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Case Details (Sorted by Age)

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VAERS ID:353100 (history)  Vaccinated:2009-07-30
Age:12.0  Onset:2009-07-30, Days after vaccination: 0
Gender:Male  Submitted:2009-07-31, Days after onset: 1
Location:North Carolina  Entered:2009-08-04, Days after submission: 4
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 - per mom
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB262AA0UNLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2666AA0UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF460CA5UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0059Y1UNRA
Administered by: Public     Purchased by: Other
Symptoms: Loss of consciousness, Syncope
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), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Write-up: Pt fainted following immunization. Pt was sitting in chair during administration & fainted following 4th vaccine. Pt was still in chair when he fainted. Pt was unconscious for approx. 30 seconds. Pt. rec''d all vaccines in full before fainting. Pt. stayed for 25 minutes a walking out to car with mom.

VAERS ID:353112 (history)  Vaccinated:2009-01-26
Age:12.0  Onset:2009-01-26, Days after vaccination: 0
Gender:Female  Submitted:2009-07-24, Days after onset: 178
Location:Unknown  Entered:2009-08-04, Days after submission: 11
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Rash forehead~Varicella (no brand name)~2~9~Sibling|Rash forehead~Hep A (no brand name)~1~9~Sibling
Other Medications: None
Current Illness: None
Preexisting Conditions: Allergic to pollen
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB185BO0UNLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.WH290700UNRA
Administered by: Other     Purchased by: Public
Symptoms: Erythema, Pruritus, Rash maculo-papular, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Night of immunization mac/pap rash of face and neck with some swelling of face with erythema and itching. Resolved in 2 weeks time with Zyrtec. No vesicles. Brother received varicella at same time.

VAERS ID:353120 (history)  Vaccinated:2009-08-04
Age:12.0  Onset:2009-08-04, Days after vaccination: 0
Gender:Female  Submitted:2009-08-04, Days after onset: 0
Location:Indiana  Entered:2009-08-04
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB 342 EB1IMLA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0652 X1IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU 2842 AA1IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0471 Y2SCRA
Administered by: Public     Purchased by: Public
Symptoms: Immediate post-injection reaction, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)
Write-up: Syncopal episode 2 minutes after immunizations. Fell to floor. B/P 98/64; Pulse 83; Oxygen sat 98%. Legs elevated. Recovered without incident; denies pain.

VAERS ID:353138 (history)  Vaccinated:2009-08-03
Age:12.0  Onset:2009-08-03, Days after vaccination: 0
Gender:Male  Submitted:2009-08-04, Days after onset: 1
Location:Kansas  Entered:2009-08-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Drug and food allergies, Dyes, Zithromax, Cefzil, melons and bananas.
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2910A0IMUN
TDAP: TDAP (ADACEL)SANOFI PASTEURUF471BA5IMUN
Administered by: Private     Purchased by: Private
Symptoms: Body temperature increased
SMQs:, Neuroleptic malignant syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Temp of 103.1 a few hrs after getting vaccines. Given Ibuprofen by his mother.

VAERS ID:353155 (history)  Vaccinated:2009-08-03
Age:12.0  Onset:2009-08-03, Days after vaccination: 0
Gender:Female  Submitted:2009-08-03, Days after onset: 0
Location:Virginia  Entered:2009-08-04, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: NKA
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2926AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC2774AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0798Y1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Patient fainted after administration of Tdap (ADACEL) shot.

VAERS ID:353200 (history)  Vaccinated:2009-07-31
Age:12.0  Onset:2009-07-31, Days after vaccination: 0
Gender:Female  Submitted:2009-08-05, Days after onset: 5
Location:Ohio  Entered:2009-08-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE REPORTED
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1130X0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2727AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B030AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0262Y0SCRA
Administered by: Public     Purchased by: Public
Symptoms: Erythema, Fatigue, Malaise, Nodule, Tenderness
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Mother brought child to HD office 8/3/09 PM to report that child''s arm became tender, with redness over deltoid spreading to just aboeve the elbow PM 7/31/09. c/o being tired and "just not feeling well" continuing today. there had been a "knot" in her arm, but it is now gone. Did not check for fever. Gave Ibuprofen, used cool compress off and on for 2 days.

VAERS ID:353236 (history)  Vaccinated:2009-08-04
Age:12.0  Onset:2009-08-04, Days after vaccination: 0
Gender:Male  Submitted:2009-08-05, Days after onset: 1
Location:New Mexico  Entered:2009-08-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Military     Purchased by: Unknown
Symptoms: Blister, Erythema, Pain, Pyrexia, Rash pustular, Skin warm
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Red, sore, hot, fever, blister pustules popping - oozing liquid.

VAERS ID:353237 (history)  Vaccinated:2009-07-16
Age:12.0  Onset:2009-07-17, Days after vaccination: 1
Gender:Male  Submitted:2009-08-05, Days after onset: 19
Location:Iowa  Entered:2009-08-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: PATADAY eye drops; NASONEX nasal spray; ALLEGRAL 80 mg d/y
Current Illness: No
Preexisting Conditions: Environmental allergies
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (HAVRIX)GLAXOSMITHKLINE BIOLOGICALSAHAVB287AB0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2873AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3248AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0642Y1SCRA
Administered by: Private     Purchased by: Private
Symptoms: Headache, Malaise, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: After vaccine given mom then tells RN patient had the chicken pox. RN explained he may have some reaction to vaccine and if she had told RN or Dr this. He would not have been admin. @ 0600 7-17-09 mom called this RN @ home reported patient was c/o not feeling well. Had fever of 100.9 oral. Emesis, headache. Had given ASA. RN instructed not to give ASA again. Give cool bath, push fluids if not feeling better by 0830 to call medical office for appt (see back of form).

VAERS ID:353238 (history)  Vaccinated:2009-08-04
Age:12.0  Onset:2009-08-04, Days after vaccination: 0
Gender:Female  Submitted:0000-00-00
Location:Texas  Entered:2009-08-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: per mom dates age unknown~ ()~~0~Patient
Other Medications:
Current Illness: no
Preexisting Conditions: no
Diagnostic Lab Data: VS: 94/65 right arm; BP 20, oriented x3
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2905AA0UNRA
TDAP: TDAP (ADACEL)SANOFI PASTEURUF456AA0UNLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0692Y1UNRA
Administered by: Other     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)
Write-up: Pt. received vaccines. Mom stated pt. had seizure in car. PMC staff did not witness any seizure activity. Pt. walked back to bus with mom. vs stable/oriented x3. Mom states pt. did not have breakfast. Given juice, crackers and cool pack placed on head observed for 20 mins on bus. No problems observed. Pt. sent home with mom.

VAERS ID:353239 (history)  Vaccinated:2009-07-30
Age:12.0  Onset:2009-08-01, Days after vaccination: 2
Gender:Female  Submitted:2009-08-05, Days after onset: 4
Location:North Dakota  Entered:2009-08-05
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: none
Diagnostic Lab Data: None
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2664AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURAC52B0B1IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.072341SCLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site pain, Injection site swelling, Injection site vesicles, Musculoskeletal pain
SMQs:, Rhabdomyolysis/myopathy (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Left upper arm, shoulder pain, swelling and redness to vaccine site, few small blisters to area; 4 1/2 in diameter of redness. Treatment consisted of ibuprofen prn and calamine lotion.

VAERS ID:353302 (history)  Vaccinated:2009-08-04
Age:12.0  Onset:2009-08-05, Days after vaccination: 1
Gender:Female  Submitted:2009-08-06, Days after onset: 1
Location:Texas  Entered:2009-08-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported
Preexisting Conditions:
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2909AA IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B036BA IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0051Y1IDLA
Administered by: Public     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: Pt represents to clinic with a 4cm x 4cm round, red, area to left upper arm, that is warm to touch. No pain to area when touched. Informed pt to apply cool compress to area and take some ibuprofen. And to return to clinic is symptoms persist or worsen.

VAERS ID:353315 (history)  Vaccinated:2008-10-13
Age:12.0  Onset:2008-11-16, Days after vaccination: 34
Gender:Female  Submitted:2009-08-06, Days after onset: 262
Location:Texas  Entered:2009-08-06
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Diagnostic Lab Data: Lab tests performed, all with normal results: Monospot, EBV titers, CBC, urinalysis, pancreatic enzymes. Many other blood tests with normal results. Biopsy performed during endoscopy in June 09 showed mild chronic gastritis. Two abdominal ultrasounds and one pelvic ultrasound were performed with normal results. LABS and DIAGNOSTCS: Monospot (-). Multiple bacteriological, parasite, and viral lab tests negative. Upper Endoscopy with Biopsies - Mild chronic gastritis. CBC - Lymph 41% (H). Urinalysis - Hazy, Blood 2+, RBC 3-9, Mucous many, Sq Epi rare, Bacteria few, Hyal Cast occ. CHEM - Bilirubin Total 1.5 mg/dL (H). Abdominal Ultrasound - WNL. Chest X-ray - WNL.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
FLU3: INFLUENZA (SEASONAL) (FLUZONE)SANOFI PASTEURU2767AA2IMRL
HPV4: HPV (GARDASIL)MERCK & CO. INC.0570X1IMLL
Administered by: Unknown     Purchased by: Unknown
Symptoms: Abdominal pain upper, Abdominal tenderness, Activities of daily living impaired, Arthralgia, Asthenia, Bacterial test negative, Biopsy stomach abnormal, Blood bilirubin increased, Blood urine, Chest X-ray normal, Diarrhoea, Disturbance in attention, Endoscopy abnormal, Epstein-Barr virus test negative, Excoriation, Fatigue, Feeling abnormal, Gastritis, Headache, Lymphocyte percentage increased, Microbiology test normal, Mononucleosis heterophile test negative, Nausea, Oropharyngeal pain, Pain, Pancreatic enzymes normal, Photophobia, Red blood cells urine positive, Ultrasound abdomen normal, Ultrasound pelvis normal, Urinary casts present, Urinary sediment present, Urine abnormality, Urine analysis normal, Viral infection, Viral test negative
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Systemic lupus erythematosus (broad), Dementia (broad), Pseudomembranous colitis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Biliary system related investigations, signs and symptoms (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (narrow), Accidents and injuries (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Chronic kidney disease (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Proteinuria (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: On 11/16/08, pt went about her day as normal, but became very tired quite suddenly around 5:00 in the evening. She went to bed to rest (something she rarely did until this point). After a couple of hours we attempted to wake her to attend church, a favorite activity, and she wanted to continue sleeping. We let her sleep until the next morning. We made her get up and prepare for school, but before she left, she complained of tiredness, headache, and sore throat, and we allowed her to stay home from school. She remained in bed for ten days, only getting up to go to the bathroom, shower, or go to the doctor. We encouraged her to sit up in a chair or even lie down in another room to help increase her energy level, but she did not have the strength for more than a few minutes. During this time the headache and sore throat remained, along with upper abdominal pain (left side right under ribs). The symptoms gradually improved, and pt was much better by the end of the first week of December. From then until the middle of January, pt continued to report mild symptoms, including fatigue and abdominal pain, but she was able to go about her normal activities. In mid January, pt came home from school, went to bed, and would not get up until morning. She went to school the remainder of that week with moderate symptoms, only because she was taking mid-term exams. Since then, pt has had three more occurrences of symptoms, missing one and two days of school. During these periods she has complained that light hurts her eyes. Upper abdominal pain, headaches, and sore throat recur periodically. Pt has also complained of periods of "feeling out-of-it", or not being able to concentrate at different times since mid-December. She has also stated that her legs "fall asleep" often. To the best of my knowledge, she has never had fever during this time. In July she received five injections (HPV/Meningitis/DPT/Varicella/HepA), and two in October (HPV/Influenza). Lot number for July 2008 HPV vaccine was 1757U. Lot number for Meningitis vaccine was U2636AA. 8/17/08 PCP Medical records received DOS 7/15/08 to 12/01/08. Assessment: Viral Syndrome. Patient presents with fatigue, sore throat, abdominal pain, headache, achiness, mild nausea. 8/18/08 PCP Medical records received DOS 12/03/08 to 6/11/09 Assessment: Abdominal pain, fatigue. Patient presents with continued fatigue, nausea, and left-side upper abdominal pain. Tenderness to palpation left upper quadrant abdomen. Diarrhea. Knee pain, headaches. Ankle abrasions. Infections disease consult. Gastroenterology consult.

VAERS ID:353386 (history)  Vaccinated:2009-08-06
Age:12.0  Onset:2009-08-06, Days after vaccination: 0
Gender:Female  Submitted:2009-08-07, Days after onset: 1
Location:Kansas  Entered:2009-08-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURUF484BA0UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Headache, Injection site erythema, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 103.0 fever the night of injection, headache, nausea, slight redness at injection site.

VAERS ID:353398 (history)  Vaccinated:2009-08-05
Age:12.0  Onset:2009-08-07, Days after vaccination: 2
Gender:Male  Submitted:2009-08-07, Days after onset: 0
Location:Texas  Entered:2009-08-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: HMV
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2990AA0UNLA
Administered by: Private     Purchased by: Private
Symptoms: Injection site erythema, Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: Surrounding erythema and swelling upper L delt R arm 39cm L arm 42.5 19x16cm L deltoid.

VAERS ID:353434 (history)  Vaccinated:2009-08-03
Age:12.0  Onset:2009-08-04, Days after vaccination: 1
Gender:Female  Submitted:2009-08-07, Days after onset: 3
Location:Texas  Entered:2009-08-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0800Y1SCRA
Administered by: Unknown     Purchased by: Unknown
Symptoms: Injection site erythema, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Write-up: 5 X 8 cm erythema at site of VARIVAX Palp heat

VAERS ID:353476 (history)  Vaccinated:2009-08-07
Age:12.0  Onset:2009-08-07, Days after vaccination: 0
Gender:Female  Submitted:2009-08-07, Days after onset: 0
Location:North Carolina  Entered:2009-08-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prozac, Adderall, Topamax
Current Illness: none
Preexisting Conditions: ADDHD, Migraines, and History of seizures as infant,
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURUF460BA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Cold sweat, Depressed level of consciousness, Dizziness, Hyperhidrosis, Hypotonia, Pallor, Pupil fixed
SMQs:, Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: Patient received Tdap. Approximately 5-8 minutes after receiving the vaccine, patient told mother she could not see or hear and she was dizzy. She became limp and mother lowered patient to the floor. Patient was pale, clammy and sweaty. Pupils were fixed and dilated. She was slow to respond. BP: 104/80, R: 24-28, P: 120-130. Patient fully recovered within 30 min.

VAERS ID:353484 (history)  Vaccinated:2009-08-06
Age:12.0  Onset:2009-08-06, Days after vaccination: 0
Gender:Female  Submitted:2009-08-07, Days after onset: 1
Location:California  Entered:2009-08-07
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: none
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0381X1IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0726Y1SCLA
Administered by: Private     Purchased by: Private
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: fainted as leaving clinic after receiving Gardasil and varicella- event happened in clinic

VAERS ID:353588 (history)  Vaccinated:2009-08-04
Age:12.0  Onset:2009-08-04, Days after vaccination: 0
Gender:Female  Submitted:2009-08-05, Days after onset: 1
Location:Georgia  Entered:2009-08-10, Days after submission: 5
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: healthy 12 year old female
Diagnostic Lab Data: CT of her head was negative for subdural hematoma, EKG was NSR
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 0IMAR
Administered by: Private     Purchased by: Unknown
Symptoms: Computerised tomogram normal, Convulsion, Electrocardiogram normal, Fall, Gaze palsy, Head injury, Scan brain, 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), Accidents and injuries (narrow), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: My daughter received her 1st dose of GARDASIL IM. We then went to check out at the receptionist''s window. My daughter fainted or had a stiffening type seizure, eyes rolled back in her head and she fell on the floor striking her head on a cement flower pot. We went by ambulance to the emergency room where she had to have a CT of her head and EKG. Thank God so far everything is ok. This was a nightmare.

VAERS ID:353599 (history)  Vaccinated:2009-08-10
Age:12.0  Onset:2009-08-10, Days after vaccination: 0
Gender:Female  Submitted:2009-08-10, Days after onset: 0
Location:South Dakota  Entered:2009-08-10
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: none
Diagnostic Lab Data: Vitals and neuros within normals limits; no pain redness or injury noted on exam of scalp.
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURC3030AA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Head injury, Hypotonia, Immediate post-injection reaction, Muscle spasms, Pallor, Skin discolouration, Skin warm, Syncope, Vital capacity normal
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (narrow), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)
Write-up: No contraindications to vaccine on screening. Client give Tdap vaccination with father present and immediately reported dizziness. Her color was pink, skin warm to touch, speaking and oriented at that time. Had client rest head between her knees while remaining in seat and dizziness resolved within one minute. She denied dizziness on standing and walked steadily to waiting area for post-vaccination monitoring. I was then summoned to waiting area 2-3 minutes post vaccination as client had collapsed in her chair beside father. She was limp and pale in color on approach. She responded by opening her eyes when I lifted her to lower her to floor to supine position. She was oriented x 3 immediately upon laying on floor. No further episodes of unresponsiveness. Color returned to normal within minutes. Cool pack applied to forehead. Father reports client spasmed briefly in chair and bumped head on wall seconds prior to collapse. No history of seizures per father. Vitals and neuros within normal limits post incident.

VAERS ID:353758 (history)  Vaccinated:2009-07-27
Age:12.0  Onset:2009-07-30, Days after vaccination: 3
Gender:Female  Submitted:2009-08-10, Days after onset: 11
Location:Utah  Entered:2009-08-11, Days after submission: 1
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Appendectomy 17 d before.
Diagnostic Lab Data: ESR - 60; nl CBC
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEP: HEP B (ENGERIX-B)GLAXOSMITHKLINE BIOLOGICALSAHBVB737BA UNLA
IPV: POLIO VIRUS, INACT. (IPOL)SANOFI PASTEURB0009 UNRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU2918AA UNLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B046AA0UNRA
Administered by: Private     Purchased by: Private
Symptoms: Arthralgia, Full blood count normal, Myalgia, Pyrexia, Rash, Red blood cell sedimentation rate increased
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Polyarthralgias, rash 24 hours post injection. Tx''d with PREDNISONE - developed fever & myalgias - After 1 wk resolved except left wrist pain.

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