-10 2 x 3/4 red and slightly raised area at site of flu vaccine. BENADRYL prn.


VAERS ID: 404765 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Wisconsin  
Vaccinated:2010-10-11
Onset:2010-10-12
   Days after vaccination:1
Submitted: 2010-10-14
   Days after onset:2
Entered: 2010-10-21
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B168AA / UNK LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. 0176Z / 1 LA / SC

Administered by: Private       Purchased by: Private
Symptoms: Hypersensitivity, Injection site erythema, Injection site oedema, Injection site pain, Injection site swelling
SMQs:, 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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MV with iron
Current Illness: No
Preexisting Conditions: Hx iron deficient anemia.
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: The patient comes in today for swollen arm. He was seen for his checkup on 10/11/2010, 2 days ago, and mom noticed almost immediately there was some redness to his arm. It was a very small amount, approximately a dime size the first night, the second day it seemed to get larger and this morning seemed to be much beefier and redder. Mom gave a dose of MOTRIN, I believe earlier this morning and it seemed to help a little bit. He is a little tender to the area but better now. He has had a no respiratory distress. No coughing, no vomiting or diarrhea. The rest of his review of systems is negative. He has allergy to Penicillins and Cephalosporins, questionable allergy to BIAXIN but has done well with ZITHROMAX. Significant for the allergies as well as iron deficiency anemia, recently much better. Mom also reports today that he had what sounds to be an allergic reaction approximately 1 month ago, did not involve any respiratory distress. He was quite puffy and needed BENADRYL. There was also another reaction when he was an infant that sounded very similar. Temperature 98.2, heart rate 84, respirations 20, weighs 42 pounds. Exam was limited to his arm. Left arm has normal circumference, however, in the area of the vaccine, particularly the MMR and varicella vaccine, there is an area of redness and slight edema that is approximately 3.5 cm x 1.5 cm. There is another area of redness that is a slight pinkish hue without edema that is approximately 5 cm x 5 cm. Area is not indurated and is not particularly tender to touch. The area of the actual injection site is also just slightly puffy as well without drainage. Allergic reaction to the immunization. Told mom this is not infection at this point, this is an allergic reaction, maybe to component of the vaccine and possibly even to our shot blocker that is used during the vaccination process. Looking at his other vaccine he received that day he also has erythema from the Band-Aid itself, although was latex free. Clearly, the patient is a very sensitive child with some allergy history. He was given 2 teaspoons of MOTRIN today. I also wrote instructions for mom to give one and a half teaspoons of BENADRYL 3 times a day for the next 2 days and then go down to b.i.d. for the next 2 days. Do the same with MOTRIN 2 teaspoons 3 times a day for 2 days and then go down to b.i.d. I asked mom to call us in 48 hours, give us a progress report. It should only improve with these measures. If it seems to worsen, there is a possibility that he would require steroids. Lastly, regarding this current allergic reaction as well as the two that mom described today, I think we should probably do an allergy panel on him. He is due for anemia labs and plan is for mom to bring him back at some point to do anemia labs including his electrophoresis as well as a full allergy panel including environmental and food allergies.


VAERS ID: 404794 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: New York  
Vaccinated:2010-10-20
Onset:2010-10-21
   Days after vaccination:1
Submitted: 2010-10-22
   Days after onset:1
Entered: 2010-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTPIPV: DTP + IPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 4 LA / IJ

Administered by: Unknown       Purchased by: Private
Symptoms: Headache, Injection site haematoma, Injection site swelling, Injection site warmth, Nausea
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow)

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

Write-up: Site of injection swelled two times as large as normal. Site became hot and bruised. Child felt sick to her stomic and had a headache.


VAERS ID: 404857 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Unknown  
Location: Wisconsin  
Vaccinated:2010-10-11
Onset:2010-10-13
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2010-10-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B168AA / UNK LA / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3576AA / 7+ RA / UN
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. 0665Z / 2 RA / UN
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. 0163Z / 2 LA / UN

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

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

Write-up: Slight redness and swelling on (L) arm where KINRIX and Varicella given. No warmth or pain/itching present. Advised Children''s BENADRYL and Ibuprofen - In if sx worsen.


VAERS ID: 405115 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Louisiana  
Vaccinated:2010-09-27
Onset:2010-09-27
   Days after vaccination:0
Submitted: 2010-09-28
   Days after onset:1
Entered: 2010-10-22
   Days after submission:24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR D00522 / 4 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Incorrect drug dosage form administered
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: LA101001

Write-up: Nurse gave sterile diluent instead of vaccine mixed with diluent for MMR/VAR.


VAERS ID: 405477 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Oregon  
Vaccinated:2010-10-25
Onset:2010-10-25
   Days after vaccination:0
Submitted: 2010-10-26
   Days after onset:1
Entered: 2010-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
DTAPIPV: DTAP + IPV (KINRIX) / GLAXOSMITHKLINE BIOLOGICALS AC20B168AA / 1 LA / UN
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U3579AA / 3 LA / UN

Administered by: Private       Purchased by: Private
Symptoms: Abdominal pain, Body temperature increased, Decreased appetite, Delirium, Poor quality sleep
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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

Write-up: Vaccines at 1200 evening T 103.8 - Acute belly pain restless sleep. Delirium decreased appetite today.


VAERS ID: 405533 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Idaho  
Vaccinated:2010-10-26
Onset:2010-10-26
   Days after vaccination:0
Submitted: 2010-10-26
   Days after onset:0
Entered: 2010-10-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 LA / -

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

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

Write-up: Fever of 101 and higher with vomiting and dizziness. Given Children''s Tylenol and fever dropped slightly, but not completely.


VAERS ID: 405668 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Louisiana  
Vaccinated:2010-10-25
Onset:2010-10-26
   Days after vaccination:1
Submitted: 2010-10-27
   Days after onset:1
Entered: 2010-10-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

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

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

Write-up: 104 fever Tylenol Temp 104 on 10/27/2010


VAERS ID: 405792 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: Unknown  
Vaccinated:2010-10-22
Onset:2010-10-22
   Days after vaccination:0
Submitted: 2010-10-22
   Days after onset:0
Entered: 2010-10-28
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 111821P1 / 1 LA / UN

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:
Other Medications:
Current Illness:
Preexisting Conditions: Multiple food allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 1 small urticarial lesion with 1/10th dose Novartis brand in pt with hx of egg allergy who tolerates baked goods with egg. He was give BENADRYL. He had no other symptoms. Had tolerated Sanofi Pasteur last year.


VAERS ID: 405843 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Female  
Location: Colorado  
Vaccinated:2010-10-25
Onset:2010-10-27
   Days after vaccination:2
Submitted: 2010-10-27
   Days after onset:0
Entered: 2010-10-28
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UH224AB / UNK RA / IM

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

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

Write-up: Erythema & swelling, 10cm x 10cm, (R) deltoid, 24-48 hours after Flu immunization. Pain, decreased mobility x 24 hours; resolving at 48 hours. No fever, no joint pain, no other rash.


VAERS ID: 405882 (history)  
Form: Version 1.0  
Age: 5.0  
Gender: Male  
Location: North Carolina  
Vaccinated:2010-10-28
Onset:2010-10-28
   Days after vaccination:0
Submitted: 2010-10-28
   Days after onset:0
Entered: 2010-10-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
IPV: POLIO VIRUS, INACT. (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -
VARCEL: VARICELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Private       Purchased by: Private
Symptoms: Anxiety, Asthenia, Dizziness, Hypotension, Loss of control of legs, Pallor, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

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

Write-up: He suddenly was week and dizzy and his legs buckled beneath him and then when I got him standing back up and walking he turned white a sheet and then threw up. The doctors office offered (after I called back from home) that this was an anxiety induced reaction (they see it in a third of patients-yet have NEVER told me this) and to give him more fluids because his blood pressure bottomed out (which caused him to turn white). I administered pedialite and rest... and am still keeping watch to see if there are any long term effects.


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