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Case Details (Sorted by Age)

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VAERS ID:379857 (history)  Vaccinated:2009-06-30
Age:16.0  Onset:2009-07-07, Days after vaccination: 7
Gender:Female  Submitted:2010-02-05, Days after onset: 213
Location:Indiana  Entered:2010-02-09, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: SPRINTEC
Current Illness: Sulfonamide allergy; Drug hypersensitivity
Preexisting Conditions:
Diagnostic Lab Data: Physical examination, negative--a complete work up from a gastrologist and cardiologist; neurological, negative
CDC Split Type: WAES1001USA03374
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0940X0IMUN
Administered by: Other     Purchased by: Other
Symptoms: Abdominal pain upper, Activities of daily living impaired, Condition aggravated, Fatigue, Loss of consciousness, Lymphadenopathy, Neurological examination normal, Similar reaction on previous exposure to drug, Syncope, Weight decreased
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), 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), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Information has been received from a medical assistant concerning a 16 year old female patient with sulfonamide and azithromycin allergy who on 30-JUN-2009 was vaccinated intramuscularly with the first 0.5ml dose of GARDASIL (lot# 659655/0940X). On 01-SEP-2009 the patient was vaccinated intramuscularly with the second 0.5ml dose of GARDASIL (lot# 663452/0671Y). Concomitant therapy included SPRINTEC. On approximately 07-JUL-2009 ("a week after administration of her first dose of GARADSIL"), the patient experienced fainting spells, stomach pains, weight loss of 16 pounds, swollen glands in the neck and fatigue. It was reported that the patient experienced the same symptoms but more intense after her second dose of GARDASIL administered on 01-SEP-2009. When she experienced a fainting spell, she was exhausted for the rest of the day. The patient still continued to have episodes of blacking out and stomach pain once or twice a week. The patient had been examined and had a complete work up from a neurologist, gastrologist and cardiologist. All tests were negative. At the time of this report, the patient was recovering. Follow up information has been received from the medical assistant who confirmed the dates and lot #s for the two doses of GARDASIL and reported that there were no concomitant vaccines were administered. She clarified that the events, experienced a week after the first dose, persisted then worsened after administration of the second dose. The events were considered as disabling since the patient could not attend school. It was unknown if the patient was hospitalized. The patient had not seen in their office since 01-SEP-2009. Fainting spells, stomach pains, weight loss of 16 pounds, swollen glands in the neck, fatigue and episodes of blacking out were considered to be disabling. Additional information has been requested.

VAERS ID:379892 (history)  Vaccinated:2009-12-18
Age:16.0  Onset:2009-12-18, Days after vaccination: 0
Gender:Male  Submitted:2010-02-02, Days after onset: 46
Location:Maine  Entered:2010-02-09, Days after submission: 7
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NK
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU3267JA0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Dizziness, Headache
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: 120/78 9:40 HA - ibuprofen 400 BTC 10 amn dizzy with headache.

VAERS ID:379894 (history)  Vaccinated:2009-11-10
Age:16.0  Onset:2009-11-10, Days after vaccination: 0
Gender:Male  Submitted:0000-00-00
Location:Unknown  Entered:2010-02-09
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP020AA0IMAR
Administered by: Other     Purchased by: Public
Symptoms: Headache
SMQs:
Write-up: Head ache 20-30 min after shot. Took 2 TYLENOL @ 10:40.

VAERS ID:379916 (history)  Vaccinated:2009-11-10
Age:16.0  Onset:2009-11-10, Days after vaccination: 0
Gender:Female  Submitted:2009-11-12, Days after onset: 2
Location:Maine  Entered:2010-02-09, Days after submission: 89
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: "amoxicillin, PCN, "Azithromycin", some sulfa", Asthma
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP02UAA0IMAR
Administered by: Other     Purchased by: Public
Symptoms: Abdominal pain upper, Headache
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Headache. Stomachache.

VAERS ID:379918 (history)  Vaccinated:2009-11-10
Age:16.0  Onset:2009-11-10, Days after vaccination: 0
Gender:Female  Submitted:2009-11-21, Days after onset: 11
Location:Maine  Entered:2010-02-09, Days after submission: 80
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: asthma
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP020AA0IMAR
Administered by: Other     Purchased by: Public
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Write-up: lightheaded - 110/60 - 60 - 18 rested, ate additional food

VAERS ID:379919 (history)  Vaccinated:2009-11-20
Age:16.0  Onset:2009-11-20, Days after vaccination: 0
Gender:Male  Submitted:2010-02-01, Days after onset: 73
Location:Maine  Entered:2010-02-09, Days after submission: 8
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None known
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP033CA0IMAR
Administered by: Other     Purchased by: Public
Symptoms: Convulsion, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Fainted 5 minutes after vaccine then brief seizure. To ER with Mom.

VAERS ID:380003 (history)  Vaccinated:2010-02-09
Age:16.0  Onset:2010-02-11, Days after vaccination: 2
Gender:Male  Submitted:2010-02-11, Days after onset: 0
Location:California  Entered:2010-02-11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Diagnostic Lab Data: N/A
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3060AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3356AA5IMLA
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)
Write-up: MINOR SWELLING AND REDNESS AT INJECTION SIGHT. NO ITCH, NO INDURATION. ICE PACK GIVEN.

VAERS ID:380228 (history)  Vaccinated:2008-08-22
Age:16.0  Onset:2008-12-15, Days after vaccination: 115
Gender:Female  Submitted:2010-02-09, Days after onset: 421
Location:California  Entered:2010-02-12, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 0 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: Pregnancy NOS (LMP = 12/25/2008)
Preexisting Conditions:
Diagnostic Lab Data: Unknown
CDC Split Type: WAES1001USA03685
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0UNUN
Administered by: Other     Purchased by: Other
Symptoms: Drug exposure during pregnancy
SMQs:, Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow)
Write-up: Information has been received from a physician for the pregnancy registry for GARDASIL concerning a 16 year old female patient with no pertinent medical history and no known drug allergies/drug reactions who on 22-AUG-2008 was vaccinated with the first dose of GARDASIL. There were no concomitant medications reported. It was reported that the patient received the first dose of GARDASIL and got pregnant. On 21-OCT-2009, the patient got the second dose of GARDASIL Lot #0702) and the third dose on 01-DEC-2009 after having the baby. The patient had a "normal prenatal care". The patient sought medical attention with an office visit. All telephone attempts to obtain follow up information have been unsuccessful. Additional information has been requested.

VAERS ID:380385 (history)  Vaccinated:2010-01-26
Age:16.0  Onset:2010-01-26, Days after vaccination: 0
Gender:Female  Submitted:2010-02-04, Days after onset: 9
Location:Texas  Entered:2010-02-15, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Pregnant
Preexisting Conditions:
Diagnostic Lab Data: Urine HCG (+)
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS1013273P0IMRA
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURUT3175AA0IMRA
HEPA: HEP A (VAQTA)MERCK & CO. INC.1604X0IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1353Y0IMLA
Administered by: Private     Purchased by: Unknown
Symptoms: Drug exposure during pregnancy, Urine human chorionic gonadotropin positive
SMQs:, Tumour markers (narrow), Pregnancy, labour and delivery complications and risk factors (excl abortions and stillbirth) (narrow), Normal pregnancy conditions and outcomes (narrow)
Write-up: Patient pregnant.

VAERS ID:380469 (history)  Vaccinated:2009-10-13
Age:16.0  Onset:2009-10-19, Days after vaccination: 6
Gender:Female  Submitted:2010-02-15, Days after onset: 119
Location:Iowa  Entered:2010-02-16, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? Yes
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data: computed axial, NL normal limits; diagnostic laboratory, within normal limits. Brain MRI normal.
CDC Split Type: WAES0912USA02484
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0311Y1IMLA
Administered by: Private     Purchased by: Private
Symptoms: Decreased appetite, Disturbance in attention, Fatigue, Headache, Laboratory test normal, Lethargy, Nausea, No reaction on previous exposure to drug, Ultrasound abdomen normal, Vomiting
SMQs:, Acute pancreatitis (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad)
Write-up: Information has been received from a physician concerning a 16 year old female patient who in August 2009, was vaccinated with the second dose of GARDASIL. According to the physician, the patient developed headaches and fatigue after the second dose of GARDASIL. At the time of the report the patient had not recovered. The patient sought medical attention by an office visit. Follow up information has been received from the physician who indicated that the patient was a female student with no known drug allergies/reactions and no pertinent medical history who on 11-AUG-2009 was vaccinated with her first dose of GARDASIL (LOT # 659054/0311Y) intramuscularly into her left arm at 14:10 pm and on 13-OCT-2009 was vaccinated with her second dose of GARDASIL (LOT # 659054/0311Y) intramuscularly into her left deltoid at 13:50 pm. No illnesses were reported at the time of vaccination. It was reported that on approximately 19-OCT-2009 the patient began experiencing headaches, daily nausea, loss of appetite, vomiting, lethargy and inability to concentrate. At the time of the report the patient had not recovered. Diagnostic laboratory tests were performed included a CT scan and the US of abdomen reportedly as normal limits, other diagnostic tests were within normal limits and other labs and hospital visits per other physician. The reporting physician considered headaches, daily nausea, loss of appetite, vomiting, lethargy and inability to concentrate to be disabling/incapacitating events since the patient missed many days at school (additional information was not legible). Additional information is not expected.

VAERS ID:380687 (history)  Vaccinated:2008-07-11
Age:16.0  Onset:2009-07-08, Days after vaccination: 362
Gender:Female  Submitted:2010-02-12, Days after onset: 219
Location:Unknown  Entered:2010-02-18, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No pre-existing conditions or problems
Diagnostic Lab Data: EEG results after each seizure are available.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1UNUN
Administered by: Unknown     Purchased by: Unknown
Symptoms: Convulsion, Electroencephalogram, Epilepsy
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Write-up: Following the injection of GARDASIL my daughter developed epilepsy, and so far various doctors are trying various anti-seizure medications to try and control the seizures, but are not successful. A healthy child after being given the second shot of vaccine 3-dose regimen developed seizure a few days later, which has now repeats at least once a month. The EEG results determined that several areas of the brain have been affected, and that no cure is possible.

VAERS ID:380710 (history)  Vaccinated:2010-02-12
Age:16.0  Onset:2010-02-12, Days after vaccination: 0
Gender:Female  Submitted:2010-02-18, Days after onset: 6
Location:California  Entered:2010-02-18
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102142P10IMRA
Administered by: Other     Purchased by: Private
Symptoms: Injection site pain, Vomiting
SMQs:, Acute pancreatitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Write-up: Student reported to nurses @ 2:40 PM that she vomited 3 times starting @ 11:45 AM. V.S.: 98.6 Pulsre 88 BP 118/80. Skin color normal. Skin warm & dry. Injection site RD painful but no redness noted.

VAERS ID:380765 (history)  Vaccinated:2010-01-25
Age:16.0  Onset:2010-01-29, Days after vaccination: 4
Gender:Female  Submitted:2010-02-05, Days after onset: 7
Location:Louisiana  Entered:2010-02-18, Days after submission: 13
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: MEDI0010459
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLUN(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (MEDIMMUNE)MEDIMMUNE VACCINES, INC.  IN 
Administered by: Other     Purchased by: Other
Symptoms: Arthropod bite, Cellulitis, Erythema multiforme, Rash
SMQs:, Severe cutaneous adverse reactions (narrow), Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: A serious spontaneous report of cellulitis, insect bite, insect bite L 3rd toe.-separate rash and erythema multiforme have been received from a physician concerning a 16-year-old female subsequent to H1N1, Intranasal. Neither relevant medical history nor concomitant medication have been reported for this patient. On 25-Jan-2010, the patient received H1N1, Intranasal for an unknown indication. On 27-Jan-2010, the physician saw the patient; at that time she had a rash on left foot and separate rash on left 3rd toe due to insect bite. The patient was admitted to the hospital on 29-Jan-2010 for cellulitis. While in the hospital several more singular rashes appeared on lower extremities and trunk. Infectious disease doctor diagnosed her with erythema multiforme. Patient was discharged on 02-Feb-2010. The patient was sent home with prescriptions of ranitidine, hydroxyzine, diphenhydramine and Aveeno bath. The outcome of the reported events was resolving.

VAERS ID:380769 (history)  Vaccinated:2010-02-15
Age:16.0  Onset:2010-02-17, Days after vaccination: 2
Gender:Female  Submitted:2010-02-17, Days after onset: 0
Location:California  Entered:2010-02-18, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Obese
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3060AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0976Y1IMRA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site pruritus, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Swollen, red, pruritis on both injection sites. Treated with Benadryl injection and Hydrocortisone 2.5% cream.

VAERS ID:381091 (history)  Vaccinated:2010-01-15
Age:16.0  Onset:2010-01-15, Days after vaccination: 0
Gender:Female  Submitted:2010-02-23, Days after onset: 39
Location:South Carolina  Entered:2010-02-23
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: unknown
Diagnostic Lab Data: none
CDC Split Type: SC1017Pan
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP050AA0IMRA
Administered by: Other     Purchased by: Public
Symptoms: Erythema, Rash pruritic
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)
Write-up: Severe itchy Rash that looked like diaper rash on knees elbows hands buttocks and small of back. Patient had red face and neck. Red face and neck relieved with Benadryl but would come back when Benadryl would wear off. Patient had prednisone shot at MD. 2/2010 Rash lightened up pt given Zyretc and nerve pills (not filled). Allergist stated may have flu shot again.

VAERS ID:381147 (history)  Vaccinated:2010-02-10
Age:16.0  Onset:2010-02-10, Days after vaccination: 0
Gender:Female  Submitted:2010-02-17, Days after onset: 7
Location:California  Entered:2010-02-23, Days after submission: 6
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Head Ct negative; Urine HCG (-) neg; PPD
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUF846AA0IMLA
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALS0086Y2IMLA
Administered by: Private     Purchased by: Public
Symptoms: Computerised tomogram normal, Fall, Head injury, Loss of consciousness, Tuberculin test negative, Urine human chorionic gonadotropin negative
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)
Write-up: Patient received H1N1 injectable vaccine and ENGERIX B in AM. At about 6:30 pm had a blackout, fell, hit corner of table. Seen in ER, CT (-)

VAERS ID:381244 (history)  Vaccinated:2010-02-09
Age:16.0  Onset:2010-02-09, Days after vaccination: 0
Gender:Female  Submitted:2010-02-25, Days after onset: 16
Location:Puerto Rico  Entered:2010-02-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: WAS SICK A WEEK BEFORE VACCINATION. DISEASE NOT SPECIFIED.
Preexisting Conditions: SINUSITIS, RHINITIS
Diagnostic Lab Data:
CDC Split Type: PR1006
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (SANOFI)SANOFI PASTEURUP063AA0IMAR
Administered by: Other     Purchased by: Public
Symptoms: Asthenia, Fatigue, Hyperhidrosis, Pallor, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: PATIENT REFERRED FEELING GENERALIZED WEAKNESS, BLURRY VISION AND TIRED. SHE APPEARED PALE AND WITH EXCESSIVE SWEATING.

VAERS ID:381326 (history)  Vaccinated:2009-12-03
Age:16.0  Onset:2009-12-03, Days after vaccination: 0
Gender:Female  Submitted:2010-02-25, Days after onset: 84
Location:New Jersey  Entered:2010-02-25
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NKDA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU(H1N1): INFLUENZA (H1N1) (H1N1 (MONOVALENT) (NOVARTIS)NOVARTIS VACCINES AND DIAGNOSTICS102125P1 UNRA
Administered by: Public     Purchased by: Public
Symptoms: Headache, Somnolence
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad)
Write-up: Complaint of drowsiness & headache. Pulse 100, B/P 104/76. Right arm site no redness or itching.

VAERS ID:381495 (history)  Vaccinated:2010-02-26
Age:16.0  Onset:2010-02-26, Days after vaccination: 0
Gender:Female  Submitted:2010-02-28, Days after onset: 2
Location:California  Entered:2010-02-28
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
DTAP: DTAP (NO BRAND NAME)UNKNOWN MANUFACTURER 5 LA
HEPA: HEP A (NO BRAND NAME)UNKNOWN MANUFACTURER 0 LA
HPVX: HPV (NO BRAND NAME)UNKNOWN MANUFACTURER 0 RA
Administered by: Private     Purchased by: Private
Symptoms: Diarrhoea, Oedema peripheral, Vomiting
SMQs:, Cardiac failure (broad), Acute pancreatitis (broad), Angioedema (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Noninfectious diarrhoea (narrow)
Write-up: Evening of shot arm swelling began. By 6pm following evening vomiting (6 times) and diarrhea began and lasted until 6am.

VAERS ID:381576 (history)  Vaccinated:2010-01-11
Age:16.0  Onset:2010-01-13, Days after vaccination: 2
Gender:Female  Submitted:2010-03-01, Days after onset: 47
Location:Kansas  Entered:2010-03-01
Life Threatening? Yes
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: None. No illness
Preexisting Conditions: None.
Diagnostic Lab Data: Holter Monitor, echo cardiogram, Liver panel, CBC
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (RECOMBIVAX HB)MERCK & CO. INC.1251Y2IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.1353Y2IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3250AA1IMRA
Administered by: Public     Purchased by: Public
Symptoms: Abdominal pain, Anaemia, Appendicectomy, Chest pain, Cyanosis, Dizziness, Dyspnoea, Echocardiogram normal, Electrocardiogram ambulatory normal, Fatigue, Full blood count, Heart rate decreased, Hypotension, Intensive care, Intestinal obstruction, Liver function test, Nausea, Oxygen saturation decreased, Ultrasound scan abnormal
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal obstruction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad)
Write-up: Parent states child c/o fatigue, nausea, abd. pain, short of breath, chest pain, dizziness. Was seen by doctor 3 days later: Liver enzymes, anemic. Sonogram discovered blocked intestine. Mas Citrate with some relief. 01/22/2010 c/o severe chest pain and blue at lips. Dr. provided breathing treatment and O2 sats began to bottom out. Facility placed pt in ICU at that time. Sent out via ambulance to another hospital. In hospital for 3 days. Only time these s/s occured was when pt was in upright position. Pt sent home with Holter Monitor. Holter monitor results was normal during event of not getting enough air. Pt had echo Cardiogram was normal. Had low B/P with slow pulse. As of 3/1/2010 child suffers from abd pain, occ sob. Had surgery for appendix out.

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