|
VAERS ID: |
164229 (history) |
Form: |
Version 1.0 |
Age: |
49.0 |
Sex: |
Male |
Location: |
Michigan |
Vaccinated: |
2006-05-03 |
Onset: |
0000-00-00 |
Submitted: |
2000-12-08 |
Entered: |
2000-12-28 |
Days after submission: |
20 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
ANTH: ANTHRAX (NO BRAND NAME) / MICHIGAN DEPT PUB HLTH |
FAV014 / UNK |
RA / SC |
Administered by: Other Purchased by: Private Symptoms: Arthralgia, Joint effusion, Joint swelling, Laboratory test abnormal, Oedema peripheral, Rheumatoid arthritis SMQs:, Cardiac failure (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Arthritis (narrow), Tendinopathies and ligament disorders (broad), Immune-mediated/autoimmune disorders (narrow) Life Threatening? No Birth Defect? No Died? No Permanent Disability? No Recovered? No Office Visit? No ER Visit? Yes ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: NONE Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: Blood drawn-No anti HB found on 3/23/98 CDC Split Type: 00AEFAV178 Write-up: Employee began receiving IZ''s on 3/11/98 as requirement of employment. In April, 1999, he noted symptoms of swelling and pain in his hands. In September of 1999, he was dx''d with rheumatoid arthritis. Through the fall and winter of 1999-2000 he had occasional episodes of joint pain and swelling, though less frequent and less severe than over the summer of 1999. These episodes of joint pain and swelling affected mainly joint; hands, wrists, elbows, shoulders, knees and hips. In the spring and summer of 2000, the frequency and severity of joint pain and swelling increased. By August, 2000, he was having longer lasting and severe pain and swelling. He had fluid aspirated from his left knee. His RA factor was elevated. He began oral and IV steroid therapy. In August, 2000, he started Embrel injections with good response. Symptoms have been decreasing in frequency and severity. He is currently taking Embrel, Azulfidine, Plaquenil and Celebrex. |
|
VAERS ID: |
236937 (history) |
Form: |
Version 1.0 |
Age: |
6.0 |
Sex: |
Female |
Location: |
Florida |
Vaccinated: |
2006-04-25 |
Onset: |
2005-04-26 |
Submitted: |
2005-04-27 |
Days after onset: |
1 |
Entered: |
2005-05-04 |
Days after submission: |
7 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR |
C2189AA / 5 |
LL / - |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR |
Y0264 / 4 |
LL / - |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0634P / 2 |
RL / - |
Administered by: Private Purchased by: Other Symptoms: Injection site erythema, Injection site oedema 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: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Red and swollen. Advised to provide Benadryl 1 1/4 tsp Q 6 H and warm compresses |
|
VAERS ID: |
249978 (history) |
Form: |
Version 1.0 |
Age: |
0.71 |
Sex: |
Male |
Location: |
Tennessee |
Vaccinated: |
2006-01-03 |
Onset: |
2006-01-03 |
Days after vaccination: |
0 |
Submitted: |
2006-01-03 |
Days after onset: |
0 |
Entered: |
2006-01-03 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21B028AA / 3 |
LL / IM |
HIBV: HIB (ACTHIB) / SANOFI PASTEUR |
UE766AA / 3 |
RL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
A74406A / 3 |
RL / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Hypersensitivity, Rash macular SMQs:, Angioedema (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad) Life Threatening? No Birth Defect? No Died? No Permanent Disability? No Recovered? Yes Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Current Illness: No illness noted, but child actively/vigorously teething & mother & grandmother stated that he had experienced some "diarrhea" in the past 2 days without fever or anorexia. Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: 15 minutes after administration of vaccines patient was noted to have a pink localized macular rash on both legs with patchy blotches on abdomen & face, child was in no apparent distress breathing normally & smiling; doctor was present & consulted, he suggested Children''s Benadryl be administered one time today as rash was fading within 15 minutes of its appearance. Doctor also suggested pre-administering Benadryl prior to next administration of vaccines as rash looked to be a localized histamine reaction; child had twice previously had same series of vaccines without problems. |
|
VAERS ID: |
250049 (history) |
Form: |
Version 1.0 |
Age: |
0.34 |
Sex: |
Male |
Location: |
Oregon |
Vaccinated: |
2006-01-02 |
Onset: |
2006-01-04 |
Days after vaccination: |
2 |
Submitted: |
2006-01-04 |
Days after onset: |
0 |
Entered: |
2006-01-04 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAP: DTAP (DAPTACEL) / SANOFI PASTEUR |
C2277AA / 2 |
LL / IM |
HBHEPB: HIB + HEP B (COMVAX) / MERCK & CO. INC. |
0923R / 2 |
RL / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR |
Y0496 / 2 |
RL / SC |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
B08638K / 2 |
LL / IM |
Administered by: Private Purchased by: Private Symptoms: Hypotonia, Irritability, Lethargy, Opisthotonus, Otitis media acute, Pyrexia, Screaming SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dystonia (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad) Life Threatening? No Birth Defect? No Died? No Permanent Disability? No Recovered? Yes Office Visit? No ER Visit? Yes ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: TYLENOL Current Illness: Minimal congestion. Preexisting Conditions: None Allergies: Diagnostic Lab Data: None CDC Split Type: OR200604 Write-up: Patient received routine 4 month DTaP during check-up on 1/02/06 around 2 PM. Pt awoke at 0535 this morning with fever to 101.8. Parents sponged pt and gave 60 mg. acetominophen. About 0720 pt suddenly screamed violently and arched his back for 4-5 seconds. He was then limp and lethargic for another 2 minutes. No tonic-clonic movements or eye-rolling. Exam at 0900 shows alert, playful, afebrile child with normal neurologic exam. Follow-up Information 26-APR-2006: Febrile seizure approximately 40hrs after 2nd DTP, IPV, Comvax, PCV, continued fever and irritability at 96 hrs post vaccines - diagnosed with acute otitis media. Dx by primary physician on 1-4-06. |
|
VAERS ID: |
250050 (history) |
Form: |
Version 1.0 |
Age: |
19.0 |
Sex: |
Female |
Location: |
Maryland |
Vaccinated: |
2006-01-03 |
Onset: |
2006-01-03 |
Days after vaccination: |
0 |
Submitted: |
2006-01-04 |
Days after onset: |
1 |
Entered: |
2006-01-04 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR |
U1858CA / 1 |
LA / IM |
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS |
AHAVBO32BA / 2 |
LA / IM |
Administered by: Military Purchased by: Military Symptoms: Rash SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad) Life Threatening? No Birth Defect? No Died? No Permanent Disability? No Recovered? Yes Office Visit? No ER Visit? Yes ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Current Illness: NONE NOTED Preexisting Conditions: NONE NOTED Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: ON 3 JAN 06, AT 09:00, PT RECEIVED 2ND DOSE OF HEP A IN UPPER LEFT ARM, AND FLU VACCINE IN LOWER LEFT ARM. PT RETURNED TO SICK CALL TODAY COMPLAINING OF REALLY ITCHY BUMPS ON BILATERAL TRICEPS REGION, NECK, BREASTS, UPPER AND LOWER TORSO AND BILATERAL THGHS. PT HAD NO OTHER COMPLAINTS. PT WAS SEEN BY HEALTH CARE PROVIDER FOR FOLLOW UP CARE. |
|
VAERS ID: |
250052 (history) |
Form: |
Version 1.0 |
Age: |
43.0 |
Sex: |
Female |
Location: |
Minnesota |
Vaccinated: |
2006-01-04 |
Onset: |
2006-01-04 |
Days after vaccination: |
0 |
Submitted: |
2006-01-04 |
Days after onset: |
0 |
Entered: |
2006-01-04 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR |
U1917AA / 1 |
LL / ID |
Administered by: Unknown Purchased by: Unknown Symptoms: Dizziness SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad) Life Threatening? No Birth Defect? No Died? No Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Ortho Novum 7/7/7 Paxil 10 mg Current Illness: None Preexisting Conditions: None Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Shot given at 10:30 am, lunch of sandwich at 11:00 am. 1:00 pm feel moderately dizzy. No other symptoms at this time. No treatment given. Will call doctor if symptoms increase or last more than a few hours. |
|
VAERS ID: |
250055 (history) |
Form: |
Version 1.0 |
Age: |
0.37 |
Sex: |
Male |
Location: |
California |
Vaccinated: |
2006-01-03 |
Onset: |
2006-01-03 |
Days after vaccination: |
0 |
Submitted: |
2006-01-04 |
Days after onset: |
1 |
Entered: |
2006-01-04 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAPHEPBIP: DTAP + HEPB + IPV (PEDIARIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC21BO37CA / 2 |
LL / IM |
PNC: PNEUMO (PREVNAR) / PFIZER/WYETH |
A25969A / 2 |
LL / IM |
Administered by: Unknown Purchased by: Unknown Symptoms: Injection site erythema, Injection site swelling, Injection site warmth, Irritability, Oral intake reduced, Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Hostility/aggression (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad) Life Threatening? No Birth Defect? No Died? No Permanent Disability? No Recovered? No Office Visit? No ER Visit? Yes ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: SLIGHT FEVER~DTaP + HepB + IPV (Pediarix)~1~0.20~In Patient Other Medications: Current Illness: Preexisting Conditions: CONGENITAL BENIGN HEART MURMUR. PT. CLEARED BY CARDIOLOGIST Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: 6 HRS. FOLLOWING IMM. DEVELOPED FEVER 101.5, VERY CRANKY, NOT EATING. GIVEN TYLENOL, FEVER REDUCED TO 99. INJECTION SITE SWOLLEN, RED, HOT TO TOUCH. |
|
VAERS ID: |
250068 (history) |
Form: |
Version 1.0 |
Age: |
4.0 |
Sex: |
Female |
Location: |
Wisconsin |
Vaccinated: |
2006-01-03 |
Onset: |
2006-01-04 |
Days after vaccination: |
1 |
Submitted: |
2006-01-04 |
Days after onset: |
0 |
Entered: |
2006-01-05 |
Days after submission: |
1 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
DTAP: DTAP (INFANRIX) / GLAXOSMITHKLINE BIOLOGICALS |
AC14A006CA / 5 |
RA / IM |
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR |
Y0298 / 4 |
RA / SC |
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
0240R / 2 |
LA / SC |
Administered by: Private Purchased by: Private Symptoms: Injection site hypersensitivity, Injection site oedema, Pruritus SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad) Life Threatening? No Birth Defect? No Died? No Permanent Disability? No Recovered? Yes Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Bactrim Current Illness: NONE Preexisting Conditions: LVUR Grade 11, Esotropia Allergies: Diagnostic Lab Data: NONE CDC Split Type: Write-up: Redness and swelling of right deltoid began at 1400 on 01/04/2006 when child awoke from nap. None had been noted earlier. Child also had itching of area which measured 7.3 by 7.0cm. Child was afebrile with no respiratory symptoms or swelling elsewhere. Treated with Benadryl Q 6 hours. Area marked and family told to call if swelling/redness extends beyond mark. |
|
VAERS ID: |
250069 (history) |
Form: |
Version 1.0 |
Age: |
58.0 |
Sex: |
Female |
Location: |
Michigan |
Vaccinated: |
2006-01-04 |
Onset: |
2006-01-04 |
Days after vaccination: |
0 |
Submitted: |
2006-01-05 |
Days after onset: |
1 |
Entered: |
2006-01-05 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. |
1004P / 2 |
LA / IM |
Administered by: Private Purchased by: Unknown Symptoms: Erythema, Joint range of motion decreased, Oedema, Pain SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad) Life Threatening? No Birth Defect? No Died? No Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: UNK Current Illness: NONE Preexisting Conditions: NONE Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Left arm is very swollen and red. Pt c/o 7/10 left arm pain. C/o limited ROM of left arm. |
|
VAERS ID: |
250078 (history) |
Form: |
Version 1.0 |
Age: |
20.0 |
Sex: |
Female |
Location: |
Colorado |
Vaccinated: |
2006-01-03 |
Onset: |
2006-01-05 |
Days after vaccination: |
2 |
Submitted: |
2006-01-05 |
Days after onset: |
0 |
Entered: |
2006-01-05 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR |
Z0042 / 1 |
LA / IM |
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR |
UE664AB / 1 |
RA / SC |
Administered by: Unknown Purchased by: Unknown Symptoms: Injection site erythema, Injection site reaction, Injection site warmth, Rash erythematous SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad) Life Threatening? No Birth Defect? No Died? No Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: Presented with local reaction at site of injection of Yellow Fever vaccine. Red, raised area ~47x60 on arm with c/o itching. Area warm to touch. Denied any difficulty breathing or generalized itching. Injection occurred 01/03/2006 noted the "rash" and itching this am (01/05/2006). Advised to use some Benadryl cream at site and could take an over the counter Benadryl. |
|