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Case Details (Sorted by Age)

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VAERS ID:463675 (history)  Vaccinated:2012-07-18
Age:12.0  Onset:2012-07-18, Days after vaccination: 0
Gender:Male  Submitted:2012-08-30, Days after onset: 43
Location:Florida  Entered:2012-08-30
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
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4238AA IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURU3957DA IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.1433AA SCLA
Administered by: Public     Purchased by: Public
Symptoms: Fall, Head injury, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Write-up: Client tolerated vaccines well when administered. After sitting for approx. 2 minutes post vaacination, client stood up and walked toward door. Mom asked me a question and when I turned around, client fainted and fell face first onto floor. Client caught himself with hands underneath him. Episode lasted less than 1 minute. Client states that he hit his head on the door when he fell, motioning to the back of his head. No raised area or bleeding noticed at site. Observed client for approx. 15 minutes. Client ambulated from clinic with mother at side without difficulty. Instrusted mother to monitor client for signs of headache, dizziness, nausea or vomiting and any other complaints. If needed, mother will proceed to ER.

VAERS ID:463703 (history)  Vaccinated:2012-08-28
Age:12.0  Onset:0000-00-00
Gender:Male  Submitted:2012-08-30
Location:Colorado  Entered:2012-08-30
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:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4053AA0IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B076DA0IMLA
Administered by: Public     Purchased by: Unknown
Symptoms: Drug administration error, No adverse event
SMQs:, Medication errors (narrow)
Write-up: On 8/28/12 FLUMIST was sprayed into right eye, when child suddenly moved. 1/2 of full dose was sprayed into eye. Eye was wiped with tissue. No adverse effects after 10 minutes. Call to mother 48 hours later indicated no eye or other health problems. Child was not revaccinated against flu,

VAERS ID:463704 (history)  Vaccinated:2012-08-17
Age:12.0  Onset:2012-08-19, Days after vaccination: 2
Gender:Male  Submitted:2012-08-27, Days after onset: 8
Location:North Dakota  Entered:2012-08-30, Days after submission: 3
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
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
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4079AA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0607AE1SCRA
Administered by: Public     Purchased by: Other
Symptoms: Blister, Pruritus, Rash erythematous, Scab, Skin lesion
SMQs:, Severe cutaneous adverse reactions (broad), Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Received #2 varicella vaccine on 8-17-12. On 8-14-12 began having vesicle filled lesions to arms, chest & legs, on 8-27-12. Continues to have lesions to these areas with itching. Taking BENADRYL prn - doing okay no fever or cough. 8/28/12 - saw client areas were clustered raised red rash - no vesicle noted. Still has lesions to legs. One scabbed area to leg on 8-30-12.

VAERS ID:463736 (history)  Vaccinated:2012-08-29
Age:12.0  Onset:2012-08-30, Days after vaccination: 1
Gender:Female  Submitted:2012-08-30, Days after onset: 0
Location:Minnesota  Entered:2012-08-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data: Dtap was given 7-16-12 same lot #
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU9046AB5UNLA
Administered by: Private     Purchased by: Unknown
Symptoms: Erythema, Pain, Skin warm
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Redness started at noon today, hot to touch and painful.

VAERS ID:467924 (history)  Vaccinated:2012-08-14
Age:12.0  Onset:2012-08-14, Days after vaccination: 0
Gender:Male  Submitted:2012-08-30, Days after onset: 16
Location:California  Entered:2012-08-30
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1208USA007319
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 1UNUN
Administered by: Other     Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, No adverse event
SMQs:, Medication errors (narrow)
Write-up: This spontaneous report as received from a medical assistant refers to a 12 years old male patient. The patient was vaccinated intramuscularly into the right arm with first dose of 0.5 ml GARDASIL (lot number not reported) in 2010 and the second dose was administered today on 14-AUG-2012. No other co-suspects or concomitant medications were reported. No adverse effects reported. Additional information has been requested.

VAERS ID:463759 (history)  Vaccinated:2012-08-30
Age:12.0  Onset:2012-08-30, Days after vaccination: 0
Gender:Male  Submitted:2012-08-31, Days after onset: 1
Location:Illinois  Entered:2012-08-31
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: ADHD; Hypopituitarism (?)
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU4384AA0IMLL
Administered by: Private     Purchased by: Private
Symptoms: Abasia, Dyspnoea, Hypersensitivity, Hypoaesthesia, Miosis, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 10 AM vacc. (ADACEL) admin. Lt thigh. Pt''s only comment was feeling tingly, but OK. 1330 Mom, called -$gprincipal called --$g pt. short of breath, arms numb/tingly, pupils very small. Pt''s family picked up & took to ER on advice of Dr. Few hours later Mom updated us. States ER phys determined pt hit on/at injection site in P.E., causing allergic response by body. ER MD told Mom not 1st time he had seen this. (of note: pt could not walk at school & at doctor). Also: Twin sister got same vacc w/o problems yesterday.

VAERS ID:463782 (history)  Vaccinated:2012-08-06
Age:12.0  Onset:2012-08-17, Days after vaccination: 11
Gender:Female  Submitted:2012-08-27, Days after onset: 10
Location:Texas  Entered:2012-08-31, Days after submission: 4
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: None
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.H0101450IMRA
HPV4: HPV (GARDASIL)MERCK & CO. INC.0652AC1IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4288AA0IMRA
TDAP: TDAP (ADACEL)SANOFI PASTEURC4137AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.0417AA1SCRA
Administered by: Private     Purchased by: Other
Symptoms: Cellulitis, Injection site erythema, Pain in extremity
SMQs:, Extravasation events (injections, infusions and implants) (broad), Tendinopathies and ligament disorders (broad)
Write-up: (Rt) arm pain, growing erythematous patch (rt) arm at varicella injection site. Dx cellulitis. Treated with Clindamycin.

VAERS ID:463785 (history)  Vaccinated:2012-08-01
Age:12.0  Onset:2012-08-01, Days after vaccination: 0
Gender:Female  Submitted:2012-08-27, Days after onset: 26
Location:Maryland  Entered:2012-08-31, 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:
Preexisting Conditions: Asthma; Congenital his dysplasia; Scoliosis
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1561AA1IMLA
Administered by: Private     Purchased by: Public
Symptoms: Dizziness, Loss of consciousness, Pallor, Tonic clonic movements
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), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Write-up: Dizzy, the lost consciousness & about 2 sec of tonic-clonic movements of upper & lower extremities. Pale, conscious within 10 sec. No cyanosis.

VAERS ID:463791 (history)  Vaccinated:2012-08-22
Age:12.0  Onset:2012-08-23, Days after vaccination: 1
Gender:Female  Submitted:2012-08-31, Days after onset: 8
Location:Texas  Entered:2012-08-31
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:
Diagnostic Lab Data: N/A
CDC Split Type: TX120043PU
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1291AA0IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU40012A0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURU4090CA0IMLA
Administered by: Public     Purchased by: Public
Symptoms: Injection site erythema, Injection site swelling, Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Write-up: 8-23-2012 el622 Redness, raised, warm to touch. 2" length 1" width. To R arm where varicella inj was administered. Pt denies itching, N/V, stinging, burning to size. Pt stated she noticed spot around 12pm today when fixing hair. Pt was recommended to take Benadryl as directed for age.

VAERS ID:463824 (history)  Vaccinated:2011-12-28
Age:12.0  Onset:2012-05-26, Days after vaccination: 150
Gender:Female  Submitted:2012-08-31, Days after onset: 97
Location:Texas  Entered:2012-09-01, 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:
Diagnostic Lab Data: MRI....normal EEG....normal Cat Scan....normal
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC. 3SYRLA
Administered by: Unknown     Purchased by: Private
Symptoms: Computerised tomogram normal, Electroencephalogram normal, Grand mal convulsion, Nuclear magnetic resonance imaging normal
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: Grand Mal seizure. She has one at the same time every month.

VAERS ID:467941 (history)  Vaccinated:2012-01-04
Age:12.0  Onset:2012-01-04, Days after vaccination: 0
Gender:Female  Submitted:2012-09-03, Days after onset: 242
Location:Unknown  Entered:2012-09-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Unknown
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1208USA006160
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0963AA2UNUN
Administered by: Private     Purchased by: Other
Symptoms: Incorrect storage of drug, No adverse event
SMQs:, Medication errors (narrow)
Write-up: This spontaneous report as received from a other health professional refers to a 12 years old female patient with no preexisting allergies, birth defects or medical conditions. The patient was vaccinated with lot # (670048/0963AA) dose 3 GARDASIL, right deltoid on 04-JAN-2012 at 03:39 PM. No other co-suspects were reported. No concomitant medications were reported. It was reported that the patient was administered an immunization that was stored at invalid temperatures, the immunization was stored at a temperature of 32 degrees F or less. No adverse reaction occurred. This is one of several reports from the same source. Additional information is not expected.

VAERS ID:467945 (history)  Vaccinated:2011-12-21
Age:12.0  Onset:2011-12-21, Days after vaccination: 0
Gender:Female  Submitted:2012-09-03, Days after onset: 256
Location:Arizona  Entered:2012-09-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1208USA006162
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0840AA1IMUN
Administered by: Private     Purchased by: Other
Symptoms: Incorrect storage of drug
SMQs:, Medication errors (narrow)
Write-up: This spontaneous report as received from a other health professional refers to a 12 years old female patient patient with no illness at time of vaccination. The patient was vaccinated with lot # (669796/0840AA) dose 2 GARDASIL, IM on 21-DEC-2011 at 14:34. No other co-suspects were reported. No concomitant medications were reported. It was reported that the patient received immunization that was stored at an improper temp <32 degrees. There were not adverse reactions to vaccine. This is one of several reports from the same source. Additional information is not expected.

VAERS ID:467948 (history)  Vaccinated:2011-12-28
Age:12.0  Onset:2011-12-28, Days after vaccination: 0
Gender:Male  Submitted:2012-09-03, Days after onset: 249
Location:Arizona  Entered:2012-09-03
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type: WAES1208USA006163
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.0963AA0IMRA
Administered by: Private     Purchased by: Public
Symptoms: Incorrect storage of drug, No adverse event
SMQs:, Medication errors (narrow)
Write-up: This spontaneous report as received from a medical assistant refers to a 12 year old male patient with no illness at time of vaccination and no known drug allergies. The patient was vaccinated with lot # (670048/0963AA) dose 1 GARDASIL, IM, right deltoid on 28-DEC-2011 at 10:11 AM. No other co-suspects were reported. No concomitant medication were reported. It was reported that the patient received above vaccine during time of refrigerator failure. Temps found to be <32 degrees. The patient was re-vaccinated due to vaccine compromise. No adverse reaction reported. There was no lab studies performed. This is one of several reports from the same source. Additional information is not expected,.

VAERS ID:463921 (history)  Vaccinated:2012-08-27
Age:12.0  Onset:2012-08-30, Days after vaccination: 3
Gender:Male  Submitted:2012-08-31, Days after onset: 1
Location:Texas  Entered:2012-09-04, Days after submission: 4
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: Platelets - 8000
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HEPA: HEP A (VAQTA)MERCK & CO. INC.0325AE1IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4241AA0IMLA
TDAP: TDAP (ADACEL)SANOFI PASTEURC3976AA0IMRA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H0065371SCRA
Administered by: Private     Purchased by: Public
Symptoms: Ecchymosis, Idiopathic thrombocytopenic purpura, Platelet count decreased
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: 2 days -ecchymosis all over body. Idiopathic thrombocytopenia purpura.

VAERS ID:464005 (history)  Vaccinated:2012-08-10
Age:12.0  Onset:2012-08-10, Days after vaccination: 0
Gender:Male  Submitted:2012-09-04, Days after onset: 25
Location:Tennessee  Entered:2012-09-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
    Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: NO ILLNESS AT THE TIME OF INJECTION
Preexisting Conditions: Pt was anxious before receiving the vaccine. He has had the vaccine in the past w/o adverse effects. He is not allergic to any medication.
Diagnostic Lab Data: NONE HERE AT THE CLINIC
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
TDAP: TDAP (ADACEL)SANOFI PASTEURU4393BA0IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.HV065351SCLA
Administered by: Unknown     Purchased by: Other
Symptoms: Dyspnoea, Hyperhidrosis, Nausea, Rash, Syncope, Tongue pruritus, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Write-up: According to the nurse present, he was on his way out the door when symptoms started. Had syncope episode with dyspnea and facial rash and c/o tongue itching. Became nauseated with vomiting and sweating. He was given epi pen jr., O2 started, ambulance transported him to hospital where he was observed overnight with no other adverse events.

VAERS ID:464014 (history)  Vaccinated:2012-08-31
Age:12.0  Onset:2012-08-31, Days after vaccination: 0
Gender:Male  Submitted:2012-09-04, Days after onset: 4
Location:Texas  Entered:2012-09-04
Life Threatening? No
Died? No
Permanent Disability? No
Recovered? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Asthma
Preexisting Conditions: Asthma
Diagnostic Lab Data:
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1969AA IMRA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU4075BA IMRA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSB081AA IMLA
VARCEL: VARICELLA (VARIVAX)MERCK & CO. INC.H007451 SCLA
Administered by: Public     Purchased by: Public
Symptoms: Dizziness, Dyspnoea, Hypoaesthesia, Nausea, Paraesthesia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad)
Write-up: Mother reports, sob, light headedness, Dizziness, Numbness and tingling of upper extremities, Nausea.

VAERS ID:464096 (history)  Vaccinated:2012-07-17
Age:12.0  Onset:2012-07-18, Days after vaccination: 1
Gender:Female  Submitted:2012-08-24, Days after onset: 37
Location:Texas  Entered:2012-09-05, Days after submission: 12
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
HPV4: HPV (GARDASIL)MERCK & CO. INC.1495AA0IMLA
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEURU3846AA0IMLA
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B060BA0IMRA
Administered by: Public     Purchased by: Public
Symptoms: Pruritus, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Write-up: Per mom: Itchy, red rash under neck, on abdomen, under arms and back of knees. Appeared within 24hrs after vaccines administered. Pt saw PCP who prescribed rx for reaction.

VAERS ID:464130 (history)  Vaccinated:0000-00-00
Age:12.0  Onset:0000-00-00
Gender:Female  Submitted:2012-09-03
Location:Texas  Entered:2012-09-05, Days after submission: 2
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: The patient''s history was not reported.
Diagnostic Lab Data: Not reported
CDC Split Type: 201207889
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPVX: HPV (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA)SANOFI PASTEUR  UNUN
TDAP: TDAP (ADACEL)SANOFI PASTEUR  UNUN
VARCEL: VARICELLA (NO BRAND NAME)UNKNOWN MANUFACTURER  UNUN
Administered by: Unknown     Purchased by: Unknown
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: Initial report was received on 23 August 2012 from a health care professional. A 12 year-old female patient with no reported past medical history had received MENACTRA, ADACEL, HPV and Varicella vaccines (lot numbers, routes, sites and dates of administration for all vaccines were not reported) manufacturer for HPV and Varicella were not reported)) and an unspecified amount of time after vaccination, experienced syncope. No further information was provided at the time of the report. The patient''s outcome was not reported. The reporter for this case is the same as for case 2012-07890 and 2012-07891. Documents held by sender: none.

VAERS ID:464147 (history)  Vaccinated:2012-08-28
Age:12.0  Onset:2012-08-28, Days after vaccination: 0
Gender:Male  Submitted:2012-09-05, Days after onset: 8
Location:Alaska  Entered:2012-09-05
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
TDAP: TDAP (BOOSTRIX)GLAXOSMITHKLINE BIOLOGICALSAC52B078AA0IMLA
Administered by: Other     Purchased by: Public
Symptoms: Feeling hot, Injection site reaction, Muscle swelling, Swelling, Tenderness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)
Write-up: Swelling of deltoid muscle from top of shoulder down to mid humerus. No swelling palpable on inferior, inner upper arm. Hot, swollen, tender. No axilla nodes palpated.

VAERS ID:464164 (history)  Vaccinated:2012-08-28
Age:12.0  Onset:2012-08-28, Days after vaccination: 0
Gender:Female  Submitted:2012-08-29, Days after onset: 1
Location:Pennsylvania  Entered:2012-09-05, Days after submission: 7
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:
Diagnostic Lab Data: Pulse oximeter
CDC Split Type:
Vaccination
Manufacturer
Lot
Dose
Route
Site
HPV4: HPV (GARDASIL)MERCK & CO. INC.1561AA1UNLA
Administered by: Private     Purchased by: Private
Symptoms: Cough, Dizziness, Flushing, Hyperhidrosis, Nausea, Pallor, Throat irritation
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Hypoglycaemia (broad)
Write-up: Nausea, dizzy, flush followed by cough, throat feeling "funny", pale, sweaty...BENADRYL & EPIPEN given.

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