Vaccine Adverse Reaction Reporting System Data 1 Pub 23oct09

VAERS_IDRECVDATESTATE AGE_YRS CAGE_YR CAGE_MOSEX RPT_DATESYMPTOM_TEXT DIED
336349 1/2/2009 CA U ### Information has been received from

336350 1/2/2009 MA 0.2 F ### Information has been received from
336352 1/2/2009 IL 14 14 F ### Information has been received from
336359 1/2/2009 ID 62 62 M ### Information has been received from
336373 1/2/2009 U ### Information has been received from
336376 1/2/2009 MA 5 5 F 1/2/2009 Local reaction of redness, swelling,
336377 1/2/2009 MA 1 1 0M 1/2/2009 Vesicular eruption, 3-4 lesions cons
336378 1/2/2009 GA 32 31 M 1/2/2009 As reported by patient, he began to
336379 1/2/2009 MA 0.6 0 0.6 F 1/2/2009 Fever of 102 within 24 hours of imm
336380 1/2/2009 MA 0.5 0 0.6 M 1/2/2009 Fever of 101 beginning within 24 ho
336381 1/2/2009 MA 0.3 0 0.3 M 1/2/2009 Fever of 100.5 within 24 hours of im
336382 1/2/2009 IL 15 15 F 1/2/2009 Was in reception area immediately a
336383 1/2/2009 KS 5 5 M 1/2/2009 Child was given an adult Hep A dos
336384 1/2/2009 KS 5 5 F 1/2/2009 Adult Hep A given to child instead o
336385 1/2/2009 IL 0.5 0 0.5 F 1/2/2009 Approximately 8 hours after receivin
336386 1/2/2009 IL 0.5 0 0.5 F 1/2/2009 Received vaccines along with twin s
336387 1/2/2009 MA 0.3 0 0.3 F 1/2/2009 Pt fussy with low-grade fever of 100
336388 1/2/2009 MA 9 0 0.4 F 1/2/2009 3cm x 4cm raised tender eryth arou
336389 1/2/2009 MA 20 20 F 1/2/2009 Slight fever, chills; local redness, sw
336390 1/2/2009 CA 18 18 F 1/2/2009 syncope or seizure still being determ
336391 1/2/2009 FL 53 53 F 1/2/2009 Beginning 12/11/08 Pt reports bump
336392 1/2/2009 NC 17 17 F 1/2/2009 BROKE OUT W/ CHICKEN POX
336393 1/2/2009 WA 17 17 F 1/2/2009 Marked local swelling, induration, er
336394 1/2/2009 MT 2 1 0.9 M 1/2/2009 None
336395 1/2/2009 WA 38 38 M 1/2/2009 Patient describes reaction as increa
336416 1/2/2009 OH 1.5 1 0.5 M ### Seizure lasting 1-5minutes. Fever 1
336417 1/2/2009 OH 37 37 F ### Has area on L arm located about 2-
336419 1/2/2009 MA 4 4 F ### Seen at hospital 12/03/08 for swellin
336420 1/2/2009 MA 37 37 F ### Swelling, redness, induration, warm
336421 1/2/2009 IL 10 10 M ### Pt received vaccines below and app
336422 1/2/2009 OH 48 48 F ### Swollen, tender supra clavicular lym
336423 1/2/2009 WI 46 46 M 12/3/2008 Nov 3rd got flu shot and needle inse
336424 1/2/2009 WI 40 40 M 12/7/2008 (2008) Received flu shot Nov 3 & ok
336425 1/2/2009 WI 55 55 F 12/8/2008 Received flu shot left deltoid on 11/3
336426 1/2/2009 WI 48 48 F ### Nov 3rd 2008 rec'd flu shot pt sore f
336427 1/2/2009 WI 33 33 F ### Pt reports getting her shot 11/3/200
336428 1/2/2009 WI 27 27 F 12/3/2008 Nov 3, 2008, shot given Nov 4 & 5 s
336429 1/2/2009 WI 48 48 M 12/3/2008 c/o left arm pain. Refusal RN intervi
336430 1/2/2009 WI 23 23 M ### He received his flu shot on Nov 3, 2
336431 1/2/2009 WI 45 45 M 12/3/2008 Flu shot received 11/3/08. States to
336432 1/2/2009 WI 38 38 F 12/3/2008 Since 11/3/08- W/E of Nov 8 & 9. ->
336433 1/2/2009 IN 61 61 F 1/2/2009 Patient got rash after getting vaccin
336434 1/2/2009 WI 41 41 M 12/3/2008 On Nov 3, 2008 flu shot given left a
336435 1/2/2009 NH 1.1 1 0.1 F ### Site of injection was blistered , raise
336436 1/2/2009 AR 17 17 F ### Mom reports child with "severe" hip
336437 1/2/2009 MA 69 69 F ### Redness, itching one vaccine left ar
336438 1/2/2009 NJ 0.3 0 0.3 F 1/3/2009 Fever on 12/30/2008- Temp 101 de
336396 1/3/2009 MI 11 11 M 1/3/2009 Patient received Menactra vaccine o
336397 1/3/2009 AK 63 63 F 1/3/2009 Patient developed Shingles 3 days
336398 1/3/2009 NJ 9 9 M 1/3/2009 Reaction occurred immediately afte
336399 1/3/2009 NJ 4 4 F 1/3/2009 Raised red area approximately 4 inc
336400 1/4/2009 IN 77 77 M 1/4/2009 The patient complains of major swe
336401 1/4/2009 VA 74 74 M 1/4/2009 Patient was given Zostavax vaccine
336402 1/5/2009 VA 75 75 M ### Pt states he had itching at injection
336403 1/5/2009 VA 60 60 M ### Chest tightness,
Y shortness of breath
336404 1/5/2009 CT 0.5 0 0.5 F ### Received flu vaccine 12/8. On 12/10
336405 1/5/2009 TN 59 59 F ### Severe congestion-nasal,ears,head
336406 1/5/2009 KY 3 3 F ### 3 days after DTaP was given right th
336407 1/5/2009 NE 34 34 F 1/2/2009 States fatigue, itching around face,
336408 1/5/2009 PA 1.7 1 0.7 M ### Large red bumps on legs after shots
336409 1/5/2009 CA 6 6 F 1/2/2009 Mother reports temp of 103 degrees
336410 1/5/2009 PA 39 39 M ### Redness and swelling around vacci
336411 1/5/2009 63 63 F 1/2/2008 On December 26 at 10 am received
336412 1/5/2009 UT 38 38 F ### 3 days following Flu vax developed
336413 1/5/2009 OR 48 48 F ### Severe pain "10/10" in deltoid area
336414 1/5/2009 IA 45 45 F ### About 4 weeks after the f/u shot, I e
336415 1/5/2009 IL 6 6 M ### Child was struggling before shot- he
336439 1/5/2009 OH 70 70 F 1/5/2009 Patient states she recieved Zostava
336440 1/5/2009 KY 19 19 M 1/5/2009 Patient complains of generalized ur
336441 1/5/2009 KY 20 20 M 1/5/2009 Patient observed having trouble bre
336442 1/5/2009 MA 1 1 0M 1/5/2009 Suspect post- MMR reactions; fine p
336443 1/5/2009 MA 1 1 0M 1/5/2009 Suspect MMR rash. Pt developed p
336444 1/5/2009 NC 6 6 F 1/5/2009 PATIENT SEEN FOR WELL CHILD
336445 1/5/2009 MA 1 1 0F 1/5/2009 Local redness at vaccine site with lo
336446 1/5/2009 MA 0.5 0 0.5 M 1/5/2009 Localized heat, redness, and swellin
336447 1/5/2009 MA 1.5 1 0.5 M 1/5/2009 Firm nodule, red skin at DTaP imm
336448 1/5/2009 TX 21 21 M 1/5/2009 PT PRESENTED TO ALLERGY/IMM
336449 1/5/2009 MA 4 4 M 1/5/2009 Localized rxn to DTaP- area of eryth
336450 1/5/2009 TX 21 21 M 1/5/2009 Erythematous, maculopapular rash
336451 1/5/2009 MA 0.3 0 0.4 M 1/5/2009 Induration, bruising at site of immun
336452 1/5/2009 MA 0.3 0 0.3 F 1/5/2009 3-4 mm subcutaneous swelling at im
336453 1/5/2009 MA 11 0 0F 1/5/2009 Site of varicella vaccine swollen to t
336454 1/5/2009 MS 1.1 1 0.1 F 1/5/2009 patient received the MMR & Varicel
336455 1/5/2009 MA 1 1 0M 1/5/2009 Redness and swelling in left thigh w
336456 1/5/2009 SD 59 59 F 1/5/2009 Got flu shot on 12/2/08 and on 12/4
336457 1/5/2009 MA 15 15 F 1/5/2009 Extreme Hives, trouble breathing / p
336458 1/5/2009 WI 14 14 M 1/5/2009 Weakness, pain in back, headache,
336459 1/5/2009 FL 65 65 M 1/5/2009 within 2 days developed ipsilateral u
336460 1/5/2009 KY 1.3 1 0.3 M 1/5/2009 patient received vaccine on decemb
336461 1/5/2009 CA 16 16 M 1/5/2009 Menactra was ordered for the patien
336463 1/5/2009 OH 1.3 1 0.3 M ### Initial information was received on 2
336466 1/5/2009 NY 41 41 F 1/5/2009 This case was reported by a lawyer
336471 1/5/2009 MO 0.2 0 0.2 M ### Admitted to hospital on 12/24/08 fo
336472 1/5/2009 CO 67 67 F ### Pt got ZOSTAVAX shot 6-16-08. Ha
336473 1/5/2009 TN 18 18 F ### Onset increased muscle pain, fatigu
336474 1/5/2009 13 13 F ### After my daughter received her 1st
336475 1/5/2009 MT 46 46 F 12/8/2008 1) Headaches 2) Visual Change: fel
336476 1/5/2009 NY 17 17 F ### She received flu shot and Pneumov
336477 1/5/2009 NY 65 65 M 12/9/2008 Patient was given PNEUMOVAX an
336478 1/5/2009 PA 75 75 F 1/1/2009 Pt came to clinic on 12/30/08. After
336479 1/5/2009 NY 29 29 F ### She developed severe right arm pai
336480 1/5/2009 FL 0.2 0 0.2 F ### Vaccine was administered 12/15/08
336482 1/5/2009 MI 66 66 M ### On 12-22-08 Patient received PNEU
336483 1/5/2009 FL 66 66 F ### Possible reaction to vaccine 1-2 day
336484 1/5/2009 VA 69 69 F ### Muscle pain (next morning) extendin
336485 1/5/2009 NY 7 7 M ### Patient presents with stomach pain,
336486 1/5/2009 MA 11 11 M ### Left deltoid hypersensitivity reaction
336487 1/5/2009 CO 39 38 F ### 2 days after vaccine had slight rash
336488 1/5/2009 NY 1 1 0M ### scattered diffuse maculo-papular ra
336489 1/5/2009 F ### Soon after receiving Hep A vaccine
336490 1/5/2009 MS 26 26 F ### None Stated
336491 1/5/2009 IN 5 5 F ### Mother called, daughter is very wea
336492 1/5/2009 FL 50 50 F ### Heat, tenderness, erythema left upp
336493 1/5/2009 MN 1.3 1 0.3 M ### Rash started 12/27, started on face
336494 1/5/2009 GA 34 34 F ### 3 1/2 X 5 inch raised, erythematous
336495 1/5/2009 TX 1.1 1 0.1 F ### Erythema 20X26
336496 1/5/2009 NC 13 13 F ### Immunization was administered in le
336497 1/5/2009 NC 17 17 F ### None. Hep B injection in gluteal reg
336498 1/5/2009 WA 60 60 M 1/5/2009 Mild swelling, tingling and redness a
336499 1/5/2009 NY 2 2 0.5 F 1/5/2009 Pt here for well child visit and had ju
336500 1/5/2009 WA 46 46 F 1/5/2009 C/o nausea, light headed, dizziness
336501 1/5/2009 CA 1.2 1 0.2 F 1/4/2009 Red rash after getting immz on rt lg.
336503 1/5/2009 15 15 F 5/15/2008 SM reported receipt IM Influenza ag
336504 1/5/2009 CA 1.1 1 0.1 F ### 13 mo brought by mom for over 1 w
336505 1/5/2009 TX 60 60 F ### Patient left arm still sore. Hard to gr
336506 1/5/2009 NJ 4 4 M ### Right arm red and swollen 12cm by
336507 1/5/2009 LA 26 26 M 3/10/2008 Description: rash 10 days after SMP
336508 1/5/2009 NJ 23 23 M ### Noticed 12/15/08, notes soreness, s
336509 1/5/2009 PA 37 37 F 1/5/2009 Patient had suspected immune reac
336510 1/5/2009 MA 57 57 M 1/5/2009 Pain at injection site x 2 days. On 3
336511 1/5/2009 MD 49 49 F 1/5/2009 Ringing in ears, jaw tightness, lighth
336512 1/5/2009 GA 14 14 M 11/6/2008 Pt received vaccine on Friday. Satu
336513 1/5/2009 GA 32 32 F ### 12/3/2008 TWINRIX given. Blistery
336514 1/5/2009 GA 0.5 0 0.5 F ### Received on immunizations on 10-2
336515 1/5/2009 GA 11 11 F ### Child in school nurse office-phone c
336518 1/5/2009 GA 47 47 F 10/7/2008 Patient complains of swelling at site
336520 1/5/2009 GA 12 12 M ### Mother called and stated this (L) arm
336521 1/5/2009 GA 29 29 F 10/9/2008 Client complains of swelling at injec
336522 1/5/2009 GA 85 85 F ### Had PNU on 12/10/08 arm red from
336462 1/6/2009 CA 1 1 0F 1/5/2009 Within 5 hours, patient experienced
336550 1/6/2009 NJ 30 30 F 1982 I was given vaccines for Typh
336551 1/6/2009 WI 53 53 F ### 11/30 T 101 Dr. ran rapid strep -> n
336552 1/6/2009 WI 60 60 F 1/2/2009 Headache within 15 min - 5 cm red
336553 1/6/2009 MA 1 1 0M ### Vaccines administered in L thigh on
336554 1/6/2009 GA 44 44 F ### Patient reports that a rash began 3
336555 1/6/2009 AL 64 64 F ### Approximately 1 wk following injecti
336556 1/6/2009 MO 17 17 F ### Patient blacked out after receiving H
336557 1/6/2009 LA 18 18 F Increased headache, increase men
336558 1/6/2009 CA 4 F ### Site of DTaP on L deltoid very red, s
336559 1/6/2009 NV 42 42 F ### Raised red area at vaccine site + ab
336560 1/6/2009 IL F 4 female school teachers c/o S.O.B
336561 1/6/2009 OK 1 0 1M ### Patient RTC on 12/31/08- c/o .5cm
336562 1/6/2009 FL 32 32 M ### Swollen shoulder w/red itchy rash
336564 1/6/2009 AZ 16 16 F ### 12/26/08 1520 client fainted 5-10 se
336565 1/6/2009 WI 61 61 F ### Left upper arm just distal to shoulde
336578 1/6/2009 NJ 19 19 F 1/5/2009 Information has been received from
336580 1/6/2009 FL 25 F 1/5/2009 Information has been received from
336581 1/6/2009 18 18 F 1/5/2009 Information has been received from
336583 1/6/2009 IL 65 65 F 1/5/2009 Information has been received from
336586 1/6/2009 PA 71 F 1/5/2009 Information has been received from
336603 1/6/2009 MD 48 48 F 1/6/2009 Post viral symptoms 4 weeks post In
336604 1/6/2009 MA 1.3 1 0.3 F 1/6/2009 Redness swelling and induration an
336605 1/6/2009 MA 1.3 1 0.3 F 1/6/2009 Patient had a seizure two hours afte
336606 1/6/2009 PA 71 71 F 1/6/2009 pain in arm, mild redness, progress
336607 1/6/2009 OH 74 74 F 1/6/2009 Client stated that the evening after r
336608 1/6/2009 MT 0.3 0 0.3 M 1/6/2009 Parents stated that pt developed a m
336609 1/6/2009 TN 0.2 0 0.2 F 1/6/2009 Within 5 minutes of getting vaccines
336610 1/6/2009 MA 9 9 F 1/6/2009 Pt presented with approx 5 cm area
336611 1/6/2009 CO 45 45 F 1/6/2009 Fever of 101 -102, body aches, and
336612 1/6/2009 IA 73 74 F 1/6/2009 12/16/08 RECIEVED VACCINE. 12
336613 1/6/2009 VA 0.2 0 0.2 M 1/6/2009 High fever (102.9F), SOB & rash 3 d
336614 1/6/2009 MA 0 0 0F 1/6/2009 Patient was given Hep B shot at 1 m
336615 1/6/2009 PA 1 1 0M 1/6/2009 Vesicles noted on right arm near sit
336616 1/6/2009 MO 12 12 F 1/6/2009 Vaccines given in same arm 12/20/0
336617 1/6/2009 IL 41 41 M 1/6/2009 Associate was given Tdap vaccinati
336618 1/6/2009 OH 41 41 M 1/6/2009 Approx. 10 hours after getting Tetan
336620 1/6/2009 NJ 36 36 F 1/6/2009 This case was reported by a lawyer
336625 1/6/2009 FL 52 F ### A serious spontaneous report of Be
336626 1/6/2009 ME 0.6 0 0.6 M This is a previously health 8-month-
336627 1/6/2009 PA 71 71 M 1/6/2009 On November 10 pt received Flu va
336628 1/6/2009 NE 52 52 F 1/6/2009 Injection site hurt longer than any pr
336629 1/6/2009 MN 54 54 F 1/6/2009 Arm was sore for prolonged amount
336630 1/6/2009 MN 22 22 M 1/6/2009 Arm was sore at site of injection for
336631 1/6/2009 MN 29 29 F 1/6/2009 Arm was sore after receiving flu sho
336632 1/6/2009 CA 69 69 M 1/6/2009 Bell's palsy-absence of muscular co
336633 1/6/2009 ME 41 41 F 1/6/2009 Patient got dizzy, was short of breat
336634 1/6/2009 IN 30 30 F 1/6/2009 Severe bilateral leg pain with cramp
336635 1/6/2009 MI 15 15 M 1/5/2009 Within 12 hrs of vaccine. L arm at va
336636 1/6/2009 MD 25 25 F ### 12/11/08 6:00pm, Rash appeared o
336637 1/6/2009 NY 1.5 1 0.5 M Localized swelling (L) lateral thigh.
336638 1/6/2009 FL 34 F 1/6/2009 Pt given vaccine and after a few min
336654 1/7/2009 NC 0.2 0 0.2 M ### Pt developed Y decreased PO intake
336655 1/7/2009 CO 55 55 M ### Began with left elbow pain, progress
336656 1/7/2009 MA 1.4 1 0.4 F 1/2/2009 As part of flu clinic 17 mo was given
336657 1/7/2009 MI 63 63 F ### Woke up on the 11th with a horrend
336664 1/7/2009 NH 38 38 F 1/5/2009 This serious case was received from
336665 1/7/2009 NH 32 32 F 1/5/2009 Initial report was received 27 Decem
336666 1/7/2009 NH 31 31 F 1/6/2009 Initial report received on 27 Decemb
336668 1/7/2009 NH 38 38 F 1/5/2009 Initial report received on 27 Decemb
336671 1/7/2009 NH 29 29 F 1/5/2009 Initial report was received on 27 De
336672 1/7/2009 NH M 1/5/2009 Initial report was received 27 Decem
336673 1/7/2009 NC 51 51 F 1/5/2009 Initial information was received on 2
336675 1/7/2009 FL 6 6 M ### Some shots have given patient the
336699 1/7/2009 VA 44 44 F 1/7/2009 Rash appeared 3 days after immun
336700 1/7/2009 AR 1 1 0F 1/7/2009 10 days past her 1 yr. shots she sta
336701 1/7/2009 NY 65 65 F 1/7/2009 Severe headache 48 hours after ad
336702 1/7/2009 WI 0.2 0 0.2 M 1/7/2009 Patient developed upper respiratory
336703 1/7/2009 PA 64 64 F 1/7/2009 Severe dizziness lasting 6 - 8 hours
336704 1/7/2009 WI 13 13 M 1/7/2009 Pt developed a blister like rash on to
336705 1/7/2009 PA 12 12 F 1/7/2009 Dizziness, nauseous, ringing in the
336706 1/7/2009 LA 11 11 M 1/7/2009 Child came in one day later with hiv
336707 1/7/2009 NY 13 13 F 1/7/2009 Patient presented to Immunization c
336708 1/7/2009 WV 65 65 F 1/7/2009 Patient complained of severe pain,
336709 1/7/2009 PA 4 4 M 1/7/2009 1 day after vaccine administration, p
336710 1/7/2009 UT 29 28 M 1/7/2009 PT SUFFERED FROM HIVES, RAS
336711 1/7/2009 VA 11 11 M 1/7/2009 Left Deltoid area on arm warm and
336712 1/7/2009 CA 38 38 F 1/7/2009 f/u redness and swelling to left uppe
336713 1/7/2009 CA 0.8 0 0.7 F 1/7/2009 One day after receiving the first dos
336714 1/7/2009 GA 14 14 F 1/7/2009 Patient had Gardasil shot and then
336715 1/7/2009 MI 73 73 M 1/7/2009 I Called Pt. Wed night to check up o
336716 1/7/2009 NJ 46 46 F 1/7/2009 This case was reported by a lawyer
336722 1/7/2009 TX 62 62 F 1/7/2009 On Jan 2, arm began itching. Got w
336723 1/7/2009 MN 40 40 F 1/6/2009 Arm was sore after receiving flu sho
336724 1/7/2009 IA 40 40 F 12/3/2008 Initial information was received on 0
336725 1/7/2009 CA 4 4 F ### Left cellulitis; red, warm, tender trea
336726 1/7/2009 9 9 F 1/5/2009 My daughter received her second in
336727 1/7/2009 CA 1 1 0M 1/7/2009 Mild varicella-like rash - Rt upper ar
336728 1/7/2009 CA 4 4 F 1/6/2009 Local reaction with itching, redness,
336729 1/7/2009 CO 15 15 F 1/7/2009 Dizziness, fever 106 degrees F, red
336730 1/7/2009 MI 21 21 F 1/7/2009 Patient received first dose of GARD
336731 1/7/2009 VT 14 14 F 1/7/2009 Syncope within minutes of administr
336732 1/7/2009 IL 14 14 F 1/6/2009 GARDASIL administered 12/22/08,
336733 1/7/2009 TX 14 14 M 1/6/2009 Sleepless night, back pain, fever, he
336773 1/8/2009 0.3 0 0.3 U 1/7/2009 Initial report received from health au
336777 1/8/2009 TN M 1/6/2009 Initial reportYwas received 05 Janua
336778 1/8/2009 DC 0.6 0 0.6 F 1/6/2009 Initial report received on 05 January
336783 1/8/2009 CA 78 78 F On Oct. 27th Monday: Nurse at me
336784 1/8/2009 IL 2 2 0F 1/8/2009 Pt developed seizure activity < 12 h
336785 1/8/2009 IL 1 1 0M 1/7/2009 Patient seen Y on 12/18/08, received
336786 1/8/2009 SC 5 5 M 1/8/2009 Diagnosed with juvenile onset diabe
336788 1/8/2009 PA 63 63 F ### 10/17/08 3:30 am Hives hospital ER
336789 1/8/2009 PA 38 38 M 1/5/2009 10/22/08 - 8pm- Body aches, fever/
336790 1/8/2009 AZ 18 18 M ### Patient administered flu vaccine; pa
336791 1/8/2009 PA 6 6 F 1/7/2009 Local redness & swelling - started -
336792 1/8/2009 AR 6 6 M ### Child had facial swelling hives body
336793 1/8/2009 MN U Injected in left arm - net sore at first
336794 1/8/2009 OH 77 77 F ### Swollen left arm, pain
336795 1/8/2009 AZ 60 60 M ### 60 y/o male with left arm swelling fro
336796 1/8/2009 1.3 1 0.3 F 1/6/2009 Patient received VARIVAX on 9/26/
336797 1/8/2009 1.3 1 0.3 F 1/6/2009 Patient received VARIVAX on 1/12/
336798 1/8/2009 OR 1.2 1 0.2 F 1/6/2009 Patient received VARIVAX on 5/7/0
336799 1/8/2009 U 1/6/2009 Patient received VARIVAX on 2/15/
336801 1/8/2009 OR 12 12 F 1/6/2009 Patient received VARIVAX on 12/27
336802 1/8/2009 M Reacci¢n alergica, ronchas, comez¢
336803 1/8/2009 U Allergic reaction, hives, itchiness, di
336810 1/8/2009 TX 18 F ### Information has been received from
336819 1/8/2009 SC 25 25 F 1/8/2009 12/15/08--Patient received Td on 9/
336820 1/8/2009 ND 40 40 M 1/8/2009 Pt. has increased swelling on L arm
336821 1/8/2009 OR 15 15 F 1/8/2009 Redness on arm and spreading. Ho
336822 1/8/2009 WI 66 66 F 1/8/2009 The patient received the Pneumova
336823 1/8/2009 MO 18 18 F 1/8/2009 Within about one minute of receivin
336824 1/8/2009 WV 60 60 F 1/8/2009 Pt telephoned 1/08/09 and stated th
336825 1/8/2009 NY 16 16 F 1/8/2009 after the vacc,pt c/o dizzyness,when
336826 1/8/2009 CA 2 2 0.9 M 1/8/2009 Flumist was administered at 11:00a
336827 1/8/2009 DE 0.8 0 0.8 F 1/8/2009 Hives, starting 1 day after shot. Str
336828 1/8/2009 NM 29 29 F 1/8/2009 Received a call from patient above
336829 1/8/2009 TX 4 4 M 1/8/2009 Fell asleep after injection. Awoke lim
336830 1/8/2009 IA 68 68 F 1/8/2009 Patient experienced acute leg weak
336831 1/8/2009 VA 20 20 F 1/8/2009 9:50 am: phone call received by he
336832 1/8/2009 TX 23 22 F 1/8/2009 23 year old female presented to Stu
336833 1/8/2009 MI 52 52 F 1/8/2009 Pt came three days later w/complain
336834 1/8/2009 CA 44 44 F 1/8/2009 Pt reports tingling and numbness/ne
336835 1/8/2009 MN 5 5 F 1/8/2009 Received the shots on 10/23/2008 a
336836 1/8/2009 15 14 F 1/8/2009 Five to ten minutes after Td shot pt.
336837 1/8/2009 NV 72 72 M 1/8/2009 SHINGLES FACE; NOSE; EYE NO
336838 1/8/2009 CT 64 64 F 1/8/2009 Gillian Barre Syndrome after receivi
336839 1/8/2009 FL 42 42 F 1/8/2009 I received an MMR shot on Decemb
336840 1/8/2009 WI 4 4 F 1/8/2009 Diagnosis of double pneumonia one
336841 1/8/2009 IL 0.2 0 0.2 F 1/9/2009 Patient found Y unresponsive in crib b
336842 1/8/2009 AZ 0.2 0 0.2 M 1/7/2009 Onset of bilious vomiting, abd. bloat
336843 1/8/2009 VA 66 66 F 1/7/2009 Numbness of upper lip < lower lip a
336844 1/8/2009 HI 1.2 1 0.2 M 1/8/2009 Several fluid-filled vesicles on red b
336845 1/8/2009 NM 82 82 F 1/8/2009 Cellulitis to RUE to include erythem
336846 1/8/2009 TX 54 54 F 1/8/2009 Local reaction to ADACEL . Pt has
336847 1/8/2009 NY 74 74 F 1/7/2009 Pain & redness - Left deltoid - pt. di
336848 1/8/2009 PA 13 13 F 1/7/2009 Loss of consciousness approximate
336850 1/8/2009 AZ 0.2 0 0.2 M 1/7/2009 12 hrs after vaccine, infant became
336851 1/8/2009 4 F 1/7/2009 Information has been received rega
336852 1/8/2009 MN 26 26 F 1/7/2009 Initial and follow up information has
336853 1/8/2009 CO 15 15 F 1/7/2009 Information has been received from
336854 1/8/2009 NY 16 16 F 1/7/2009 Information has been received from
336861 1/9/2009 WY 18 F ### Information has been received from
336865 1/9/2009 OR 2 2 0.5 F 1/5/2009 Prolonged soreness/pain complaint
336866 1/9/2009 FL 8 8 M ### Mother states child developed swell
336867 1/9/2009 OH 14 14 M 1/5/2009 After vaccination patient appeared p
336868 1/9/2009 OH 11 11 M 1/5/2009 Approximately ten minutes after his
336870 1/9/2009 NM 18 18 F ### Patient was mistakenly administered
336871 1/9/2009 CT 38 38 M 1/4/2009 Pt presented with redness on his to
336872 1/9/2009 WI 15 15 F ### Rec'd varicella and FLUZONE R arm
336873 1/9/2009 MD 25 25 F 1/6/2009 Pt passed and approximately 15-30
336876 1/9/2009 NC 0.1 0 0.1 M 1/6/2009 Crying nonstop day of vaccines unc
336877 1/9/2009 PA 50 50 F 1/2/2009 Patient had right deltoid IM injection
336878 1/9/2009 WA 14 14 M Right deltoid soreness, dizziness an
336879 1/9/2009 CA 69 69 U 1. Received vaccine on 12-10-08. 2
336880 1/9/2009 LA 1.1 1 0.1 F 1/5/2009 Patient received vaccines (PREVNA
336881 1/9/2009 NJ 0.7 F No physical exam. Child received H
336882 1/9/2009 28 28 F 1/6/2009 Migraine with auras, nausea and he
336888 1/9/2009 MI 18 18 F ### Information has been received from
336913 1/9/2009 VA 28 28 M 1/9/2009 SM RECEIVED THE INFLUENZA IN
336914 1/9/2009 VA 5 5 F 1/9/2009 Redness/Swelling 4 inches around
336915 1/9/2009 OH 31 31 F 1/9/2009 Had been sick the week before vacc
336916 1/9/2009 VA 49 49 F 1/9/2009 SM RECEIVED THE INFLUENZA IN
336924 1/9/2009 VA 42 41 M 1/9/2009 RECEIVED INFLUENZA IM VACCI
336928 1/9/2009 TX 18 18 F 1/9/2009 pain from left elbow to left shoulder
336929 1/9/2009 WA 32 32 M 1/9/2009 Patient recieved Flumist (lot 500570
336930 1/9/2009 TX 27 27 F 1/9/2009 TC from patient @ 11am. Started w
336931 1/9/2009 UT 49 49 F 1/9/2009 1) 5 min after injection, heat flush &
336932 1/9/2009 MS 3 3 M ### Mom noted swelling to left upper arm
336933 1/9/2009 VA 26 26 F 1/9/2009 HAD THE SERIES OF 3 GARDISIL
336934 1/9/2009 AZ 0.2 0 0.2 F 1/9/2009 ON 1/1/2009 CHILD STARTED RUN
336935 1/9/2009 KY 24 24 F 1/9/2009 Received tdap in the afternoon of 1-
336936 1/9/2009 TX 62 62 F 1/9/2009 AFTER TWO DAYS OFIMMUNIZAT
336937 1/9/2009 MA 17 17 F 1/9/2009 Patient received HPV vaccine on 10
336938 1/9/2009 MA 4 4 F 1/9/2009 Left arm where dtap and polio was g
336939 1/9/2009 TX 17 17 F 1/9/2009 Mother of patient called immunizatio
336940 1/9/2009 MO 21 21 F 1/8/2009 1/7/09@1000-Patient calls this offic
336941 1/9/2009 FL 39 39 F 1/9/2009 On January 6, 2009, 2.5 weeks afte
336942 1/9/2009 AR 24 24 F 1/9/2009 COMPLAINING OF PAIN AND TEN
336943 1/9/2009 AR 47 47 M 1/9/2009 Patient received vaccine on 12/18/0
336944 1/9/2009 TX 5 5 F 1/9/2009 Per mom C/O at about 5 - 6 PM sta
336945 1/9/2009 OH 18 18 F 1/9/2009 Woke up that Sunday a.m. feeling v
336946 1/9/2009 CO 47 47 F 1/9/2009 Got the vaccine at 4 in the afternoon
336961 1/9/2009 CO F 1/8/2009 This case was reported by a healthc
336962 1/9/2009 AZ 0.2 U 1/8/2009 This case was reported by a physici
336963 1/9/2009 AZ 0.2 U 1/8/2009 This case was reported by a physici
336964 1/9/2009 NY 32 32 F 1/8/2009 This case was reported by a physici
336968 1/9/2009 MT 65 65 M 1/9/2009 Pt phoned 1/8/09 stating that he had
336969 1/9/2009 MI 0.4 0 0.4 M 1/7/2009 Mother states child developed Temp
336970 1/9/2009 MI 8 8 F 1/7/2009 No information Provided
336971 1/9/2009 KY 57 57 F 1/9/2009 Patient reported to facility with 5 1/2
336972 1/9/2009 ND 20 20 M 1/2/2009 1-2-09 client received MENACTRA
336973 1/9/2009 IN 1.1 1 0.1 F 1/9/2009 Rash over body started 1/8/09, wors
336974 1/9/2009 AZ 11 11 F 1/9/2009 B/L deltoid area with erythema/ war
336975 1/9/2009 NY 18 18 F 1/9/2009 Patient given GARDASIL- fainted af
336977 1/9/2009 HI 20 20 F 1/5/2009 Dizzy, lightheaded, tachycardia, inte
336978 1/9/2009 UT 19 19 F 1/9/2009 15 min after immunization complain
336979 1/9/2009 OR 18 18 M 1/9/2009 Mini stroke. 2/18/09 Neurology cons
336980 1/9/2009 TX 1.2 1 0.2 F 1/9/2009 DTAP 0.5 cc IM right deltoid. With in
336981 1/9/2009 NY 75 75 F 1/9/2009 Patient developed shingle along C3
336982 1/9/2009 NH 12 12 M 1/9/2009 Patient developed redness and pain
336983 1/9/2009 CO 0.3 0 0.3 M 1/9/2009 Within 72 hrs of receiving 4 month v
336984 1/9/2009 VA 1.5 1 0.5 M 1/9/2009 Profuse Vomiting
336985 1/9/2009 CA 1.3 1 0.3 F 1/9/2009 8:51 am onset of 104 degree fever.
336986 1/9/2009 CA 1.5 1 0.5 F 1/9/2009 (L) chin swelling. Increase fever of 4
336947 1/10/2009 TX 31 31 F 1/10/2009 Low grade fever, sore throat, swolle
336948 1/10/2009 PA 80 80 F 1/10/2009 Patient's son (a DMD) is visiting from
336949 1/10/2009 CA 65 65 F 1/10/2009 Dermatofibroma at site (subcutaneo
336950 1/11/2009 MA 3 3 M 1/11/2009 Vomiting and fever. Had Vaccine m
336951 1/11/2009 NE 28 28 F 1/11/2009 Erroneously received two doses of M
336952 1/11/2009 MN 42 42 F 1/11/2009 Fever (<100dF), which lasted sever
336953 1/11/2009 UT 50 50 F 1/11/2009 Wed, 7 Jan afternoon, shut van slid
336954 1/11/2009 FL 29 29 M 1/11/2009 high temperature, respiratory illness
336955 1/11/2009 CA 72 72 F 1/11/2009 Swelling, inflamation, pain at shot s
336956 1/11/2009 TN 0.3 0 0.3 F 1/11/2009 Behavior changes including fussine
337032 1/12/2009 TN 18 F 1/9/2009 Information has been received from
337033 1/12/2009 U 1/9/2009 InformationYhas been received from
337035 1/12/2009 GA 0.2 0 0.2 M 1/9/2009 Information has been received from
337036 1/12/2009 NY 71 71 M 1/7/2009 6-27-02 1st PNEUMOVAX - 0 reach
337037 1/12/2009 FL 25 25 F ### Cellulitis infection near injection site
337038 1/12/2009 AZ 32 32 M 1/6/2009 Nausea, vomiting, fatigue and hot fl
337039 1/12/2009 WI 17 17 M ### Loss of consciousness sonorous br
337040 1/12/2009 CT 17 F Fluctuating total body urticaria. Tre
337041 1/12/2009 NV 60 60 F 1/7/2009 Client called and reported a rash all
337042 1/12/2009 FL 1.2 1 0.2 M 1/7/2009 rash
337043 1/12/2009 MN 53 53 F ### 4 Inch redness at injection site that
337045 1/12/2009 NC 0.2 0 0.2 M ### High pitched unconsolable crying +
337046 1/12/2009 IN 47 47 F 1/3/2009 Received MMR + VARIVAX vaccine
337047 1/12/2009 TN 0.8 0 0.8 M ### Local reaction redness, swelling for
337048 1/12/2009 TN 1 1 0M ### Had temp 102.4 evening following v
337049 1/12/2009 FL 1.1 1 0.1 M 1/5/2009 Red bumps all over face, neck, arm
337050 1/12/2009 LA 0.4 0 0.4 M ### 1 by 1 cm redden area to (R) thigh &
337051 1/12/2009 HI 11 11 F ### Right arm redness 7.5cm x 3.5cm, t
337052 1/12/2009 MN 2 2 0.2 F Temperature unknown. Symptoms i
337053 1/12/2009 MT 65 65 F 12/3/2008 Female complains of sore right arm
337054 1/12/2009 MI 51 51 F 1/6/2009 Pain at injection site for 2 months.
337055 1/12/2009 WV 4 4 F ### At approx 11:30 am pt developed ra
337056 1/12/2009 OR 8 8 M ### 12/30 Mom noticed swelling at injec
337057 1/12/2009 FL 1 1 0M 1/7/2009 Pt received varicella immunization o
337058 1/12/2009 CO 12 12 M ### Developed diffuse, maculopapular r
337059 1/12/2009 MI 62 62 F Pt states about 2-3 days after inject
337060 1/12/2009 OH 71 71 F Hard, warm swelling shoulder to elb
337061 1/12/2009 PA 0.4 0 0.4 F 1/12/2009 Intussusception. 2/23/09 Received
337062 1/12/2009 MN 23 23 F 1/12/2009 Patient felt hot, dizzy, lightheaded, h
337063 1/12/2009 WV 42 42 F 1/8/2009 Right deltoid developed edema afte
337064 1/12/2009 MI 90 90 F 1/7/2009 Elevated swelling with in duration an
337065 1/12/2009 GA 44 44 F 1/6/2009 States she had nausea and chest p
337067 1/12/2009 PA 57 57 M 1/12/2009 Patient received a pneumococcal va
337068 1/12/2009 VA 50 50 F 1/12/2009 "Tender anterior cervical adenoopat
337069 1/12/2009 SC 6 6 F 1/12/2009 Parent reported temp of 101.1 on ev
337070 1/12/2009 CA 26 26 F 1/12/2009 Received TDAP Vaccine on 1/7/200
337071 1/12/2009 ND 14 14 M 1/12/2009 Four hours after vaccination, patien
337072 1/12/2009 OH 18 18 F 1/12/2009 Patient left message on voicemail 0
337073 1/12/2009 OK 0.2 0 0.2 F 1/12/2009 gave pt wrong immunization in wron
337074 1/12/2009 GA 0.3 0 0.3 F 1/12/2009 SPOKE WITH MOTHER AND NOT
337075 1/12/2009 CA 14 13 M 1/12/2009 fever 104, Rt arm swollen from elbo
337076 1/12/2009 TN 0.2 8 F 1/12/2009 diarrhea
337077 1/12/2009 HI 19 19 M 1/12/2009 FEVER 102F, VOMITING X1 DAY.
337078 1/12/2009 MD 63 65 M 1/12/2009 Malaise onset 36-48 h after immuniz
337079 1/12/2009 MD 0.1 0 0.1 M 1/12/2009 3 DAYS AFTER VACCINES PT DE
337080 1/12/2009 LA 0 0 0F 1/12/2009 Pt recieved two Hep B vaccines dur
337081 1/12/2009 OK 55 55 F 1/12/2009 Complains of upper right arm pain s
337082 1/12/2009 4 4 F 1/12/2009 RASH ALL OVER BODY
337083 1/12/2009 AZ 46 46 F 1/12/2009 Nerve tingling at all sites from bottom
337084 1/12/2009 CO 34 34 F 1/12/2009 "Breathing difficulty, fever, body ach
337086 1/12/2009 KY 67 67 F 1/12/2009 Arm developed a 3 inch diameter re
337099 1/12/2009 21 21 M ### 18 Days after small pox and anthrax
337100 1/12/2009 AL 1.8 1 0.8 F 1/5/2009 Febrile seizure - Had flu shot 11-14-
337101 1/12/2009 KY 46 46 F 1/9/2009 Patient had Tdap injection LT arm o
337102 1/12/2009 MI 0.5 0 0.5 M ### Infant found listless, poor muscle to
337103 1/12/2009 AL 9 9 F FLUMIST received 12/27/08. On 12
337104 1/12/2009 AL 41 41 M ### Flumist received on Saturday, 12/27
337105 1/12/2009 FL 62 62 F 1/6/2009 Had a headache from 12-17-08 time
337113 1/12/2009 MN 70 U ### Information has been received from
337087 1/13/2009 GA F 1/12/2009 This case was reported by a healthc
337088 1/13/2009 WA 70 70 F 1/12/2009 This case was reported by a consum
337089 1/13/2009 OH F 1/12/2009 This case was reported by a pharma
337094 1/13/2009 AZ 1.4 1 0.4 M 1/12/2009 Vomiting, fever, Heat @ site.
337095 1/13/2009 MN 60 60 F 1/12/2009 Shortness of breath, bodyaches. Tr
337096 1/13/2009 PA 12 12 F 1/12/2009 Pt recvd menactra + Hep A vaccine
337097 1/13/2009 TX 35 35 F 1/12/2009 Developed shaking, shivering with p
337098 1/13/2009 WA 19 19 M 1/12/2009 Patient filled out info sheet stating h
337115 1/13/2009 MO F ### Information has been received from
337130 1/13/2009 TX 0.3 0 0.3 M Pt. examined Y and vaccinated on 12
337132 1/13/2009 CA 1.8 1 0.8 F 1/8/2009 Developed cold, cough, vomiting aft
337133 1/13/2009 WA 16 16 F ### Within 5 mins of receiving HPV injec
337134 1/13/2009 OR 44 44 F 1/6/2009 Saw PCP With X 3days fever 99 , H
337135 1/13/2009 MN 0.9 0 0.9 F 1/8/2009 Hours after flu vaccine administered
337136 1/13/2009 NC 1.6 1 0.6 F 1/9/2009 Seen on 1-7-09 = lt leq red + swolle
337137 1/13/2009 IN 33 33 F 1/9/2009 Patient had a flu shot in October 20
337138 1/13/2009 NH 26 26 M ### Member developed a satellite pustu
337139 1/13/2009 VT 54 54 F 12/3/2008 Burning itch over upper body, extrem
337141 1/13/2009 MN U Right Arm cellulitis.
337142 1/13/2009 PA 63 63 F 10/20/08 Vaccinated at 9AM- Pain i
337143 1/13/2009 NJ 3 3 F ### Slept 14 hours; woke up dizzy; then
337144 1/13/2009 IL 18 18 F 1/6/2009 Patient fainted 4 days after vaccinat
337145 1/13/2009 TX 1.1 1 0.1 M 1/8/2009 Erythema 20 x 20 over (L) arm PCV
337146 1/13/2009 TX 26 26 F 1/6/2009 Dizzy, headache, brown spot in visio
337147 1/13/2009 VA 26 26 F 1/9/2009 Blister at the side where HEPTAVAX
337148 1/13/2009 MA 5 5 M 1/7/2009 (L) deltoid with 11.5cm x 13cm area
337149 1/13/2009 MN 11 11 M ### 20cm erythema, pruritis and pain at
337150 1/13/2009 MA 49 49 F 1/8/2009 Generalized body rash with mild ede
337151 1/13/2009 AL 37 37 F 11/4/2008 Nerve damage in right arm. I have p
337152 1/13/2009 M 1/12/2009 Information has been received from
337155 1/13/2009 FL 15 15 F 1/12/2009 Information has been received for th
337157 1/13/2009 OH 4 4 M 1/13/2009 Redness noted at injection site on le
337158 1/13/2009 MN 22 22 F 1/13/2009 after first two HPV shots had muscle
337159 1/13/2009 MI 5 5 M 1/13/2009 Patient has received two Varicella v
337160 1/13/2009 OK 16 16 F 1/13/2009 PT RECEIVED GARDASIL, MENAC
337161 1/13/2009 MI 0.8 0 0.8 M 1/13/2009 On 1-9-09 patient had a seizure at 7
337162 1/13/2009 OK 6 6 F 1/13/2009 PT PRESENTED TO OFFICE ON 1
337163 1/13/2009 GA 41 41 M 1/13/2009 Headache, malaise, myalgias began
337165 1/13/2009 WI 0.3 0 0.4 M 1/13/2009 3 days following vaccination patient
337166 1/13/2009 LA 14 14 F 1/13/2009 Started complaining with joint pain,
337167 1/13/2009 VA 0.2 0 0.2 F 1/13/2009 1/8, 11:40am - parent returned to he
337168 1/13/2009 FL 11 11 F 1/13/2009 My daughter recived the first HPV g
337169 1/13/2009 TX 0.6 0 0.6 F 1/13/2009 Child had seizure 7 hours after 2nd
337170 1/13/2009 GA 0.5 0 0.5 U 1/13/2009 Flush race on face and swelling of f
337171 1/13/2009 TX 0.3 0 0.3 M 1/13/2009 Sseizure within 24 hours of vaccina
337172 1/13/2009 CO 63 63 F 1/13/2009 WEAKNESS; PAIN & NUMBNESS
337173 1/13/2009 AZ 58 58 F 1/13/2009 10/16/08 1 PM-PT REPORTED FRE
337174 1/13/2009 FL 35 35 F 1/13/2009 Right deltoid slightly swollen, with w
337175 1/13/2009 PA 75 75 F 1/13/2009 Four days of chills without fever, my
337176 1/13/2009 IL 11 11 F 1/13/2009 Itchy rash, raised bump at the site, s
337177 1/13/2009 CA 0.2 0 0.2 M 1/13/2009 My son was a very happy and relax
337178 1/13/2009 MI 38 38 F 1/13/2009 1-10-09 11am stiff neck, tight jaw m
337179 1/13/2009 MO 12 12 M 1/13/2009 Within five minutes of vaccine admin
337180 1/13/2009 NV 17 17 F 1/13/2009 Pt developed strong daily headache
337181 1/13/2009 ME 35 34 M 1/13/2009 Site was mildly painful, warm, red, s
337182 1/13/2009 IL 15 15 F 1/8/2009 Patient developed genital herpes pr
337183 1/13/2009 HI 20 20 F Dizziness, lightheaded, tachycardia
337186 1/13/2009 CA 4 4 M 1/12/2009 L upper arm- erythematous mac rais
337187 1/13/2009 NM 52 52 F Swelling of entire arm down to finge
337188 1/13/2009 KY 1.3 1 0.3 M 1/8/2009 Developed fever of 104 degrees foll
337189 1/13/2009 NY 1.7 1 0.7 M 1/13/2009 Swelling to LL at site of vaccine. Ad
337190 1/13/2009 NY 1 1 0M 1/9/2009 Fever (low grade), rash of a vesicula
337191 1/13/2009 NC 37 37 F ### (L) dt area where she got ADACEL
337192 1/13/2009 NC 26 26 F ### Patient developed low back pain tha
337193 1/13/2009 CA 1.3 1 0.3 M 1/9/2009 Fever 104 - x2Days, Motrin/Tylenol.
337194 1/13/2009 NY 18 18 M 1/13/2009 Night of vaccines pt broke out in hiv
337195 1/13/2009 NY 16 16 M 1/13/2009 Mom stated child had congestion, s
337196 1/13/2009 CT 26 26 F 1/6/2009 Left arm pain since flu shot reported
337197 1/13/2009 CT 70 70 M 1/6/2009 Pt states his whole right arm was sw
337199 1/13/2009 CT 72 72 M 1/12/2009 Pt states his whole right arm was sw
337204 1/13/2009 CT 50 50 F 1/6/2009 12/10/08 Reported persistent pain a
337205 1/13/2009 OH 73 73 F 1/12/2009 1/6/09 left upper arm became red, w
337206 1/13/2009 MO 79 79 F 1/5/2009 30x50 mm area of erythema and wa
337207 1/13/2009 OR 56 56 F 1/13/2009 Day 3 post tetanus/pertussis vaccin
337208 1/13/2009 NC 18 18 M ### Pt given RECOMBIVAX HB instead
337209 1/13/2009 NC 57 57 F ### Infection of left deltoid following Influ
337210 1/13/2009 VA 19 19 F 1/12/2009 C/O redness and swelling at injectio
337211 1/13/2009 NY 48 48 F 1/12/2009 45 minutes after injection - develope
338020 1/13/2009 NY 1.3 M 1/12/2009 Information has been received from
338021 1/13/2009 1.1 1 0.1 F 1/12/2009 Information has been received from
338022 1/13/2009 TX U 1/12/2009 Information has been received from
338024 1/13/2009 OH 1.3 1 0.3 M 1/12/2009 Information has been received from
337227 1/14/2009 61 F ### Information has been received from
337242 1/14/2009 NM 20 20 F 1/9/2009 My daughter Y had her 3rd GARDASI
337243 1/14/2009 PA 0.4 0 0.4 M 1/9/2009 Patient developed
Y hemorrhagic sho
337245 1/14/2009 OH 1 1 0M 1/9/2009 Can the chicken pox vaccine cause
337246 1/14/2009 MA 14 14 F 1/12/2009 VARIVAX & influenza given in left a
337247 1/14/2009 PA 38 38 F 1/8/2009 Pain in L upper arm with 2 hours of
337248 1/14/2009 F 1/12/2009 Hives after ZOSTAVAX vaccination
337249 1/14/2009 27 27 F 1/12/2009 Diagnosed with rheumatoid arthritis
337250 1/14/2009 20 20 F ### Pt describes onset of pain at R shou
337251 1/14/2009 77 M ### 12/22/08 patient called after hours w
337252 1/14/2009 65 M 1/3/2009 Fever, Erythema Multiforme, Diarrhe
337301 1/14/2009 PA 16 16 F 1/13/2009 Information has been received from
337303 1/14/2009 CT 12 12 F 1/13/2009 Information has been received from
337304 1/14/2009 OK 67 F 1/13/2009 Initial and follow-up information has
337309 1/14/2009 MA 66 66 F ### PNEUMOVAX 23 given 12/2/08 bet
337310 1/14/2009 IL 55 55 M 1/13/2009 Persistent right deltoid pain after He
337321 1/14/2009 RI 78 78 M 1/14/2009 Patient began with cough and uppe
337322 1/14/2009 FL 51 51 M 1/14/2009 01/05/2009 Increase Tempature/ 0
337323 1/14/2009 NE 12 12 F 1/14/2009 Provider notified
Y on 1/2/09 that patie
337324 1/14/2009 MI 76 76 F 1/14/2009 TWO WEEKS AFTER VACCINATIO
337325 1/14/2009 AZ 2 2 0.2 F 1/14/2009 A little more than 24 hours I noticed
337326 1/14/2009 TX 4 4 M 1/14/2009 2 days after receiving Hepatitis A an
337327 1/14/2009 FL 4 4 M 1/14/2009 THE DAY AFTER I ADMINISTERED
337328 1/14/2009 TX 12 12 M 1/14/2009 Pt ran fever to 102. Had a large kno
337330 1/14/2009 MN 44 44 F 1/14/2009 upper arm 7cm red/warm tender bu
337331 1/14/2009 CT 0.5 0 0.5 M 1/14/2009 Pt developed fever of 104.5 with irri
337332 1/14/2009 NC 28 28 F 1/14/2009 Flushot given around 11AM? About
337333 1/14/2009 NC 5 5 F 1/14/2009 RED,SWOLLEN LEFT DELTOID RE
337334 1/14/2009 MI 14 14 F 1/14/2009 Arm swelling (site of innoculation), a
337335 1/14/2009 MI 36 36 M 1/14/2009 Approximately 2 hours after receive
337336 1/14/2009 MI 18 18 F 1/14/2009 Given Meningococcal (MCV4) vacci
337337 1/14/2009 KS 22 22 F 1/14/2009 Sharp stomach pains within 2 hours
337338 1/14/2009 FL 65 M 1/14/2009 yfvax administered 01/12/09, 01/13/
337340 1/14/2009 IL 4 4 F 1/14/2009 DTaP given on 1/12/09 right arm, H
337341 1/14/2009 MN 26 26 F 1/14/2009 4 hours after shot administered, felt
337342 1/14/2009 NC 45 45 M 1/14/2009 1 1/2 hours after receiving the MMR
337343 1/14/2009 UT 23 23 F 1/14/2009 Shots at 2:30pm 12/30/08 Slight he
337344 1/14/2009 ME 64 64 F 1/14/2009 Patient reported having a fever, loca
337345 1/14/2009 VA 65 65 F 1/14/2009 Shingle Shot was administered and
337346 1/14/2009 63 63 F 1/14/2009 patient came down with Shingles. W
337347 1/14/2009 GA 6 6 F 1/14/2009 SHE RECEIVED THE FLU SHOT IN
337348 1/14/2009 OR 4 4 F 1/14/2009 Fever at least 103, chills, fatigue, lo
337353 1/14/2009 NY 47 47 F 1/11/2008 Description: 47 y/o female AD SM re
337354 1/14/2009 TX 20 20 U 1/14/2009 The patient states with every flu vac
337355 1/14/2009 FL 68 68 F 1/14/2009 Pt came in c/o pain to L side of face
337356 1/14/2009 CA 4 4 F 1/14/2009 Mild local hypersensitivity Rxn to va
337357 1/14/2009 CA 0.4 0 0.4 M 1/14/2009 Injection given on 01/13/09 in arm. M
337358 1/14/2009 AZ 67 F 1/7/2009 Rash- has been to 2 Doctors who s
337359 1/14/2009 NC 7 7 F 1/19/2009 Rt arm red & swelled where VARIVA
337361 1/14/2009 NY 48 48 F 1/14/2009 C/O chills, fever, headache, body ac
337362 1/14/2009 MI 1.2 1 0.2 M 1/14/2009 There is a 6x7cm hard red patch on
337363 1/14/2009 IN 12 12 F 1/14/2009 Patient eyes swollen shut, itchy. BE
337364 1/14/2009 NC 1.3 1 0.3 M 1/14/2009 3 erythematous areas distal to site o
337365 1/14/2009 IL 16 16 F 1/6/2009 Lower abdominal discomfort, onset
337417 1/15/2009 33 33 M 1/12/2009 This patient was a 34 year old male
337419 1/15/2009 25 25 M 1/15/2009 SM who received multiples doses o
337420 1/15/2009 OH 60 60 F 1/12/2009 1-05-2009 received flu vaccine. Pt r
337421 1/15/2009 NH 53 53 F 1/12/2009 Pt developed cellulitis on the site of
337422 1/15/2009 AZ 22 22 F 1/13/2009 Patient received yellow fever and ty
337423 1/15/2009 WA 67 67 U Within 18 hours-swelling 2"x3" raise
337424 1/15/2009 WA 52 52 F 1/11/2009 Flu Shot was fine at first but overtim
337425 1/15/2009 AZ 2 2 0.1 F 1/10/2009 Pain at sight, fever, non-weight bea
337426 1/15/2009 AZ 2 M 1/10/2008 Pain at injection site, fever, non-wei
337427 1/15/2009 21 21 F 1/10/2009 Prior to 3 doses of GARDASIL I had
337428 1/15/2009 WA 12 12 F 1/7/2009 After first shot of GARDASIL on 2-7
337429 1/15/2009 27 27 M 6/2/2008 27 y.o. AD AA male SM presents wi
337430 1/15/2009 NC 19 19 M 1/15/2008 SM received his primary SPV on 11
337431 1/15/2009 NC 40 40 F 1/9/2008 Less than one minute after receiving
337432 1/15/2009 32 32 M 1/4/2008 SM developed redness, swelling, pa
337433 1/15/2009 NC 21 21 M ### noted rash on arm, redness into his
337434 1/15/2009 NC 41 41 M ### SM with h/o eczema that received S
337435 1/15/2009 NC 22 22 M ### SM noted redness, swelling around
337436 1/15/2009 19 19 M ### SM had large local reaction with his
337437 1/15/2009 21 21 M 12/7/2007 SM notes he had large local reactio
337438 1/15/2009 28 28 F ### Developed large local reaction to an
337439 1/15/2009 NC 29 29 F 11/7/2007 SM went to PCP for evaluation of H
337440 1/15/2009 FL M 1/14/2009 Information has been received from
337442 1/15/2009 16 16 F 1/14/2009 Information has been received, for t
337444 1/15/2009 0.2 0 0.2 U 1/14/2009 Information has been received from
337452 1/15/2009 55 55 F 1/15/2009 This case was reported by a consum
337453 1/15/2009 OR 0.5 0 0.5 M 1/15/2009 Intussusception. First began with bl
337454 1/15/2009 CO 64 64 F 1/12/2009 Bright red, hard area approximately
337455 1/15/2009 AZ 0.3 0 0.3 M 1/13/2009 Mother reported elevated temperatu
337456 1/15/2009 AZ 5 5 F 1/13/2009 Redness developed at injection site
337457 1/15/2009 NY 17 17 M 1/15/2009 About 2-3 mins after receiving vacci
337458 1/15/2009 NY 18 18 F 1/15/2009 Patient states that right wrist was sw
337459 1/15/2009 CA 1.4 1 0.4 F 1/15/2009 Red, warm to touch rash at injection
337460 1/15/2009 KS 0.2 0 0.2 M 1/15/2009 Mother noted blood in infant's stool
337461 1/15/2009 PA 0.2 0 0.2 M 1/15/2009 high pitched screaming for hours on
337462 1/15/2009 KY 2 2 0.6 F 1/15/2009 Mother reports hives on back- uppe
337463 1/15/2009 IA 86 85 F 1/15/2009 Patient reported raised red very pai
337464 1/15/2009 OH 0.5 0 0.6 F 1/15/2009 Motehr called and reported need to
337465 1/15/2009 MD 17 17 F 1/15/2009 Within 3 days of receiving the 2nd r
337466 1/15/2009 CA 69 69 F 1/15/2009 patient was accidently give Tdap ins
337467 1/15/2009 WA 12 12 F 1/15/2009 High fevers 102+, Nausea, Dizzy, le
337468 1/15/2009 GA 4 4 F 1/15/2009 Pt R leg 11 x 7 cm reddened area n
337469 1/15/2009 WA 63 63 F 1/15/2009 Lower upper arm is very swollen an
337470 1/15/2009 ID 54 54 F 1/15/2009 Received 3rd hep B injection on 12/
337471 1/15/2009 NY 3 3 F 1/15/2009 low grade fever, vomiting, dehydrati
337472 1/15/2009 CA 40 40 F 1/15/2009 Patient complained of persistent red
337473 1/15/2009 OR 6 6 M 1/15/2009 Acute icshemic stroke (basilar artery
337474 1/15/2009 CO 50 50 M 1/15/2009 Following receipt of vaccines in trav
337475 1/15/2009 TN 62 62 F 1/15/2009 Patient received vaccine 01/06/2009
337476 1/15/2009 CA 25 25 F 1/15/2009 Hepatitus B Vaccine series given at
337477 1/15/2009 MI 1.3 1 0.3 M 1/15/2009 Uncontrollable screaming and fits of
337478 1/15/2009 CA 42 42 F 1/15/2009 Onset of reactive lymphadenopathy
337479 1/15/2009 IN 1 0 0M 1/15/2009 Jacob had a febrile seizure with a te
337480 1/15/2009 NC 4 4 M 1/14/2009 Dar reported patient "almost passed
337481 1/15/2009 NH 1.6 1 0.6 F 1/15/2009 Mom called-mosquito bite size area
337482 1/15/2009 NC 0.3 0 0.3 M 1/13/2009 When pt was brought to my office fo
337483 1/15/2009 0.8 0 0.8 M 1/6/2009 Hepatitis A given to 9 month old chi
337484 1/15/2009 CA 0.2 0 0.2 F ### persistent severe irritability, 4-6 hrs
337485 1/15/2009 WI 5 5 F 1/8/2009 Upper leg Swelling, warmth redness
337486 1/15/2009 TX 46 46 M 1/8/2009 12/20 1 1/2 area of redness with ele
337487 1/15/2009 GA 5 5 M 1/9/2009 Left upper arm - redness and swellin
337488 1/15/2009 MA 23 23 F 1/9/2009 C/O light headedness and inability t
337489 1/15/2009 NC 9 9 F 9/22/2008 Client given Tdap - recommended fo
337490 1/15/2009 CA 15 15 F 1/15/2009 Complained of pain radiating from in
337491 1/15/2009 IN 68 68 F 1/15/2009 Five inch red circle around administ
337492 1/15/2009 32 32 M 11/1/2007 SM changed bandage over SPV site
337493 1/15/2009 ME 10 10 M 1/15/2009 1/12/09- Area swelled red raised. V
337494 1/15/2009 IA 0.4 0 0.4 F 1/14/2009 Child came to appointment for 4 mo
337495 1/15/2009 OH 0.2 0 0.2 M 1/12/2009 Abnormal sounding cry, crying cons
337496 1/15/2009 IN 0.9 0 0.9 M 1/15/2009 On 1-14-09 per mother at 10:30 pm
337499 1/15/2009 MD U None stated
337502 1/15/2009 CA 35 35 F 1/15/2009 Within 2 hours of vaccination Pt exp
337503 1/15/2009 MI 29 29 F 1/15/2009 11-14-09 back of neck began to itch
337506 1/15/2009 VT 58 58 M 1/13/2009 Severe Shaking Chills myalgias for
337507 1/15/2009 NY 1.5 1 0.5 F ### Here with both parents for rash, Frid
337541 1/16/2009 CA 4 4 F 1/12/2009 1/5/09 received DTAP, IPV, MMR,V
337542 1/16/2009 CA 25 25 M 1/13/2009 Left arm cellulitis 24 hours after vac
337544 1/16/2009 FL 75 75 F Vaccine injection 3:45p- woke up 9:
337545 1/16/2009 MO 15 15 F 1/8/2009 10/07- Vomiting, Diarrhea Daily-No
337546 1/16/2009 MO 15 15 F 1/12/2009 Within 24 hours of HPV dose given
337547 1/16/2009 NY 61 61 F 1/12/2009 1/9/09 0830 Pt. called to report that
337548 1/16/2009 NY 60 60 F patient developed a 1"x1 1/2" indura
337549 1/16/2009 CA 0.1 0 0.1 F 1/12/2009 Bloody, mucousy stools after ROTA
337550 1/16/2009 NY 4 4 F 1/4/2009 24 hrs after UMM placed erythema,
337551 1/16/2009 IL 2 2 0M 1/12/2009 Child received PEDIARIX/PREVNA
337552 1/16/2009 AZ 1.1 1 0.1 F ### Started 10-15 min after getting vacc
337553 1/16/2009 62 62 U Large lump- size of "grape" in arm -
337584 1/16/2009 PA 0.2 0 0.2 F 12/1/2008 Information has been received from
337585 1/16/2009 U 1/15/2009 Information has been received from
337586 1/16/2009 M 1/15/2009 Information was obtained on reques
337591 1/16/2009 FL 13 13 F 1/15/2009 Information has been received from
337592 1/16/2009 CA 19 19 F 1/15/2009 Information has been received from
337596 1/16/2009 NJ F 1/15/2009 Information has been received from
337600 1/16/2009 FL 66 66 F 1/16/2009 Within 30 minutes of vaccination to
337601 1/16/2009 FL 69 69 F 1/16/2009 The patient presented with swelling
337602 1/16/2009 FL 67 67 M 1/16/2009 Patient presented with cellulitis of rig
337603 1/16/2009 NY 24 24 F 1/16/2009 I HAD SEVERE PAIN AT THE SITE
337605 1/16/2009 TX 1 1 0F 1/16/2009 Patient had a rash on the thighs and
337606 1/16/2009 NM 15 15 F 1/16/2009 Abdominal pain/stomach cramps for
337607 1/16/2009 NM 13 13 M 1/16/2009 Was disoriented, unable to answer
337608 1/16/2009 DC 5 5 F 1/16/2009 PT RECEIVED EXPIRED FLUMIST
337609 1/16/2009 SC 42 42 F 1/16/2009 Reported rash & periorbital swelling
337610 1/16/2009 TN 42 42 F 1/16/2009 Patient reported burning and stingin
337611 1/16/2009 FL 44 44 F 1/16/2009 Pt experienced large local reaction
337612 1/16/2009 CA 54 54 F 1/16/2009 Patient came to clinic today and pre
337613 1/16/2009 WY 0.2 0 0.2 F 1/16/2009 Patient developed watery diarrhea 1
337614 1/16/2009 AZ 34 34 F 1/16/2009 Patient came to Health Center at 12
337615 1/16/2009 WY 33 33 M 1/16/2009 eyes itching, tightness in chest, cou
337616 1/16/2009 AZ 18 18 F 1/16/2009 Had 1st HPV on November 4th, 200
337617 1/16/2009 CA 2 2 0.1 F 1/16/2009 Patient had an afebrile seizure even
337618 1/16/2009 PA 29 29 F 1/16/2009 Sore arm, fever, body aches, chills,
337649 1/16/2009 UT 1.1 1 0.1 M 1/16/2009 Information has been received from
337651 1/16/2009 F 1/16/2009 Information has been received from
337652 1/16/2009 MA F 1/15/2009 This case was considered medically
337663 1/16/2009 NJ 48 48 M 1/16/2009 This case was reported by a lawyer
337664 1/16/2009 NY M 1/16/2009 This case was reported by a lawyer
337665 1/16/2009 NJ M 1/16/2009 This case was reported by a lawyer
337667 1/16/2009 NJ F 1/16/2009 This case was reported by a lawyer
337668 1/16/2009 NY 46 46 M 1/16/2009 This case was reported by a lawyer
337670 1/16/2009 AL 0.1 0 0.1 M 1/12/2009 Found by father
Y not breathing appro
337671 1/16/2009 AR 0.5 0 0.5 F 1/16/2009 Pt was administered
Y vaccines on 01
337672 1/16/2009 MA 5 5 F 1/12/2009 Developed hives/facial swelling, loc
337674 1/16/2009 GA 8 8 F 1/16/2009 11/4 had varicella shot R arm. 11/5
337675 1/16/2009 IL 32 32 U Lt deltoid became red, swollen, war
337688 1/16/2009 VA 87 87 F 1/14/2009 VARICELLA- like rash
337689 1/16/2009 KS 19 19 M 1/15/2009 Chills, fever of 101.9, aches, stiffnes
337690 1/16/2009 MN 44 44 F 1/9/2009 My left shoulder started pinching. T
337691 1/16/2009 MN 43 43 F 1/9/2009 Worst shot ever given- hurt immedia
337692 1/16/2009 NC 0.6 0 0.6 F 3/5/2008 Redness, induration, swelling on R
337693 1/16/2009 WI 15 15 F 1/16/2009 Syncopal episode following GARDA
337694 1/16/2009 AZ 53 53 M 1/16/2009 Redness, firm, warm to touch 6.0cm
337695 1/16/2009 TX 1.4 1 0.4 F Area is swollen, hot red to left thigh.
337696 1/16/2009 FL 1.3 1 0.3 M 1. Inconsolable, crying within 6 hrs.
337697 1/16/2009 WI 12 12 M 1/14/2009 Confused/blurriness/head pain/naus
337698 1/16/2009 36 36 M 1/25/2008 SM developed redness, swelling an
337699 1/16/2009 31 31 M 1/31/2008 Developed redness, pain and swelli
337700 1/16/2009 CA 9 9 F 1/15/2009 Pt received vaccine at our office on
337701 1/16/2009 MI 65 65 F 1/16/2009 Vaccines given 1/14/09. Left arm s
337702 1/16/2009 MN 1 1 0F 1/19/2009 Patient developed hives within 2 hrs
337703 1/16/2009 OH 1 1 0M 1/12/2009 Red raised rash over torso, about 3
338026 1/16/2009 U 1/12/2009 On unspecified dates, the subjects r
338027 1/16/2009 U 1/12/2009 This case was reported by a sales r
338028 1/16/2009 DC 21 21 F 1/12/2009 This case was reported by a healthc
338029 1/16/2009 GA 45 45 M 1/12/2009 This case was reported by a healthc
338034 1/16/2009 MO M 1/12/2009 This case was reported by a physici
338035 1/16/2009 NY U 1/12/2009 This case was reported by a pharm
338036 1/16/2009 CT 10 10 F 1/12/2009 This case was reported by a healthc
338037 1/16/2009 WI 39 39 M 1/12/2009 This case was reported by a healthc
338038 1/16/2009 OK F 1/12/2009 This case was reported by a physici
338039 1/16/2009 CA 38 38 F 1/12/2009 This case was reported by a healthc
338040 1/16/2009 8 F 1/12/2009 This case was reported by a consum
338041 1/16/2009 U 1/12/2009 This case was reported by a healthc
338042 1/16/2009 CA U 1/12/2009 This case was reported by a physici
338043 1/16/2009 IN 48 F 1/12/2009 This case was reported by a healthc
338044 1/16/2009 NY 0.3 0 0.3 F 1/12/2009 This case was reported by a healthc
338045 1/16/2009 F 1/12/2009 This case was reported by a consum
338047 1/16/2009 IN 0.1 0 0.1 M 1/12/2009 This case was reported by a pharma
338048 1/16/2009 38 38 F 1/12/2009 This case was reported by a healthc
338075 1/16/2009 NC 26 26 M 1/12/2009 This case was reported by a health
338076 1/16/2009 PA 48 48 M 1/12/2009 This case was reported by a pharma
338077 1/16/2009 F 1/12/2009 This case was reported by a healthc
338078 1/16/2009 U 1/12/2009 This case was reported by a physici
338079 1/16/2009 IL M 1/12/2009 This case was reported by a consum
338080 1/16/2009 OH 50 50 M 1/12/2009 This case was reported by a healthc
338082 1/16/2009 NJ 45 45 M 1/12/2009 This case was reported by a healthc
338083 1/16/2009 TX F 1/12/2009 This case was reported by a healthc
338084 1/16/2009 TX M 1/12/2009 This case was reported by a healthc
338086 1/16/2009 MI 3 3 F 1/12/2009 This case was reported by a healthc
338087 1/16/2009 PA F 1/12/2009 This case was reported by a nurse a
338088 1/16/2009 NC 26 26 M 1/12/2009 This case was reported by a healthc
338090 1/16/2009 WI 27 27 F 1/12/2009 This case was reported by a healthc
338091 1/16/2009 F 1/12/2009 This case was reported by a physici
338092 1/16/2009 IN U 1/12/2009 This case was reported by a pharma
338095 1/16/2009 DE 50 M 1/12/2009 This case was reported by a healthc
338096 1/16/2009 U 1/12/2009 This case was reported by a pharma
338098 1/16/2009 SC M 1/12/2009 This case was reported by a pharma
338138 1/16/2009 SC M 1/12/2009 This case was reported by a pharma
338147 1/16/2009 22 M 2/12/2009 This case was reported by a pharma
338148 1/16/2009 TX 18 18 F 1/12/2009 This case was reported by a healthc
338150 1/16/2009 U 1/12/2009 This case was reported a physician,
338151 1/16/2009 36 36 M 1/12/2009 The subject was in clinic for day 180
338152 1/16/2009 MO 13 U 1/12/2009 This case was reported by a physici
338154 1/16/2009 IN 37 37 F 1/12/2009 This case was reported by a healthc
338155 1/16/2009 NY 55 55 M 1/12/2009 This case was reported by a healthc
338156 1/16/2009 MO 77 77 F 1/12/2009 This case was reported by a healthc
338157 1/16/2009 M 1/12/2009 This case was reported by a physici
338158 1/16/2009 U This case was reported by a healthc
338159 1/16/2009 CT 62 62 M 1/12/2009 This case was reported by a healthc
338161 1/16/2009 GA F 1/12/2009 This case was reported by a healthc
338162 1/16/2009 NY 29 29 F 1/12/2009 This case was reported by healthca
338163 1/16/2009 CT 42 42 M 1/12/2009 This case was reported by a physici
338164 1/16/2009 CT 31 F 1/12/2009 This case was reported by a consum
338166 1/16/2009 AZ F 1/12/2009 This case was reported by a healthc
338172 1/16/2009 FL 25 25 M 1/12/2009 This case was reported by a healthc
338173 1/16/2009 GA 23 F 1/12/2009 This case was reported by a healthc
338174 1/16/2009 MD 32 32 F 1/12/2009 This case was reported by a consum
338175 1/16/2009 TX 54 F 1/12/2009 This case was reported by a pharma
338176 1/16/2009 MI 79 79 M 1/12/2009 This case was reported by a healthc
338177 1/16/2009 MN 30 M 1/12/2009 This case was reported by a physici
338178 1/16/2009 AZ 78 78 F 1/12/2009 This case was reported by a healthc
338179 1/16/2009 AZ 76 76 F 1/12/2009 This case was reported by a healthc
338182 1/16/2009 KY 58 58 M 1/12/2009 This case was reported by a physici
338183 1/16/2009 ND U 1/12/2009 This case was reported by a pharma
338185 1/16/2009 NY 53 F 1/12/2009 This case was reported by a healthc
338186 1/16/2009 M 1/12/2009 This case was reported by a healthc
338189 1/16/2009 F 1/12/2009 This case was reported by a physici
338190 1/16/2009 AK 53 M 1/12/2009 This case was reported by a consum
338192 1/16/2009 TX 29 29 F 1/12/2009 This case was reported by a physici
338193 1/16/2009 IA 15 15 M 1/12/2009 This case was reported by a healthc
338197 1/16/2009 TX U 1/12/2009 This case was reported by a healthc
338198 1/16/2009 U 1/12/2009 This Case was reported by a pharm
338199 1/16/2009 WI 56 F 1/12/2009 This case was reported by a healthc
338200 1/16/2009 TX U 1/12/2009 On 18 September 2007 the subject
338202 1/16/2009 MI 21 21 M 1/12/2009 This case was reported by a healthc
338353 1/16/2009 FL 0.5 0 0.5 M ### This case was reported by a healthc
338354 1/16/2009 CO 5 5 M ### This case was reported by a healthc
338355 1/16/2009 IL 2 2 0.7 M ### This case was reported by a physici
338356 1/16/2009 IA 5 5 F ### This case was reported by a healthc
338357 1/16/2009 CA 0.3 U ### This case was reported by a physici
338358 1/16/2009 0.5 F ### This case was reported by a physici
338359 1/16/2009 U ### This case was reported by a pharma
338360 1/16/2009 U ### This case was reported by a pharma
338361 1/16/2009 TN 0.2 0 0.2 M ### This case was reported by a healthc
338362 1/16/2009 IN 0.2 0 0.2 M ### This case was reported by the moth
338363 1/16/2009 NC 0.3 U ### This case reported by a physician, v
338364 1/16/2009 NC 0.3 U ### This case was reported by a physici
338365 1/16/2009 NJ 0.2 F ### This case was reported by a physici
338366 1/16/2009 NJ 0.2 0 0.2 M ### This case was reported by a physici
338367 1/16/2009 TX U ### This case was reported by a physici
338368 1/16/2009 VA 2 2 0.1 M ### This case was reported by a healthc
338369 1/16/2009 NY 0.6 0 0.6 F ### This case was reported by a physici
338370 1/16/2009 WA 11 M ### This case was reported by a healthc
338371 1/16/2009 1.1 F ### This case was reported by a consum
338381 1/16/2009 IL 0.6 0 0.6 M ### This case was reported by a physici
338383 1/16/2009 GA 1 1 0F ### This case was reported by a physici
338385 1/16/2009 GA 0.2 0 0.2 M ### This case was reported by a physici
338388 1/16/2009 GA 0.2 0 0.2 M ### This case was reported by a physici
338389 1/16/2009 M ### This case was reported by a physici
338390 1/16/2009 CA M ### This case was reported by a healthc
338391 1/16/2009 MI 1.3 1 0.3 M ### This case was reported by the moth
338392 1/16/2009 IN 1.5 1 0.5 F ### This case was reported by a consum
338393 1/16/2009 IL 0.3 0 0.3 F ### This case was reported by a healthc
338394 1/16/2009 PA 0.3 U ### This case was reported by a physici
338395 1/16/2009 IN 0.4 0 0.4 M ### This case was reported by a healthc
338396 1/16/2009 IL 0.2 0 0.2 F ### This case was reported by a consum
338397 1/16/2009 OR 0.1 0 0.1 M ### This case was reported by a healthc
338398 1/16/2009 U ### This case was reported by a physici
338524 1/16/2009 MO 0.7 M ### A non-serious spontaneous report o
338525 1/16/2009 CT 4 M 12/3/2008 A non-serious spontaneous report a
338526 1/16/2009 KS 1.8 F 12/4/2008 A spontaneous non serious report o
338527 1/16/2009 KY 1.6 1 0.6 M 12/8/2008 A non-serious report "given FLUMIS
338528 1/16/2009 IN 0.9 M ### A non serious report of "gave FLUM
338529 1/16/2009 CA 4 4 M ### A non-serious report of administratio
338530 1/16/2009 TN 0.6 U ### A non serious, spontaneous report o
338531 1/16/2009 GA 2 F ### Expired vaccine used (Expired drug
338532 1/16/2009 FL 4 M ### A non serious spontaneous report o
338533 1/16/2009 CA 1.9 1 0.9 F ### A non serious report of a child unde
338534 1/16/2009 WV 4 4 F ### A non serious report of administered
338535 1/16/2009 MO 2 F ### A non serious, spontaneous report o
338536 1/16/2009 3 F ### A non-serious report of administratio
338537 1/16/2009 MI 3 F ### A non-serious report of administered
338538 1/16/2009 MI 4 M ### A non-serious spontaneous report o
338539 1/16/2009 MI U 1/5/2009 This case was reported by a healthc
337619 1/17/2009 TN 61 61 M 1/17/2009 Redness, swelling, itching, pain and
337620 1/17/2009 NY 1 0 0F 1/17/2009 Patient has history of seizures. She
337621 1/17/2009 59 59 U 1/17/2009 Raised bubble 2 inches by 4 inches
337676 1/17/2009 IL 4 4 M 1/17/2009 8cm wide x 10cm long, redness, wa
338994 1/17/2009 TX 60 60 M 1/7/2009 This case was reported by a pharma
337622 1/18/2009 NJ 48 48 F 1/18/2009 Patient suffered Severe back pain, T
337623 1/18/2009 CO 66 66 F 1/18/2009 lower leg,ankle,and foot were swolle
337624 1/18/2009 IA 15 15 F 1/18/2009 Seizure activity, lower paralysis, exh
337625 1/18/2009 VA 19 19 F 1/18/2009 Immediately after receiving shot,sev
337626 1/19/2009 TX 0.5 0 0.6 F 1/19/2009 Prolonged crying spell for hours afte
337627 1/19/2009 WY 60 60 F 1/19/2009 Slight, itchy red rash area across be
337628 1/19/2009 TN 17 17 F 1/19/2009 SYNCOPE
337629 1/19/2009 SC 63 63 F 1/19/2009 PATIENT FELT LIKE HER HEART
337630 1/19/2009 WY 70 70 F 1/19/2009 Patient reported slight rash across b
337634 1/19/2009 TN 31 31 F 1/19/2009 Approximately 6-8 hrs after taking th
337635 1/19/2009 TX 41 41 M 1/19/2009 30 minutes after vaccine developed
337636 1/19/2009 NJ 2 2 0.5 M 1/19/2009 Pt received MMR on 1/10/09. On 1
337637 1/19/2009 UT 0.5 0 0.5 M 1/19/2009 Acute onset right hemisphere ische
337638 1/19/2009 TX 43 43 M 1/19/2009 Pt developed Myocardial infarction a
337639 1/19/2009 GA 1.3 1 0.3 M 1/19/2009 On 04/13/07, my son was treated in
337640 1/19/2009 AZ 5 5 F 1/19/2009 Temperature 104.1, heavy chest co
337645 1/20/2009 VA M 1/16/2009 This case was considered medically
337669 1/20/2009 MI 1 1 0M 1/19/2009 Pt given HIB Y #4; PREVNAR #4; Hep
337673 1/20/2009 OH 0.3 0 0.3 F 1/14/2009 Abd. pain, (+) Stool Guaiac, scream
337677 1/20/2009 GA 0.4 0 0.4 M 1/8/2009 4 month old male, received shots by
337678 1/20/2009 KY 12 12 F 1/19/2009 Mother states "eye lids swelling, and
337679 1/20/2009 DE 73 73 F 1/16/2009 Presented to office on 1/9/09 c/o "ra
337680 1/20/2009 NJ 1.9 1 0.9 M 1/19/2009 ? febrile sz on 1/16/09 - started seiz
337681 1/20/2009 NJ 0.9 0 0.9 M 1/19/2009 Localized redness, lump, tendernes
337682 1/20/2009 OR 80 80 F 1/19/2009 Pt complained of pain in muscle aro
337683 1/20/2009 OR 53 53 F 1/11/2009 1st attempt to administer dose: Una
337684 1/20/2009 CA 42 42 F 1/19/2009 Lymph Node swelling
337685 1/20/2009 AL 16 16 F 1/19/2009 red wheel apprx 3" immediately afte
337686 1/20/2009 AL 11 11 M 1/19/2009 Red wheal immediately after giving
337687 1/20/2009 WA 67 67 F 1/19/2009 Red disc at eye of 50 cent piece pin
337704 1/20/2009 54 54 M 1/20/2009 Within a few hours after immunizatio
337705 1/20/2009 MO 16 16 F 1/13/2009 Headache in "forehead". Nausea - n
337706 1/20/2009 MA 18 18 F 1/20/2009 Tdap administered R deltoid 1/16/08
337707 1/20/2009 TN 54 54 F 1/20/2009 After 24 hours, injection site swelled
337708 1/20/2009 PA 20 20 F 1/20/2009 Client given dose of adult hep A. Cl
337709 1/20/2009 MI 64 63 M ### PATIENT CAME INTO OFFICE ON
337710 1/20/2009 TX 1.6 1 0.6 M 1/20/2009 behavioral changes, encephalopath
337711 1/20/2009 LA 11 11 F 1/20/2009 I believe the symptoms started after
337712 1/20/2009 TX 23 23 F 1/20/2009 Tues - Administered vaccine Wed -
337713 1/20/2009 NM 25 25 M 1/20/2009 Patient complains of excessive swe
337714 1/20/2009 NM 23 23 M 1/20/2009 Patient came in on Friday 16 Jan 20
337715 1/20/2009 NM 21 21 M 1/20/2009 Patient came in complaining of exce
337716 1/20/2009 NM 20 20 M 1/20/2009 Patient complains of lump, hardnes
337717 1/20/2009 NM 23 23 M 1/20/2009 Patient complaining of fever.
337718 1/20/2009 CA 1.1 M 1/20/2009 PT DEVELOPED ,MACULOPAPUL
337719 1/20/2009 WI 47 47 F 1/20/2009 PATIENT RECIEVED VACCINATIO
337720 1/20/2009 IA 1.3 1 0.3 F 1/20/2009 Cheeks swollen and hot
337721 1/20/2009 TX 5 5 F 1/20/2009 PATIENT STARTIED TO BREAK O
337722 1/20/2009 TX 11 M 1/20/2009 PT HAD LOCALIZED HIVE REACT
337723 1/20/2009 HI 0.9 0 0.9 F 1/20/2009 I have seen the slightest symptoms
337724 1/20/2009 MA 47 47 M 1/20/2009 A week after I received my flu shot I
337725 1/20/2009 4 4 U 1/20/2009 Patient received 2 varicella vaccines
337735 1/20/2009 IN 4 4 F 1/20/2009 6:45pm Jan 17th mom noticed welts
337736 1/20/2009 MT 2 2 0.1 M 10/8/2008 Severe seizure (grand mal) lasting o
337737 1/20/2009 FL 15 15 M 1/5/2009 Seizures X 2 1-5-09. First time seiz
337738 1/20/2009 AR 41 41 F 1/6/2009 Pt had TDAP vaccine on 10/29/08,
337739 1/20/2009 PA 16 16 F 1/15/2009 Arm Pain- Contests Rash
337740 1/20/2009 OH 1 1 0F 1/20/2009 Child broke out in lesions mostly on
337741 1/20/2009 OR 17 17 F 1/12/2009 Bilateral leg weakness / had to use
337742 1/20/2009 NY U 1/20/2009 24 After immunization unable to ma
337743 1/20/2009 NY 21 21 F 1/20/2009 Felt faint 30 sec post injection, laid d
337744 1/20/2009 CA 0.2 0 0.2 F 1/20/2009 Rash is diffuse in location, reddish a
337745 1/20/2009 ID 65 65 F 1/20/2009 Phone call from patient stating a po
337746 1/20/2009 MN 11 11 M 1/19/2009 Patient received 1st Tdap in L uppe
337747 1/20/2009 CA 0.2 0 0.2 F 1/13/2009 2 months old girl with one day histo
337748 1/20/2009 MI 15 15 F Hypotensive, unresponsive for NSR
337749 1/20/2009 CA 80 80 F 1/20/2009 24 hrs after ZOSTAVAX - develope
337751 1/20/2009 WA 69 69 F ### Redness, induration, just below delt
337752 1/20/2009 NY 15 15 F 1/13/2009 25 days after GARDASIL #3 develo
337753 1/20/2009 MD 15 15 M 1/14/2009 No adverse symptoms known-3rd M
337754 1/20/2009 NC 12 12 F 1/12/2009 Induration - 2x2, Erythema - 5x3 lef
337755 1/20/2009 NJ 13 13 F 1/14/2009 1/12/09 received call from mother sh
337756 1/20/2009 NE 57 57 M ### 7pm 12/14/08 received flu shot 10p
337758 1/20/2009 CA 13 13 F 1/20/2009 Patient had fainted about 2-4 min po
337759 1/20/2009 WI 1.3 1 0.3 M 1/5/2009 Patient developed fever, irritability a
337760 1/20/2009 LA 12 12 F 1/7/2009 Vomiting x 2 approx 6-8 hours after
337761 1/20/2009 NM 14 14 F 1/16/2009 Week of 1/23/2007 pain at site of G
337762 1/20/2009 PA 0.4 0 0.4 M 1/13/2009 No adverse reactions. Child was giv
337763 1/20/2009 GA 0.4 0 0.4 M 1/8/2009 4 month old male, received shots by
337764 1/20/2009 KY 0.5 0 0.5 F 1/18/2009 Patient seen in office today for seizu
337765 1/20/2009 PA 7 7 F 1/20/2009 Err:508
337766 1/20/2009 59 59 M 1/20/2009 Patient was given Td vaccine and in
337767 1/20/2009 PR 29 F None Stated
337768 1/20/2009 CT 4 4 M 1/13/2009 1-9 Had immunization at 11 am tem
337769 1/20/2009 PA 18 18 F June 1 Sun- fever, chills, abdomina
338542 1/20/2009 SC F 1/16/2009 Information has been received from
338546 1/20/2009 CA 26 F 1/16/2009 Information has been received from
338547 1/20/2009 CA 40 40 F 1/16/2009 Information has been received a co
338548 1/20/2009 CA 26 26 F 1/18/2009 Initial and follow-up information has
338551 1/20/2009 IL 24 F 1/16/2009 Initial Information and follow up has
338553 1/20/2009 KS 15 15 F 1/16/2009 Information has been received for th
338572 1/20/2009 ID 18 18 F 1/16/2009 Information has been received from
338573 1/20/2009 VA 19 19 F 1/16/2009 Information has been received from
338576 1/20/2009 19 F 1/16/2009 Information has been received from
338577 1/20/2009 IL F 1/16/2009 Information has been received from
338579 1/20/2009 NJ 22 F 1/16/2009 Information has been received from
338580 1/20/2009 14 14 F 1/16/2009 Information has been received for th
338581 1/20/2009 WA 15 F 1/16/2009 Information has been received from
338582 1/20/2009 TX 24 F 1/16/2009 Information has been received from
338587 1/20/2009 DE 20 F 1/16/2009 Information has been received from
338590 1/20/2009 MI 18 18 F 1/16/2009 Information has been received from
338593 1/20/2009 AL 19 F 1/16/2009 Information has been received from
338645 1/20/2009 UT 17 17 F 1/16/2009 Information has been received from
338650 1/20/2009 VA 19 F 1/16/2009 Information has been received from
338651 1/20/2009 OR 14 F 1/16/2009 Information has been received from
338652 1/20/2009 TX F 1/16/2009 Information has been received from
338655 1/20/2009 MD 21 F 1/16/2009 Information has been received from
338656 1/20/2009 CO U 1/16/2009 Information has been received from
338659 1/20/2009 GA 12 12 F 1/16/2009 Information has been received from
338662 1/20/2009 IN F 1/16/2009 Information has been received from
338666 1/20/2009 NY 18 F 1/16/2009 Information has been received from
338675 1/20/2009 WI 0.6 M 1/16/2009 Information has been received from
338676 1/20/2009 MA 14 14 F 1/16/2009 Information has been received from
338683 1/20/2009 MI U 1/16/2009 Information has been received from
338685 1/20/2009 IN U 1/16/2009 Information has been received from
338687 1/20/2009 AZ 12 12 F 1/16/2009 Information has been received from
338688 1/20/2009 MD 18 18 F 1/16/2009 Information has been received from
338700 1/20/2009 MO 25 25 F 1/16/2009 Information has been received from
338701 1/20/2009 CT F 1/16/2009 Information has been received from
338703 1/20/2009 NE 19 19 F 1/16/2009 Information has been received from
338748 1/20/2009 TN 0.6 0 0.6 M 1/16/2009 Initial and follow-up information has
338749 1/20/2009 NJ 0.4 U 1/16/2009 Information has been received from
338751 1/20/2009 MI 0.8 M 1/16/2009 Information has been received from
338752 1/20/2009 0.3 U 1/16/2009 Information has been received from
338753 1/20/2009 CA 1.1 1 0.1 F 1/16/2009 Information has been received from
338754 1/20/2009 NJ 0.2 0 0.2 M 1/16/2009 Information has been received from
338755 1/20/2009 NY 0.2 U 1/16/2009 Information has been received from
338756 1/20/2009 PA 0.3 F 1/16/2009 Information has been received from
338758 1/20/2009 0.4 F 1/16/2009 Information has been received from
338759 1/20/2009 CT 0.2 F 1/16/2009 Information has been received from
338760 1/20/2009 CA 0.1 0 0.1 M 1/16/2009 Pediatric medical records were rece
337726 1/21/2009 CA 62 62 M 1/21/2009 Severe swelling and pain. Took Cep
337727 1/21/2009 NY 12 12 F 1/21/2009 Within a couple hours of receiving th
337770 1/21/2009 MI 0 0 0F 1/21/2009 3 day old recieved comvax. Nurse w
337771 1/21/2009 MI 54 54 F 1/21/2009 No known reaction because patient
337772 1/21/2009 MI 56 56 F 1/21/2009 No knowm symptoms. She never ca
337773 1/21/2009 MI 0.4 0 0.5 M 1/21/2009 The day after infant was given Tdap
337774 1/21/2009 DC 2 2 0.4 M 1/21/2009 PT RECEIVED EXPIRED FLUMIST
337775 1/21/2009 DC 2 2 0F 1/21/2009 PT RECEIVED EXPIRED FLUMIST
337776 1/21/2009 CO 15 15 F 1/21/2009 Received HPV vaccine on January
337777 1/21/2009 VA 33 33 M 1/21/2009 approximately 1100 1-20-08 given s
337778 1/21/2009 MD 22 22 F 1/21/2009 PT is complaining of post smallpox
337779 1/21/2009 FL 62 62 M 1/21/2009 Soreness of skin on abdomen and l
337780 1/21/2009 TX 29 29 M 1/21/2009 16 Jan 09 arms were sore. 17 Jan 0
337781 1/21/2009 IL 1.3 1 0.3 M 1/21/2009 PATIENT CAME IN OFFICE ON 1-7
337782 1/21/2009 CA 82 82 M 1/21/2009 Patient developed herpes zoster on
337783 1/21/2009 AZ 51 51 F 1/21/2009 Local reactions on upper Lt. arm, re
337784 1/21/2009 NJ 3 3 F 1/21/2009 Child received the Flu vaccine betw
337785 1/21/2009 OH 10 10 F 1/21/2009 RECEIVED VARICELLA VACCINE
337786 1/21/2009 TX 24 23 M 1/21/2009 HA, temp of 104.8, B/P 168/80, ach
337787 1/21/2009 DC 4 4 F 1/21/2009 EXPIRED FLUMIST GIVEN TO CH
337788 1/21/2009 GA 0.5 0 0.5 F 1/21/2009 Mom phoned today 01/21/2009 @9
337789 1/21/2009 FL 47 47 F 1/21/2009 Approximately 12 hours after vaccin
337790 1/21/2009 NM 4 4 M 1/21/2009 itching, difficulty breathing, lips swel
337791 1/21/2009 VT 24 24 F 1/21/2009 Headache, Nausea, Vomiting, Diarr
337792 1/21/2009 IL 25 25 F 1/21/2009 extreme weakness, fatigue, dizzines
337793 1/21/2009 MI 65 65 F 1/21/2009 Pt felt fine after shot. 6 hrs later site
337794 1/21/2009 MI 9 9 F 1/21/2009 Patient developed large area of eryt
337795 1/21/2009 SC 27 27 F 1/21/2009 Client reports noticing itching and so
337796 1/21/2009 MO 14 14 F 1/21/2009 Passed out immediately after HPV s
337797 1/21/2009 NM 18 18 F 1/21/2009 Headaches,Yperiods were very errat
337798 1/21/2009 CO 0.5 0 0.5 F 1/21/2009 Possible seizures (repetitive head tu
337799 1/21/2009 TX 13 13 F 1/21/2009 Pt c/o pain, swelling, redness to righ
337800 1/21/2009 VA 50 50 F 1/10/2009 Fever developed; Right arm red, sw
337801 1/21/2009 MT 27 27 M 1/22/2009 Jan 16 received vaccine (Anthrax) in
337802 1/21/2009 TX M 1/21/2009 Patient reported a lot of pain in left a
337803 1/21/2009 CA 0.4 0 0.4 M 1/20/2009 Within a few hours of shots pt devel
337804 1/21/2009 AZ 4 4 F 1/21/2009 Left upper arm 6 inch by 9 inch eryt
337805 1/21/2009 NY 13 13 F 1/21/2009 Site never got swollen or red. Just v
337806 1/21/2009 MN 23 23 F 1/21/2009 Gave pediatric dose of HEP A was
337808 1/21/2009 PA 0.6 0 0.6 M 1/21/2009 Child received PENTACEL, HEP B,
337809 1/21/2009 IN 0.3 0 0.3 F 1/21/2009 Developed red rash around injection
337810 1/21/2009 ND 79 79 F 1/21/2009 Red, slightly warm to touch, swelling
337819 1/21/2009 GA 0.2 0 0.2 M 1/20/2009 Information has been received from
337821 1/21/2009 1.7 M 1/20/2009 Information has been received from
337822 1/21/2009 MI 1 1 0M 1/21/2009 Patient developed erythematous pa
337823 1/21/2009 PA 81 81 F 1/21/2009 Patient lips were swelling. Patient w
337824 1/21/2009 VA 1.3 1 0.3 M 1/20/2009 Quarter- sized erythema around inje
337825 1/21/2009 MI 86 86 M 1/21/2009 Erythema and pruritis on forehead &
337827 1/21/2009 NJ 12 12 F 1/20/2009 1. Legs pain. 2. Some time weake
337828 1/21/2009 ME 68 68 M 1/21/2009 Patient had vaccination- shortly afte
337829 1/21/2009 TX 1 1 0M 1/20/2009 1 yr old boy (WM) seen 1/9/2009 fo
337830 1/21/2009 MA 13 13 F ### Localized reaction to VARIVAX give
337831 1/21/2009 MA 0.3 0 0.3 M ### Patient received 2nd dose of Rotate
337832 1/21/2009 MA 5 5 F 12/5/2008 7x6cm area erythema, warm, tende
337834 1/21/2009 WI 76 76 F 1/20/2009 Information has been received from
337835 1/21/2009 NJ 26 M 1/16/2009 Left upper arm & shoulder; edema &
337837 1/21/2009 NJ 19 19 F 1/15/2009 Vaccination small pox, left shoulder
337838 1/21/2009 MI 51 51 F ### Deep aching pain in upper arm, and
337845 1/21/2009 28 U W/in 30 seconds: tingling & numbne
337848 1/21/2009 0.3 0 0.3 M 1/21/2009 This male subject was enrolled in th
337849 1/21/2009 NJ 41 41 F 1/16/2009 T 98.0 degree rash on left arm surro
337850 1/21/2009 NC 0.4 0 0.4 M 1/21/2009 Fever to 103.5, lethargy with crying
337851 1/21/2009 ME 0.4 0 0.4 M 1/15/2009 Patient was admitted to medical cen
337853 1/21/2009 CA 0.4 0 0.4 M 1/20/2009 On 12/17 and 12/18 4-5 episodes w
338761 1/21/2009 FL 17 17 M 9/29/2008 Initial report received on 12 March 2
337958 1/22/2009 VA 70 70 M 1/21/2009 Information has been received from
337959 1/22/2009 OH 34 34 F 1/21/2009 Information has been received from
337962 1/22/2009 OH 5 5 F ### DKA New onset juvenile diabetes.
337963 1/22/2009 OR 21 21 F 1/14/2009 Soon after Gardasil, pt developed fe
337965 1/22/2009 NJ 15 15 F 1/22/2009 ON 1/21/2009 APPROXIMATELY @
337966 1/22/2009 IL 1.6 1 0.6 F 1/22/2009 NEST DAY AFTER INJECTION, 2 S
337967 1/22/2009 AL 0.2 0 0.2 F 1/22/2009 No adverse event, just diagnosed w
337968 1/22/2009 NC 59 59 F 1/22/2009 Injection site swelled about the size
337969 1/22/2009 NC 58 58 F 1/22/2009 Patient described area around vacc
337970 1/22/2009 IA 65 65 F 1/22/2009 Patient was vaccinated on 01/08/20
337971 1/22/2009 PA 0.2 0 0.2 F 1/22/2009 2 month shots (HepB, Rotavirus, Pn
337972 1/22/2009 CA 46 46 F 1/22/2009 I have had pain in my Deltoid area t
337973 1/22/2009 CA 25 25 F 1/22/2009 On 15Jan2009, pt was administered
337974 1/22/2009 NC 54 54 F 1/22/2009 The 2 nights after the inject I was ve
337975 1/22/2009 KY 17 17 F 1/22/2009 Patient fainted miniutes after the inj
337976 1/22/2009 OH 54 53 F 1/22/2009 Pain/swelling/erythema at injection s
337977 1/22/2009 WA 16 16 F 1/22/2009 dizziness, hot flushing, sweating, bl
337978 1/22/2009 KY 0.2 0 0.2 F 1/22/2009 no adverse event at this date and tim
337979 1/22/2009 SC 20 19 F 1/22/2009 Approximately 10 minutes after rece
337980 1/22/2009 MO 1 1 0M 1/22/2009 Mild varicella disease, less than 50
337981 1/22/2009 MN 11 11 F 1/22/2009 Adolescent became lightheaded the
337982 1/22/2009 HI 5 5 F 1/22/2009 Local swelling, erythema, warmth an
337983 1/22/2009 SC 61 61 M 1/22/2009 In the week following the vaccinatio
337984 1/22/2009 IN 11 11 F 1/16/2009 About 12 hrs after vaccines, mild diz
337985 1/22/2009 KY 17 17 F 1/21/2009 Vaccine given 6 days ago Pt noticed
337986 1/22/2009 NJ 1.3 1 0.3 M 1/22/2009 Fever to 102, maculopapular rash o
337988 1/22/2009 NH 0.6 0 0.6 M 1/22/2009 Neck: normal, supple, no lymphade
337989 1/22/2009 MD 1 1 0M 1/22/2009 Started breaking out 1/19. Itches - r
337990 1/22/2009 NY 10 10 F 1/19/2009 Left upper arm - hot and swollen, re
337991 1/22/2009 UT 1.1 1 0.1 M 1/21/2009 Patient received VARIVAX (chicken
337992 1/22/2009 TX 1 1 0F 1/22/2009 Received vaccine 1-16-09 - On 1-21
337993 1/22/2009 63 F 1/14/2009 Patient received ZOSTAVAX shot o
337994 1/22/2009 VA 1.4 1 0.4 F 1/16/2009 Pt developed fever to 102 degree a
337995 1/22/2009 HI F 1/18/2009 Pt. scratching at site & next day arm
337996 1/22/2009 AZ 2 2 0M 1/22/2009 Had temp of 101-102 X 24 hours - s
337997 1/22/2009 PA 0.6 0 0.6 F 1/13/2009 Fussiness in the hours after vaccine
337998 1/22/2009 CA 57 57 F 12/1/2008 Nerve in arm feel affected. Cannot l
337999 1/22/2009 27 27 M 1/22/2009 Denied problems with AVA #1 and #
338000 1/22/2009 NC 0.6 0 0.6 F 1/15/2009 105 fever night that vaccines given.
338002 1/22/2009 NY 17 17 F 1/8/2009 Swelling in both wrist, itching on pal
338003 1/22/2009 NY 29 29 F 1/22/2009 Large area of erytheima & edema &
338004 1/22/2009 CA 3 3 F 1/20/2009 Pt given 1 (HEP A) vaccine/left offic
338005 1/22/2009 NJ 32 32 M 1/14/2009 Within 2 minutes of vaccination c/o
338006 1/22/2009 OH 0.3 0 0.3 M 1/19/2009 Vomiting, fussiness X 24 hrs, vomiti
338007 1/22/2009 VA 0.4 0 0.4 F 1/14/2009 Pt developed temp to 106 degrees a
338008 1/22/2009 37 37 M 1/21/2009 2 days post ava #1 broke out in a ra
338009 1/22/2009 DC 55 F 1/16/2009 Patient complains of pain in left delt
338010 1/22/2009 AL 12 12 M 1/19/2009 None Stated
338011 1/22/2009 UT 13 13 F 1/22/2009 No side effect, patient was fine.
338012 1/22/2009 RI 2 2 0.9 F 1/22/2009 1 cm nodule. 7 cm erythema + indu
338013 1/22/2009 OR 12 12 F 1/14/2009 After receiving 3 shots, client becam
338014 1/22/2009 PA 1.9 1 0.9 F 1/13/2009 Non stated.
338015 1/22/2009 PA 0.7 0 0.7 F 1/13/2009 None stated.
338016 1/22/2009 CA 62 62 F 1/22/2009 Pt called 10/31/08 said had blurring
338017 1/22/2009 OR 70 70 F 1/22/2009 11/27/2006 Patient noticed pain in h
338049 1/23/2009 KY 14 14 F 1/22/2009 Information has been received from
338050 1/23/2009 SC 17 17 F 1/22/2009 Information has been received from
338052 1/23/2009 MO 15 F 1/22/2009 Information has been received from
338057 1/23/2009 FL 0.2 0 0.2 F 1/22/2009 Information has been received from
338058 1/23/2009 GA 0.2 0 0.2 F 1/22/2009 Information has been received from
338064 1/23/2009 ID 4 4 F ### Developed angio edema of face, lar
338065 1/23/2009 ID 6 6 M 10/2/2008 Redness occurred evening of vaccin
338066 1/23/2009 ID 29 29 M ### Client woke up following morning wi
338067 1/23/2009 ID 39 39 F ### Afternoon of day HEB B# 3 received
338068 1/23/2009 ID 27 27 F ### 1 hr after HBV #1 patient experienc
338069 1/23/2009 ID 59 59 F ### Incident occurred on 7/16/08 and ag
338070 1/23/2009 ID 58 58 F ### Received TDAP on 11/24/08 for trav
338071 1/23/2009 MA 15 15 F 1/20/2009 Pt reports had significant vomiting d
338072 1/23/2009 FL 4 4 F 1/9/2009 Lat 4 1/2" X 4" circular swelling red,
338073 1/23/2009 MD 43 43 F 1/21/2009 Few hours after TdAP in left deltoid
338074 1/23/2009 KS 0.3 0 0.3 M 1/14/2009 Immunizations given (Hib in upper R
338099 1/23/2009 MI 1.3 1 0.3 F 1/23/2009 After receiving immunizations the pa
338100 1/23/2009 TX 5 5 F 1/23/2009 "Rash" 1 day after MMR. Parent con
338101 1/23/2009 NH 21 21 F 1/23/2009 Vaccine given in error. PCP ordere
338102 1/23/2009 GA 0.4 0 0.4 F 1/23/2009 NO ADVERSE REACTIONS NOTE
338103 1/23/2009 CO 10 10 M 1/23/2009 Dizziness, very pale, fainted getting
338104 1/23/2009 PR 39 39 F 1/23/2009 Numbness of hand and legs, cough
338105 1/23/2009 TX 5 4 F 1/23/2009 Patient went came into the Immuniz
338106 1/23/2009 GA 26 26 M 1/23/2009 PT had an itching sensation in the b
338107 1/23/2009 VA 5 M 1/23/2009 Left arm swollen and warm to touch
338109 1/23/2009 NJ 41 41 M 1/23/2009 generalized rash noticed approxima
338110 1/23/2009 PA 1 1 0M 1/23/2009 On 1/21/09 at the time of immunizat
338111 1/23/2009 CA 0.2 0 0.2 M 1/23/2009 It happen over night (Dec 16th 2008
338112 1/23/2009 MT 59 59 F 1/23/2009 Immediately following venipuncture
338113 1/23/2009 MI 18 18 F 1/23/2009 Received MCV4, Hep.A, Varicella o
338114 1/23/2009 IL 1.5 1 0.5 M 1/23/2009 rash on the body and neck, has bee
338122 1/23/2009 FL 0.2 0 0.2 M 1/8/2009 Severe diarrhea, dehydration, 1 wee
338123 1/23/2009 OR 12 12 F 1/23/2009 She received her immunizations on
338124 1/23/2009 MA 5 5 M 12/5/2008 S1. erythematous left upper arm, sli
338125 1/23/2009 NC 6 6 M 1/23/2009 24 hours after influenza and HAVRI
338126 1/23/2009 NM 11 11 M 1/23/2009 Received both MENACTRA and BO
338127 1/23/2009 IA 71 71 F Patient broke out with a couple of re
338128 1/23/2009 GA 66 66 M 1/23/2009 Patient stopped by the clinic and sta
338129 1/23/2009 MD 13 13 M 1/23/2009 Possible erythema multiform.
338130 1/23/2009 CA 1.1 1 0.1 M 1/23/2009 About 10 hrs after giving immunizat
338131 1/23/2009 KY 1.6 1 0.6 F 1/23/2009 Fever 103.3 Febrile seizure X 5 min
338136 1/23/2009 GA 54 54 F 1/7/2009 Client reports shortly after the shot,
338137 1/23/2009 SC 1 1 0M 1/23/2009 Rash- looks like measles. No fever
338500 1/23/2009 21 F 1/21/2009 I took the GARDASIL shot series. I
338789 1/23/2009 NY 39 M ### Initial report received from the patie
338828 1/23/2009 TX 5 5 M 8/27/2008 Initial report was received 08 May/2
338829 1/23/2009 CT 68 68 M ### Initial report received on 02 Septem
338830 1/23/2009 OH 71 71 F ### A 71-year-old female patient experie
338837 1/23/2009 NC 55 55 M 7/17/2008 Initial report was received from a he
338115 1/24/2009 TN 0.2 0 0.2 F 1/24/2009 Developed rash within 24 hours of a
338116 1/24/2009 IN 54 54 F 1/24/2009 Patient stated pain began 4 hours a
338117 1/24/2009 MA 1.3 1 0.3 F 1/24/2009 About 3 hours, after the vaccines, m
338118 1/24/2009 IL 21 21 M 1/24/2009 His a 21yo navy recruit that present
338119 1/24/2009 CA 68 67 F 1/24/2009 Patient called to report reddened ar
338120 1/24/2009 CA 50 50 M 1/24/2009 Mild rash on thorax. Lasted for 5 da
338121 1/26/2009 22 22 M 1/26/2009 mild cellulitis of arm. 3/3/09 MR rece
338209 1/26/2009 OH 27 27 F 1/22/2009 Initial information received on 21 Ja
338210 1/26/2009 CA 47 47 F 1/20/2009 Acute to chronic resp. congestion, m
338212 1/26/2009 71 71 M 1/26/2009 On Wednesday had sore throat, run
338213 1/26/2009 74 74 M 1/1/2009 Pt has no history of shingles, but in
338214 1/26/2009 71 F 1/20/2009 I received the vaccine ZOSTAVAX.
338215 1/26/2009 PA 2 1 1U None Stated
338216 1/26/2009 TX 0.5 0 0.5 F 1/24/2009 Seizure approx 16 hour after immun
338217 1/26/2009 MA 14 14 F 1/23/2009 After waiting in office for 15 minutes
338218 1/26/2009 UT F 1/22/2009 Intermittent soreness let deltoid sub
338219 1/26/2009 LA 63 63 F 1/21/2009 Three days after I received the ZOS
338220 1/26/2009 IA 1 1 0F 12/1/2008 11-12 day after injection developed
338221 1/26/2009 NY 63 63 F 1/26/2009 See note attached. Called patient 1
338222 1/26/2009 TX 1 1 0M 1/22/2009 The infant had an immediate reactio
338223 1/26/2009 GA 1 1 0M 1/20/2009 Rash at injection site- plus erythema
338224 1/26/2009 WA 5 5 F 1/22/2009 Developed hives 12 hrs after receiv
338225 1/26/2009 CA 5 5 M 1/23/2009 Swollen Left thigh with redness arou
338229 1/26/2009 LA 54 54 U 1/23/2009 Information has been received from
338240 1/26/2009 GA 68 68 F 1/26/2009 Pt called Health Department this am
338241 1/26/2009 MI 17 17 M 1/26/2009 2:13 pm - shots given,alert and orie
338242 1/26/2009 OK 11 11 M 1/26/2009 Left arm red, hot and swollen
338243 1/26/2009 MA 52 53 M 1/26/2009 Received vaccine at 9:30 am, stated
338244 1/26/2009 MI 14 14 F 1/26/2009 Passed out with seizure like behavio
338245 1/26/2009 NC 77 F 1/26/2009 Swelling of arm and itching one day
338246 1/26/2009 MT 1 1 0M 1/26/2009 Patient had his 1 yr well-baby check
338247 1/26/2009 NC 17 17 F 1/26/2009 7/16/07 - Developed severe case of
338248 1/26/2009 KY 22 22 F 1/26/2009 On 1/12/09 pt received a Tdap inj b
338249 1/26/2009 ID 21 21 F 1/26/2009 Client received Engerix B vaccine o
338250 1/26/2009 MI 40 40 F 1/26/2009 Pt was fine fol shot. Woke up the ne
338251 1/26/2009 GA 1 1 0M 1/26/2009 DIAGNOSED WITH SHINGLES 01/
338252 1/26/2009 MO 69 69 M 1/26/2009 Hospitalized and diagnosed with Gu
338253 1/26/2009 TX 42 42 F 1/26/2009 Symptoms started two days after re
338254 1/26/2009 OK 3 0 0.2 F 1/26/2009 Mother reports high fever (104.7, se
338255 1/26/2009 FL 13 13 F 1/26/2009 15 minutes after the vaccine the pat
338256 1/26/2009 CA 60 60 F 1/26/2009 Patient called to report swelling of ri
338257 1/26/2009 MA 13 13 F 1/26/2009 Patient received the Varivax on Sat
338258 1/26/2009 WI 65 65 M 1/26/2009 After receiving vaccination at 11am
338259 1/26/2009 CA 64 64 F 1/26/2009 64 yo F calling to report possible rea
338260 1/26/2009 MI 18 18 M 1/26/2009 3-4 hours after being vaccinated pt.
338265 1/26/2009 PA 0.2 0 0.2 F 1/26/2009 Right leg with erythema and edema
338266 1/26/2009 AR 54 54 F ### Redness, swelling, warmth to site fe
338267 1/26/2009 AR 53 53 F 11/3/2008 Approximately 24 hrs after injection,
338268 1/26/2009 AR 42 42 F Tetanus shot. Red, sore. Bump 3 to
338269 1/26/2009 AR 58 F 12/4/2007 Swollen, warm, painful area 2"x4" a
338270 1/26/2009 AR 58 58 F 11/7/2007 Where shot given-is red and warm t
338271 1/26/2009 AR 56 56 U Moderate headache with fatigue ap
338272 1/26/2009 AR U Hot swelling, hives, feverish.
338273 1/26/2009 AR 26 26 F ### 12/10 Wed. got shot. Thursday the
338274 1/26/2009 AR 58 58 F ### 2" red, round, fever, swollen area, te
338275 1/26/2009 MO 46 46 F 1/20/2009 Dizziness (severe vertigo) vomiting,
338276 1/26/2009 NH 61 61 F 2/9/2009 1/24/08 onset right flank rash-itchy v
338277 1/26/2009 VA 1 1 0M 1/22/2009 Rash - erythematous maculopapula
338280 1/26/2009 TX 1.2 1 0.2 M 1/26/2009 Mom returned to clinic 2d after vacc
338281 1/26/2009 KS 1.5 1 0.5 F ### Right lower back - few small red rais
338282 1/26/2009 KS 52 52 M ### Pt received ADACEL RA upper delt
338283 1/26/2009 14 14 M 11/7/2008 C/O pain left shoulder, et with deep
338284 1/26/2009 KS 12 12 F 8/19/2008 Headache, chills, fatigue, fever (hig
338285 1/26/2009 KS 5 5 M 8/8/2008 Left arm with erythema, warmth + s
338286 1/26/2009 KS 14 14 M 8/12/2008 Patient immediately began to feel tir
338287 1/26/2009 KS 14 14 M 8/12/2008 Headache, fever 101.0F, neck ache
338288 1/26/2009 KS 5 5 M 7/25/2008 Pt. on 7/23/05-1445- after receiving
338289 1/26/2009 KS 18 18 F 7/2/2008 Very fearful - Hyperventilating - trem
338290 1/26/2009 FL 11 F 1/26/2009 Patient's mother reported that child
338291 1/26/2009 FL 36 36 M 1/26/2009 Patient states developed muscle an
338292 1/26/2009 KS 13 13 F Mother states" child can not move h
338293 1/26/2009 KS 23 23 U Was given HPV during her pregnan
338294 1/26/2009 KS 18 18 F ### After giving MMR patient eyes rolled
338295 1/26/2009 KS 57 57 F ### Got vaccination 10-27-2008. 10-29-
338296 1/26/2009 KS 58 58 F ### Headache, weakness, decreased co
338297 1/26/2009 KS 10 10 F 10/1/2008 Redness, Tenderness, difficulty bre
338298 1/26/2009 KS 4 4 M 9/29/2008 Redness at swelling from top of kne
338299 1/26/2009 KS 0.4 0 0.4 M 8/25/2008 Incorrect immunization administered
338300 1/26/2009 KS 1.1 1 0.1 F 8/8/2008 Redness/ Rash immediately around
338301 1/26/2009 PA 11 11 M 7/8/2008 Mother called clinic at 5:15 pm 7/8/
338302 1/26/2009 KS 10 10 F 6/9/2008 10 Minutes after administering vacc
338303 1/26/2009 KS 10 10 F 5/8/2008 TDAP administered 6 mo too soon p
338304 1/26/2009 KS 4 4 M ### Mother noticed last NOC right thigh
338305 1/26/2009 KS 0.5 0 0.5 F 1/5/2009 101-102 Temp- eyes matted - clear
338306 1/26/2009 NH 20 20 F ### W/ 1st dose broke out in hives, w/2n
338307 1/26/2009 WA 1 1 0F 1/23/2009 Erythematous Maculopapular rash a
338308 1/26/2009 KY 4 4 F 1/23/2009 Rash over abdomen, onset 1-22-09
338309 1/26/2009 TX 9 9 M 1/23/2009 FLUMIST and VARIVAX vaccine we
338310 1/26/2009 WA 58 58 F 1/22/2009 Morning of 1-16-2009 noticed back
338311 1/26/2009 4 4 M 1/22/2009 Patient has about 2in erythema and
338312 1/26/2009 ND 45 45 F 1/23/2009 Patient received pediatric dose of A
338313 1/26/2009 TX 0.5 0 0.5 F 1/23/2009 Received DPH and IPV. Reporting m
338314 1/26/2009 IA 15 15 F 1/20/2009 C1 woke up at 5pm with vomiting. F
338315 1/26/2009 NC 20 20 F 1/22/2009 Redness-itching-blistering at injectio
338316 1/26/2009 IA 67 67 F 1/2/2009 Red swollen arm - about size of bas
338317 1/26/2009 MA 14 14 F 1/26/2009 Onset of nausea, dizziness within 3
338318 1/26/2009 MI 63 63 F 1/12/2009 Pt. given Tdap in left upper arm-IM
338261 1/27/2009 MI 60 60 M 1/27/2009 Shingles vaccine was administered
338372 1/27/2009 LA 1.1 1 0.1 M 1/23/2009 Initial report received on 13 January
338374 1/27/2009 NY 65 65 M 1/23/2009 Initial report received on 15 January
338376 1/27/2009 MA 16 16 M 1/23/2009 Initial report was received 16 Janua
338386 1/27/2009 FL F 1/26/2009 Information has been received from
338407 1/27/2009 1.1 F 1/26/2009 It was reported
Y in a published article
338419 1/27/2009 GA 34 34 M 1/27/2009 erythema, edema of the eye, distort
338420 1/27/2009 NY 14 14 F 1/27/2009 About 7 minutes after patient had th
338421 1/27/2009 NY 1.5 1 0.5 M 1/27/2009 coughing, wheezing, hives, dyspnea
338422 1/27/2009 KY 30 30 F 1/27/2009 Received Hepatitis B #2 and TdaP.
338423 1/27/2009 WI 17 17 F 1/27/2009 Few minutes after vaccine administe
338424 1/27/2009 TX 24 24 F 1/27/2009 I had my first injection on 7/10/2008
338425 1/27/2009 TX 65 65 F 1/27/2009 Upset Stomach, sore Muscles, joint
338426 1/27/2009 WI 15 15 F 1/27/2009 Client received two vaccines after o
338427 1/27/2009 LA 47 57 F 1/27/2009 Left upper arm pain that remains se
338428 1/27/2009 MI 83 83 F 1/27/2009 Mild cellulitis and soreness in left ar
338429 1/27/2009 OK 12 12 F 1/27/2009 Within 5 minutes of receiving the Td
338430 1/27/2009 OK 13 13 F 1/27/2009 Approximately 6 minutes after recei
338431 1/27/2009 FL 51 51 F 1/27/2009 PT CLAIMS TO HAVE FLU AFTER
338432 1/27/2009 WA 23 23 F 1/27/2009 Pt Received Anthrax vaccine 10 De
338433 1/27/2009 AL 68 68 F 1/27/2009 Redness, swelling, heat, bruising &
338434 1/27/2009 LA 22 22 F 1/27/2009 approximately 3-6 wks after vaccina
338435 1/27/2009 WA 17 17 F 1/27/2009 Localized inflamation at injection sit
338491 1/27/2009 NC 23 23 F 1/9/2009 12X12 can area of redness + swellin
338492 1/27/2009 GA 66 66 M 1/23/2009 Patient had injury to left arm and ca
338493 1/27/2009 NC 68 68 F 1/27/2009 Redness, swelling at injection site; s
338494 1/27/2009 GA 18 18 F 1/27/2009 Patient presented in Health Departm
338497 1/27/2009 WA 33 33 M 1/27/2009 TDAP administered 1-21-09 pt wife
338498 1/27/2009 OH 0.4 0 0.4 M 1/23/2009 Hives + fever on arms and legs 1/21
338499 1/27/2009 NJ 13 13 F 1/27/2009 Started with redness on 01/23/09 an
338504 1/27/2009 KY 7 7 F 1/27/2009 Large red swollen area at injection s
338505 1/27/2009 CA 1.1 1 0.1 M Localized reaction to MMR & VARIV
338436 1/28/2009 SC 11 11 M 1/28/2009 Local reaction to Tdap
338437 1/28/2009 VA 0.3 0 0.3 F 1/28/2009 Baby was fussy and very gassy for
338438 1/28/2009 OH 69 69 M 1/28/2009 redness, inflammation and pain at in
338439 1/28/2009 NC 1.3 M 1/28/2009 Presented 1/27/09 with Zoster L1 de
338440 1/28/2009 MO 1 1 0.1 F 1/28/2009 Mild varicella rash started 1/27/2009
338443 1/28/2009 PA 65 M 1/27/2009 Information has been received from
338448 1/28/2009 18 18 F 1/27/2009 Information has been received throu
338454 1/28/2009 LA 15 F 1/27/2009 Information has been received from
338457 1/28/2009 PA 48 48 F 1/28/2009 This case was reported by a lawyer
338458 1/28/2009 NY 46 46 M 1/28/2009 This case was reported by a lawyer
338459 1/28/2009 DE 47 47 M 1/28/2009 This case was reported by a lawyer
338466 1/28/2009 NC 62 62 M 1/28/2009 Retiree who received flu and ZOSTA
338467 1/28/2009 TX 15 15 M 1/28/2009 In AM: Post vaccination: dizzy, dimm
338468 1/28/2009 CA 58 M 1/22/2009 58 yo M with ESRD on HD, HTN, an
338469 1/28/2009 CA 33 33 F 1/22/2009 Pt had vaccination 1/20/09, and 1/2
338470 1/28/2009 OH 0.2 0 0.2 F 1/21/2009 Parents state that infant cried screa
338471 1/28/2009 IL 64 64 F 1/25/2009 24 hours after the injection patient n
338472 1/28/2009 WI 46 46 M 1/27/2009 Received FLUZONE 1/15/09. 1 we
338473 1/28/2009 NC 79 79 M 1/28/2009 Five days after administration, a 2 in
338474 1/28/2009 NY 3 30 F 1/28/2009 CELLULITIS TO LT. DELTOID REG
338475 1/28/2009 OH 24 24 F 1/28/2009 I received 2 of the 3 Gardisil shots.
338476 1/28/2009 CA 4 4 F 1/28/2009 Patient recieved vaccines on 1/16/0
338477 1/28/2009 TX 68 68 F 1/28/2009 patient experienced swollen, red, ho
338478 1/28/2009 NY 0.3 0 0.4 F 1/28/2009 24 hours after 1st PCV, baby's thigh
338479 1/28/2009 MO 1 1 0F 1/28/2009 Varicella rash; about 2 dozen lesion
338480 1/28/2009 MI 15 15 M 1/28/2009 None
338481 1/28/2009 MS 24 24 M 1/28/2009 Chills, fevers of up to 103.2, body a
338483 1/28/2009 MO 1 1 0M 1/28/2009 20-25 ERYTHEMATOUS LESIONS
338484 1/28/2009 CA 1.1 1 0M 1/28/2009 FOURTH IPV GIVEN AT 12 MONTH
338485 1/28/2009 OR 5 5 U 1/28/2009 Area of swelling 10.5 cm x 9.5 cm, f
338486 1/28/2009 CA 47 F 1/28/2009 Patient developed a rash 7-10 days
338487 1/28/2009 UT 5 -1 1M 1/28/2009 Mom to clinic with 5 yo with concern
338488 1/28/2009 AK 49 49 F 1/28/2009 THE FLU SHOT WAS GIVEN DIRE
338489 1/28/2009 OH 1 1 0M 1/28/2009 My son was on target with speech a
338495 1/28/2009 NC 16 16 F 1/28/2009 1. Bruising x 3 weeks. 2. Local pain
338496 1/28/2009 TN 22 22 F 1/27/2009 Pt describes temp 102.2 F orally se
338501 1/28/2009 GA 28 28 F 1/28/2009 Employee c/o headache, nausea, v
338502 1/28/2009 KS 71 71 F 1/28/2009 Very stiff neck muscles, onset 24 ho
338503 1/28/2009 NJ 5 5 M 1/26/2009 1-16-09 vaccine given. 1-22-09 at 6
338506 1/28/2009 AZ 4 4 F 1/28/2009 Left deltoid localized reaction with re
338508 1/28/2009 IL 60 60 M 1/28/2009 Patient c/o right upper arm swelling,
338509 1/28/2009 CA 1.8 1 0.8 F 1/28/2009 Erythema, Hyperemia and edema a
338510 1/28/2009 VA 1 1 0M 1/28/2009 Triaged by Dr via telephone and ad
338511 1/28/2009 FL 4 4 F 1/26/2009 Swelling, redness with the left shou
338512 1/28/2009 IL 70 70 M 1/28/2009 Patient was diagnosed with shingles
338522 1/28/2009 IL 65 65 M ### On May 1, 2006 I went to the Hospi
338523 1/28/2009 NC 35 35 M 6/10/2008 35 y/o male SM referred to hospital
338556 1/29/2009 2 U 1/27/2009 Initial report received on 21 January
338557 1/29/2009 NJ 0.5 0 0.5 F 1/26/2009 Initial report received on 15 January
338558 1/29/2009 1 1 0F 1/28/2009 Information has been received from
338567 1/29/2009 73 73 F 1/27/2009 Shingles vaccine given 12/31/2008.
338568 1/29/2009 61 61 F 1/26/2009 Patient reported rash and itching ar
338569 1/29/2009 KY 43 43 F 1/22/2009 L arm - deltoid region with redness,
338570 1/29/2009 WY 73 73 F Left arm Pneumonia Vaccine R arm
338571 1/29/2009 NV 2 2 1M 1/21/2009 MOC called on 1/15/08 at 11 am, st
338594 1/29/2009 NY 1.3 1 0.2 F 1/29/2009 Patient developed a facial palsy on
338595 1/29/2009 NY 21 21 F 1/29/2009 PT. HAD FLUSHOT 12/15/08 AND
338596 1/29/2009 MI 1.5 1 0.5 F 1/29/2009 NONE REPORTED
338597 1/29/2009 NY 67 67 F 1/29/2009 SWELLING AT INJECTION SITE
338598 1/29/2009 NC 14 14 F 1/29/2009 01/28/2009 pt report n&v, confussio
338599 1/29/2009 VA 0.2 0 0.1 M 1/29/2009 first vaccinations, including rotateg,
338600 1/29/2009 ID 52 52 F 1/29/2009 To start with, I was never alergic to
338601 1/29/2009 MS 26 26 M 1/29/2009 20 Jan 2009- received vaccination.
338602 1/29/2009 AL 14 14 F 1/29/2009 On 1/20/09 after clinic visit, and @ 7
338604 1/29/2009 WA 11 11 F 1/29/2009 Lip swelling for 12 hours. 10 days la
338605 1/29/2009 NY 14 14 F 1/29/2009 Bell's palsy 1 week after HPV #3 va
338606 1/29/2009 MO 31 31 F 1/12/2009 Within 6 hours of receiving vaccine
338607 1/29/2009 CO 0.3 0 0.3 F 1/29/2009 Infant received HIB #1, Prevnar #1,
338608 1/29/2009 AZ 4 4 F 1/29/2009 Local reaction, erythema, induration
338609 1/29/2009 IL 62 62 F 1/29/2009 Six Hours post Injection patient exp
338610 1/29/2009 CA 13 1 0.1 F 1/29/2009 About 3-5 days after injection, 2 cm
338611 1/29/2009 CA 0.4 0 0.4 F 1/29/2009 6 hours after immunization, patient
338612 1/29/2009 WI 61 61 F 1/28/2009 2cm X 3cm Reddened Raised area
338614 1/29/2009 NE 60 60 F Right sided neck pain/stiffness radia
338615 1/29/2009 WI 0.2 0 0.2 F After 1st dose of ROTATEQ pt. had
338616 1/29/2009 VA 51 51 M 1/29/2009 Pt states that in 2004 she received
338617 1/29/2009 RI 65 65 M 1/23/2009 4x5cm area of redness. Left should
338618 1/29/2009 PA 1.3 1 0.3 F 1/29/2009 Localized VARICELLA reaction - red
338619 1/29/2009 CO 64 64 M 1/29/2009 Patient complaining of rash on right
338620 1/29/2009 NJ 65 65 F 1/29/2009 Zosterform eriphan with pain, itching
338621 1/29/2009 NY 0.2 0 0.2 F 1/29/2009 Baby has rash on both thighs. No fe
338622 1/29/2009 MA 12 12 M 1/29/2009 Developed lump in R. arm circumfer
338623 1/29/2009 WI 63 63 F 1/29/2009 Administered ZOSTAVAX IM instea
338624 1/29/2009 WI 61 61 F 1/29/2009 None administered IM instead of Su
338638 1/29/2009 M 1/29/2009 This case was reported by a lawyer
338639 1/29/2009 PA 0.5 0 0.5 M 1/29/2009 Patient received ROTATEQ on 1-27
338640 1/29/2009 CT 8 8 F 1/28/2009 Pt has received FLUMIST in previou
338641 1/29/2009 F 1/29/2009 Patient received injection 6-9-08. Ex
338642 1/29/2009 NC 28 28 M 1/29/2009 SM developed erythematous, pruriti
338667 1/30/2009 PA 1 1 0M 1/28/2009 Sudden death Y at home morning of 1
338671 1/30/2009 TX 62 62 F 1/26/2009 Patient called our office approx 30 m
338672 1/30/2009 NC 32 32 F 1/8/2009 None stated
338673 1/30/2009 AR 0.2 0 0.2 M 1/15/2009 Lethargy started in 1/14/09, had to b
338689 1/30/2009 AZ 61 61 M ### Received Flu shot 10/14/08 Fry's. T
338690 1/30/2009 FL 14 14 F 1/21/2009 Passed out, tremors, eyes rolling in
338691 1/30/2009 NC 0.5 0 0.5 F 1/29/2009 No known reaction. KINRIX acciden
338692 1/30/2009 VA 44 44 F 1/30/2009 Pt states she gets frequent breakou
338693 1/30/2009 KY 1.2 1 0.2 F 1/30/2009 On 12-19-08 increased temp 105.8
338694 1/30/2009 AZ 14 14 M 1/29/2009 Immediately after the 2 vaccines ad
338695 1/30/2009 MO 1 1 0M 1/30/2009 Pt received VARIVAX vaccine on 09
338696 1/30/2009 CA 4 4 M 1/30/2009 Redness, Swelling, itching, warmne
338697 1/30/2009 AR 3 3 M 1/30/2009 Itchy, red, swollen. Cold compress a
338698 1/30/2009 CA 5 5 M 1/30/2009 Early Thursday morning fever of 100
338704 1/30/2009 MI 14 14 M 1/30/2009 HE HAD CONVULSIONS FOR A D
338705 1/30/2009 ND 1 1 0F 1/30/2009 Incident occured 1/2/09 mid-mornin
338706 1/30/2009 MD 42 F 1/30/2009 Pt states that the Last flu vaccine ca
338707 1/30/2009 OH 35 37 M ### Within 4 hours, patient began cough
338708 1/30/2009 IL 43 43 M 1/30/2009 Patient presented to BHC 237 with
338709 1/30/2009 DC 39 39 F 1/30/2009 TDAP given 1/14/09 in L arm Patien
338710 1/30/2009 PA 41 41 F 1/30/2009 Fever 102.7 degrees, chills, body ac
338711 1/30/2009 KY 51 51 M 1/30/2009 MEMBER REPORTED TO SICK CA
338712 1/30/2009 NY 0.5 0 0.5 M 1/30/2009 Immunized 1/21 morning. Rash to n
338713 1/30/2009 PA 52 52 M 1/30/2009 On 1/08/09 Pt. awoke with flu like sy
338714 1/30/2009 IL 1.7 1 0.7 F 1/29/2009 CLIENT HAS IMMUNIZATIONS ON
338715 1/30/2009 OK 67 67 F 1/30/2009 Patient experienced soreness at the
338716 1/30/2009 NY 11 11 M 1/30/2009 Father reports fever of 100-103 for 3
338717 1/30/2009 GA 4 4 M 1/30/2009 Five minutes post administration of
338718 1/30/2009 NY 24 24 M 1/30/2009 right arm swelling, pain & redness 2
338719 1/30/2009 NJ 4 4 M 1/30/2009 Seen in our office on 1/22/09 and re
338720 1/30/2009 OR 6 6 F 1/30/2009 One day after administration of Vari
338721 1/30/2009 AZ 4 4 M 1/30/2009 ACCORDING TO MOTHER, CHILD
338722 1/30/2009 OH 79 79 F 1/30/2009 patient with extremely sore arm limi
338723 1/30/2009 DC 63 63 F 1/30/2009 Fever (Tmax 102F 2 days after shin
338724 1/30/2009 TX 19 19 F 1/30/2009 Vaccine administered around 11 Ju
338725 1/30/2009 CA 28 28 F 1/30/2009 Skin rash all over the body, mostly i
338726 1/30/2009 OR 1 1 0M 1/30/2009 Evening of 7/22/2008 child had a pr
338727 1/30/2009 NE 61 61 F 1/30/2009 The pain in my upper left arm is som
338738 1/30/2009 NM 0.6 0 0.6 F 1/30/2009 This case was reported by a healthc
338740 1/30/2009 WA 77 77 F 1/31/2009 Started with lower back progressing
338741 1/30/2009 CO 14 14 M 1/30/2009 In the evening after his shot, he dev
338742 1/30/2009 MA 9 9 F 1/30/2009 Left arm large red, warm, painful are
338743 1/30/2009 CT 4 4 M 1/30/2009 R arm. 15x15 cm. edema, erythema
338744 1/30/2009 VA 51 51 M 1/29/2009 To H.D. 12-23-08 for vaccines to tra
338745 1/30/2009 MO 3 3 F 1/30/2009 Left deltoid area red, swollen, warm
338746 1/30/2009 CA 25 25 F 1/30/2009 Pt. C/O redness some swelling at si
338747 1/30/2009 AR 29 29 M 1/29/2009 C/O diarrhea and aching approxima
338886 1/30/2009 TX 47 47 F 1/16/2008 Patient received TD vaccination on
338887 1/30/2009 CA 48 F 2/4/2008 The patient received a routine boos
338888 1/30/2009 WV 27 27 M 3/24/2008 Patient received TD-171 on 01/25/0
338889 1/30/2009 WV 27 27 F 1/9/2009 Patient received TD on 03/12/2008.
338890 1/30/2009 CT 65 65 F 9/4/2008 Patient was vaccinated on 02/01/08
338924 1/30/2009 MA 42 42 F 9/4/2008 Patient experienced a high fever of
338925 1/30/2009 MD 66 66 M 6/16/2008 Patient received TD vaccine on 6/12
338926 1/30/2009 IN 47 47 M 8/14/2008 A male patient received vaccine on
338927 1/30/2009 IN 23 23 F 8/14/2008 A female patient received vaccine o
338928 1/30/2009 IN 37 37 M 8/14/2008 A male patient received vaccine on
338929 1/30/2009 IN 22 22 F 8/14/2008 A female patient received vaccine o
338930 1/30/2009 44 44 M 8/15/2008 C.K. received TD vaccine on 06/20/
338931 1/30/2009 39 39 F 8/15/2008 Patient received TD vaccine on 06/2
338932 1/30/2009 IN 47 47 F 1/21/2009 Patient received Td injection intrade
338933 1/30/2009 18 18 M 7/16/2008 A male patient came to doctor's offic
338934 1/30/2009 45 45 M 8/12/2008 Patient was administered TD vaccin
338935 1/30/2009 39 39 F 8/12/2008 Patient was administered Td vaccin
338936 1/30/2009 TX 42 42 F 9/12/2008 Patient received TD injection on 04/
338937 1/30/2009 TX 37 37 F 9/12/2008 Patient received TD injection on 10/
338938 1/30/2009 IA 31 31 F ### On 08/25/08 TD was administered t
338939 1/30/2009 AZ 27 27 F 1/22/2009 Patient developed induration at inje
338940 1/30/2009 AZ 81 81 F 1/9/2009 Patient reported not feeling good af
338941 1/30/2009 AZ 13 13 F 1/22/2009 Patient developed induration and re
338942 1/30/2009 MA 71 F 12/2/2008 Patient received TD vaccine, lot TD
338943 1/30/2009 IN 18 18 M ### Fever, sweating, migraine headach
338944 1/30/2009 MA F 1/7/2009 This case was reported by a healthc
338946 1/30/2009 MN 1.3 1 0.3 M 1/7/2009 This case was reported by a healthc
338947 1/30/2009 FL 65 65 M 1/7/2009 This case was reported by a physici
338948 1/30/2009 FL F 1/7/2009 This case was reported by a consum
338949 1/30/2009 NY F 1/7/2009 This case was reported by a healthc
338950 1/30/2009 NC F 1/7/2009 This case was reported by a healthc
338951 1/30/2009 NC F 1/7/2009 This case was reported by a healthc
338952 1/30/2009 NC M 1/7/2009 This case was reported by a healthc
338955 1/30/2009 NC U 1/7/2009 This case was reported by a healthc
338956 1/30/2009 FL 37 37 F 1/7/2009 This case was reported by a healthc
338957 1/30/2009 CA 35 35 F 1/7/2009 This case was reported by a physici
338958 1/30/2009 VA 30 F 1/7/2009 This case was reported by a healthc
338959 1/30/2009 MA 60 F 1/7/2009 This case was reported by a physici
338961 1/30/2009 UT 57 57 F 1/7/2009 This case was reported by a healthc
338963 1/30/2009 KY U 1/7/2009 This case was reported by a pharma
338964 1/30/2009 CT F 1/7/2009 This case was reported by a healthc
338965 1/30/2009 CT F 1/7/2009 This case was reported by a healthc
338967 1/30/2009 NY 69 69 F 1/7/2009 This case was reported by a healthc
338968 1/30/2009 PA 77 77 F 1/7/2009 This case was reported by a physici
338969 1/30/2009 TN 68 68 F 1/7/2009 This case was reported by an allerg
338970 1/30/2009 NV 29 29 F 1/27/2009 This case was reported by a healthc
338971 1/30/2009 NV 68 68 F 1/7/2009 This case was reported by a healthc
338972 1/30/2009 AZ 58 58 F 1/7/2009 This case was reported by a consum
338973 1/30/2009 LA 20 20 F 1/7/2009 This case was reported by a physici
338974 1/30/2009 MD 52 52 M 1/7/2009 This case was reported by a physici
338975 1/30/2009 FL 54 M 1/7/2009 This was reported by a healthcare p
338984 1/30/2009 DC 64 64 F 1/7/2009 This case was reported by a consum
338985 1/30/2009 MN 34 34 F 1/7/2009 This case was reported by a consum
338986 1/30/2009 CT 62 62 F 1/7/2009 This case was reported by a physici
338987 1/30/2009 NM 34 34 F 1/7/2009 This case was reported by a healthc
338988 1/30/2009 IN 37 37 F 1/7/2009 This case was reported by a healthc
338989 1/30/2009 MA 35 35 M 1/7/2009 This case was reported by a healthc
338990 1/30/2009 AZ 8 F 1/7/2009 This case was reported by a mother
338991 1/30/2009 AZ 13 M 1/7/2009 This case was reported by a mother
338992 1/30/2009 AZ 17 M 1/7/2009 This case was reported by a mother
339055 1/30/2009 VA U 1/7/2009 This case was reported by a healthc
339056 1/30/2009 VA 81 81 F 1/7/2009 This case was reported by a healthc
339057 1/30/2009 KY 33 F 1/7/2009 This case was reported by a healthc
339060 1/30/2009 UT F 1/7/2009 This case was reported by a physici
339061 1/30/2009 FL M 1/7/2009 This case was reported by a healthc
339062 1/30/2009 FL M 1/7/2009 This case was reported by a healthc
339063 1/30/2009 FL F 1/7/2009 This case was reported by a healthc
339067 1/30/2009 CO M 1/7/2009 This case was reported by a healthc
339068 1/30/2009 CO F 1/7/2009 This case was reported by a healthc
339069 1/30/2009 OH 15 15 F 1/7/2009 This case was reported by a healthc
339071 1/30/2009 NC 39 39 F 1/7/2009 This case was reported by a pharma
339072 1/30/2009 IN 25 25 F 1/7/2009 This case was reported by a pharma
339074 1/30/2009 NC 39 39 F 1/7/2009 This case was reported by a consum
339075 1/30/2009 KS M 1/7/2009 This case was reported by a healthc
339076 1/30/2009 KS M 1/7/2009 This case was reported by a healthc
339077 1/30/2009 KS F 1/7/2009 This case was reported by a healthc
338728 2/1/2009 40 40 M 2/1/2009 On January 8, 2009, patient recieve
338729 2/1/2009 41 41 M 1/3/2009 LEFT SIDE UPPER BODY MUSCL
338730 2/1/2009 GA 4 4 M 2/1/2009 My son had a seizure the day after
338731 2/1/2009 AZ 0.5 0 0.5 M 2/1/2009 Patient received the vaccine on 1/30
338732 2/1/2009 PA 70 70 M 2/1/2009 Patient devleoped herpes zoster on
338733 2/1/2009 NY 16 16 F 2/1/2009 February 2008 first shot experience
338762 2/2/2009 MA 20 20 F 1/29/2009 I got the first HPV vaccine, and 1 hr
338763 2/2/2009 F 1/29/2009 Pt. received ZOSTAVAX IN; approx
338764 2/2/2009 LA 1.2 1 0.2 M 1/23/2009 Pt given 5th PCV7 instead of Hept A
338765 2/2/2009 WI 63 63 F 1/29/2009 1-2 inch red & warm spot just below
338766 2/2/2009 PA 4 M 1/28/2009 5 m. erythema, swelling L upper arm
338767 2/2/2009 PA 16 16 F 1/28/2009 LA posterior redness 3x4 1/2 in elev
338768 2/2/2009 WA 0.2 0 0.2 F 2/18/2009 Started giving RATATEQ by mouth,
338770 2/2/2009 VT 51 51 M 1/16/2009 Fever, Chills, and cramps, vomiting
338771 2/2/2009 67 67 F 1/29/2009 Patient was given 0.5 ml pneumocc
338772 2/2/2009 41 41 F 1/28/2009 12/1/08 patient received tetanus/dip
338778 2/2/2009 IN 41 41 M 1/29/2009 Initial report received on 07 October
338785 2/2/2009 OH 0.4 F 1/30/2009 Information has been received from
338786 2/2/2009 KS 1.3 F 1/30/2009 Information has been received from
338788 2/2/2009 0.3 F 1/30/2009 Information has been received on re
338790 2/2/2009 OK 54 54 F 2/2/2009 Early the next day after receiving in
338791 2/2/2009 MN 69 68 M 2/2/2009 Red and swollen underarm muscle
338792 2/2/2009 MA 24 24 F 2/2/2009 Severe swelling, cold sweats, vomit
338793 2/2/2009 MI 11 11 U 2/2/2009 2 DAYS AFTER INJECTION, SHE D
338794 2/2/2009 MI 1.2 1 0.2 F 2/2/2009 Mom states child had a seizure 1/31
338795 2/2/2009 PA 29 29 F 2/2/2009 DAY AFTER INJECTION-FEVER A
338797 2/2/2009 FL 65 65 F 2/2/2009 swelling lips , throat and very itchy r
338798 2/2/2009 AK 42 42 F 2/2/2009 Headache 6 hours after injection las
338799 2/2/2009 MN 0.2 0 0.2 F 2/2/2009 2 month old in for immunizations. B
338800 2/2/2009 CA 1 1 0F 2/2/2009 fever w/ poss tonic seizure, mild ras
338801 2/2/2009 OH 48 48 M 2/2/2009 7:00 p.m. fever and dizziness. 8:00
338802 2/2/2009 UT 33 33 M 2/2/2009 Received vaccines on 1-12-09. Sym
338803 2/2/2009 CT 62 62 M 2/2/2009 Pt presents to the emergency room
338804 2/2/2009 NC 40 40 F 2/2/2009 40 yo 70kg WF received 0.5ml Pneu
338805 2/2/2009 KY 1 1 0F 2/2/2009 After getting the MMR, Hep A, and V
338806 2/2/2009 VA 67 67 M 1/30/2009 At approximately 6:00 pm on 1/24/0
338807 2/2/2009 CA 1.1 1 0.1 M 2/2/2009 Low grade fever (100-107 F) multifo
338808 2/2/2009 WA 11 11 M 2/2/2009 1/30/09 - seen in office with redness
338809 2/2/2009 CA 0.4 0 0.4 F 2/2/2009 2pm - received shots. 2:08pm- dev
338811 2/2/2009 OH 47 47 F 2/2/2009 Shot 1-27-09 reported 1-30-09 L arm
338812 2/2/2009 AZ 0.4 0 0.4 F 2/2/2009 fever > 102 X 48 degrees. Fever de
338813 2/2/2009 MI 49 49 F 2/2/2009 Flu vaccine received on 1/30/08 her
338814 2/2/2009 LA 37 37 F 2/2/2009 Pain upon injection, in 24 hours, ho
338815 2/2/2009 OH 30 30 F 2/2/2009 Onset pain in upper outer arm wher
338817 2/2/2009 VA 5 5 F 2/2/2009 Fever- few pustules on trunk (small
338818 2/2/2009 MA 60 60 M 2/2/2009 Hours after following injection patien
338820 2/2/2009 NH 45 45 M 1/29/2009 Bell's Palsy
338821 2/2/2009 WA 1 1 0F 2/2/2009 This case was
Y reported by a healthc
338822 2/2/2009 NJ 16 16 F 1/31/2009 MENACTRA + VARIVAX given on 1
338824 2/2/2009 OR 4 4 M 1/28/2009 (see attached) seizure - like episode
338825 2/2/2009 IN 17 17 M 11/4/2008 At about 6pm he received his two v
338826 2/2/2009 AL 84 84 M 1/29/2009 Right upper arm swollen and warm-
338827 2/2/2009 PA 5 5 F 1/29/2009 Fever for 4-6 hr > 24 hrs post vaccin
338823 2/3/2009 MO 0.2 0 0.2 F 1/27/2009 T 39, diarrhea, mottled, decreased c
338840 2/3/2009 TX 20 F 2/2/2009 Information has been received for th
338841 2/3/2009 TN 20 20 F 2/2/2009 Information has been received from
338844 2/3/2009 LA U 2/2/2009 Information has been received from
338846 2/3/2009 FL 81 81 M 2/2/2009 Information has been received from
338847 2/3/2009 1.3 U 2/2/2009 It was reported in a published article
338849 2/3/2009 NM 0.6 0 0.6 F 1/29/2009 Information has been received from
338873 2/3/2009 23 F ### This case was received on 27 Nove
338891 2/3/2009 23 23 M 2/3/2009 Swelling, Inflamation
338892 2/3/2009 IL 57 57 F 2/3/2009 I became very light headed, as thou
338893 2/3/2009 LA 2 2 0F 2/3/2009 Vaccination was administered 11/5/
338894 2/3/2009 CA 42 42 F 2/3/2009 Patient received MMR vaccination o
338895 2/3/2009 NJ 0.8 0 0.8 M 2/3/2009 Kawaski disease, resulting with the
338896 2/3/2009 SC 53 53 M 2/3/2009 Pain in shoulder of same side as va
338897 2/3/2009 CT 69 69 F 2/3/2009 Pt. received Zostavax on 01/06/200
338898 2/3/2009 OH 0.2 0 0.2 M 2/3/2009 Brought to the office on 01/31/09 fo
338899 2/3/2009 NY 0.7 0 0.7 M 2/3/2009 Few hours later high fever. Next day
338900 2/3/2009 HI 1 1 0F 2/3/2009 Shingles diagnosed 1/09
338901 2/3/2009 MA 20 20 F 2/3/2009 48 hours after administration - Feve
338902 2/3/2009 MI 67 67 M 2/3/2009 NO ADVERSE EVENTS, SYMPTOM
338903 2/3/2009 OH 70 70 M 2/3/2009 ON FRIDAY, JAN 30 PAT CALLED
338904 2/3/2009 CO 78 M 2/3/2009 One day after receiving the pneumo
338905 2/3/2009 IL 3 3 M 8/19/2008 Rash at injection site after varicella
338906 2/3/2009 MN 14 14 M 2/3/2009 father states symptoms started at 1
338907 2/3/2009 WI 12 12 F 2/3/2009 FATHER REPORTS CHILD DEVEL
338909 2/3/2009 OK 57 57 F 2/3/2009 PATIENT REPORTS TINGLING RIG
338910 2/3/2009 NY 1 1 0M 2/3/2009 MMR and Varicella shot given on 1/
338911 2/3/2009 WI 16 16 F 2/3/2009 Severe, chronic headaches that beg
338912 2/3/2009 MI 21 21 M 2/3/2009 Fever, pain, severe swelling, hives.
338913 2/3/2009 23 23 M 2/3/2009 1) Developed vasculltic lesions on le
338914 2/3/2009 FL 72 72 F 1/31/2009 On day 7, broke out in welts. Entire
338915 2/3/2009 PA 3 3 F 2/3/2009 1/7/09 Large cluster of pinpoint vesi
338916 2/3/2009 73 M 1/23/2009 Patient had used topical Neosporin
338917 2/3/2009 WA 68 68 F 1/31/2009 Shot given 12/23. Pt had ache front
338918 2/3/2009 DC 1.2 1 0.2 M 1/12/2009 None Stated
338919 2/3/2009 WI 18 18 F 2/3/2009 US Army NG SGT who noticed a sin
338920 2/3/2009 NC 0.2 0 0.2 M 1/27/2009 High pitch screaming x 48 hrs.
338921 2/3/2009 AL 1 1 0M 2/2/2009 Possible staring spells vs sandifer's
338922 2/3/2009 GA 37 37 F 1/9/2009 Rash on upper arm flu shot 46 X 44
338923 2/3/2009 IN 8 8 F 1/29/2009 Leg turned a little red immediately a
339054 2/3/2009 84 84 F 2/3/2009 Almost after the vaccine neck starte
338960 2/4/2009 MN 0.4 U 2/3/2009 Initial report received on 23 January
338978 2/4/2009 CA 0.3 M 2/3/2009 Initial report received 28 January 20
339004 2/4/2009 GA 1.2 1 0.2 M 2/1/2009 The exact dates of adverse events w
339014 2/4/2009 NJ 0.6 0 0.6 F 2/2/2009 104 degree T 24 hours after shots.
339015 2/4/2009 WI 2 2 0M 2/4/2009 Right leg pain, fever, vomiting, perio
339016 2/4/2009 IL 68 68 F 2/4/2009 Starting on Tues eve (2/3) pat expe
339017 2/4/2009 IL 1.3 F 2/4/2009 Received vaccine 1/23/09. Febrile
339018 2/4/2009 MO 14 14 F 2/4/2009 Temp 102 degree F the day after Td
339019 2/4/2009 KY 68 68 F 1/26/2009 Received ZOSTAVAX vaccine appr
339020 2/4/2009 CT 15 15 F 1/29/2009 Fever, headaches, rash prior to imm
339021 2/4/2009 ME 37 37 F 2/4/2009 Myalgia beginning w/; 24 hrs- fatigu
339022 2/4/2009 CA 10 10 M ### None (patient was given DTap at 10
339023 2/4/2009 IL 1.3 M 2/4/2009 Erythematous maculopapular spots
339024 2/4/2009 ME 1.5 1 0.5 F 2/2/2009 Given Dtap, Hep A at well child che
339025 2/4/2009 FL 0.2 0 0.2 F 2/4/2009 Mucoid diarrhea for 1 month.
339026 2/4/2009 MO 1 1 0F 1/30/2009 1/23/09 1:30 p.m. I administered MM
339027 2/4/2009 NM 4 4 M 2/4/2009 Patient hadYfever within 24 hours of
339028 2/4/2009 FL 56 56 U 2/4/2009 Large lump on arm at site of admini
339029 2/4/2009 PR 0.2 0 0.2 F 2/4/2009 Irritability and crying for more than 3
339030 2/4/2009 NY 1.3 1 0.4 F 2/4/2009 Received MMR and Varivax on 1/30
339031 2/4/2009 IL 50 50 F 2/4/2009 Pt. reported headache, upper torso
339032 2/4/2009 IA 52 52 F 2/4/2009 Patient underwent surgical debridem
339033 2/4/2009 OH 1.3 1 0.3 M 2/4/2009 Developed vomitting, diarrhea, and
339034 2/4/2009 CA 11 11 F 2/4/2009 Progressive weakness and muscle
339035 2/4/2009 GA 33 33 F 2/4/2009 Client developed fever of 103 and v
339036 2/4/2009 FL 4 4 F 2/4/2009 Parent returned to clinic 1/29/09 wit
339037 2/4/2009 WA 19 19 F 2/4/2009 Complained of fever last night (2/3/0
339038 2/4/2009 PA 15 15 F 2/4/2009 HEPATITIS A VACCINE WAS ADM
339039 2/4/2009 PA 55 U 2/4/2009 Subject in pneumococcal vaccine tr
339040 2/4/2009 CA 1.3 U 2/4/2009 RASH INNER L EAR AND CHEEK.
339041 2/4/2009 AZ 16 16 F 2/4/2009 Patient fainted after vaccines
339042 2/4/2009 WA 0.2 0 0.2 M 2/4/2009 Physician ordered pneumo vaccine.
339043 2/4/2009 CO 2 2 0.2 M 2/4/2009 fever up to 104 24 hours after vacci
339044 2/4/2009 CA 1.2 1 0.2 F 2/4/2009 Small blister on the inside, left lower
339045 2/4/2009 HI 79 79 M 2/4/2009 PNEUMOVAX administered at 10:0
339046 2/4/2009 OH 25 25 F MMR vaccine administered IM in rig
339047 2/4/2009 AL 57 57 M Hives and wheezing 01 hour after In
339048 2/4/2009 WA 12 12 M 2/4/2009 6" area of redness and swelling in L
339049 2/4/2009 CA 1.4 1 0.4 M 1/29/2009 Mom reports that patient had sudde
339050 2/4/2009 TN 1.1 1 0.1 M 2/4/2009 Mild localized reaction
339051 2/4/2009 WA 20 20 F 2/4/2009 48 degrees after vaccine given (give
339052 2/4/2009 WA 11 11 M 2/4/2009 3"x3 1/2" raised tender erythematou
339053 2/4/2009 IN 4 4 M Had area of blanchable erythema a
339315 2/4/2009 OH 0.2 U 1/30/2009 This case was reported by a healthc
339316 2/4/2009 WV U 1/30/2009 This case was reported by a physici
339318 2/4/2009 LA 5 5 M 1/30/2009 This case was reported by a healthc
339319 2/4/2009 LA 4 4 M 1/30/2009 This case was reported by a healthc
339320 2/4/2009 LA 5 5 F 1/30/2009 This case was reported by a healthc
339070 2/5/2009 FL 35 F 1/7/2009 This case was reported by a pharma
339085 2/5/2009 WV 2 2 0M 2/4/2009 Information has been received from
339093 2/5/2009 17 17 F 2/2/2009 When I joined in March of 1987 I wa
339095 2/5/2009 62 62 M 2/2/2009 Patient Received ADACEL vaccine
339096 2/5/2009 CA 36 F 2/4/2009 Unlikely time vaccine reaction. The
339097 2/5/2009 50 F 2/2/2009 Chest pain, hoarse throat 3 hrs afte
339098 2/5/2009 M 2/2/2009 Large local reaction 10X18 cm arou
339099 2/5/2009 FL 5 5 M 2/5/2009 Area of redness, swelling + warmth
339100 2/5/2009 MI 1.5 1 0.5 M 2/3/2009 Seizure activity at 3-4 minutes durat
339101 2/5/2009 LA 29 28 U 2/5/2009 Pt is allergic to eggs, and vaccine c
339102 2/5/2009 MD 0.3 0 0.4 M 2/5/2009 child deleloped rash bilaterally over
339103 2/5/2009 NC 39 72 F 2/5/2009 Severe redness and swelling in arm
339104 2/5/2009 IA 0.4 0 0.4 F 2/5/2009 Pt. presented to the family practice
339105 2/5/2009 MO 8 8 F 2/5/2009 Local allergic skin reaction.
339106 2/5/2009 WA 0.2 0 0.2 F 2/5/2009 Sudden onset of lethargy and vomit
339107 2/5/2009 PA 11 11 F 2/5/2009 Parent reports adolescent having hi
339108 2/5/2009 TX 1.6 1 0.6 M 2/5/2009 Patient began febrile episode on 1/3
339109 2/5/2009 VA 46 46 M 2/5/2009 10"x10" warm erythema area on rt.
339110 2/5/2009 MN 26 26 F 2/5/2009 Spoke with pt on Tuesday 2/3/09 sh
339111 2/5/2009 MO 15 F 2/5/2009 Patient complains of severe pain in
339112 2/5/2009 MA 54 54 F 2/5/2009 raised errythematous tender reactio
339113 2/5/2009 NY 12 12 F 2/5/2009 Client was administered Hep A in rig
339114 2/5/2009 CA 45 45 F 2/5/2009 Immediate localized reaction at injec
339115 2/5/2009 OR 2 2 0M 2/5/2009 Patient recieved HAV#2 on 2/3/09,
339116 2/5/2009 CO 1 1 0M 2/5/2009 Recurrent generalized seizures with
339117 2/5/2009 LA 40 40 F 2/5/2009 ADMINISTERED IN LEFT DELTOID
339119 2/5/2009 MA 85 85 M 2/5/2009 The above client had within 24 hour
339120 2/5/2009 ID 0.2 0 0.2 M 2/4/2009 Inconsolable crying X 8 hours
339122 2/5/2009 NM 0.5 0 0.5 M 2/5/2009 Rash all over body. Got shot yester
339124 2/5/2009 HI 1.6 1 0.6 F 2/4/2009 Redness, warmth, swelling around s
339127 2/5/2009 WA 13 13 F 2/5/2009 Call patient dad who said skin was b
339131 2/5/2009 NH 15 15 F ### Patient experienced a vasovagal re
339132 2/5/2009 MA 11 11 M Chicken pox rash site 2/2/09 - No o
339133 2/5/2009 AL 24 24 F 2/5/2009 c/o right arm & chest with + urticaria
339139 2/5/2009 WA 0.2 0 0.2 F 2/5/2009 Sleeping and lethargic and poor fee
339140 2/5/2009 OR 1.6 1 0.6 M 2/5/2009 No adverse reactions known patien
339141 2/5/2009 CA 19 19 M 2/5/2009 Pt noted right eye to be a "little pink
339142 2/5/2009 IL 76 76 M 2/5/2009 Patient developed hundreds of vesi
339143 2/5/2009 PR 25 M 2/5/2009 Since 2003, hearing loss, sleep diso
339144 2/5/2009 PR 21 21 M 2/5/2009 2003-present, hearing loss, scoliosi
339219 2/5/2009 MA 2 M 1/29/2009 Information has been received from
339220 2/5/2009 NY 0.7 M 1/29/2009 Information has been recieved from
339221 2/5/2009 MA 62 F 1/26/2009 Information has been received from
339223 2/5/2009 CA 1.1 M 1/29/2009 Information has been received from
339118 2/6/2009 30 30 M 2/6/2009 Bell's Palsy developed 17 DEC 08 2
339152 2/6/2009 VA 0.2 0 0.2 F 2/6/2009 Baby expired Y 7 days after immuniza
339153 2/6/2009 NE M 2/6/2009 Pt reports swelling due to tetanus to
339154 2/6/2009 OK 26 26 F 2/6/2009 The day I got the vaccine I didn't ha
339155 2/6/2009 NE 64 64 F 2/6/2009 Employee received a Tdap vaccine
339156 2/6/2009 TX 2 2 0.2 M 2/6/2009 approx 19 hours after rec'ing the MM
339157 2/6/2009 MI 38 38 M 2/6/2009 4:30pm found alert but shaking in b
339158 2/6/2009 ID 52 52 M 2/6/2009 Patient started receiving Anthrax va
339159 2/6/2009 AZ 1.3 1 0.3 F 2/6/2009 Rash at vaccination site and over en
339160 2/6/2009 AL 0.8 0 0.8 F 2/6/2009 Received Vaccines on 2/3/2009, an
339161 2/6/2009 CA 2 2 0.1 M 2/6/2009 Cellulitis of left thigh. Hospital admis
339162 2/6/2009 AR 28 28 F 2/6/2009 0815 Hep B vaccine administered. 0
339163 2/6/2009 LA 4 4 M 2/6/2009 Left Thigh noted to get red, swollen
339164 2/6/2009 OH 0.4 0 0.4 M 2/6/2009 Mom was up with patient around 2-3
339165 2/6/2009 OR 1.5 1 0.5 F 2/6/2009 Patient had a hard time walking the
339166 2/6/2009 SC 72 72 F 2/6/2009 Day after vaccine, left deltoid becam
339167 2/6/2009 CA 0.4 0 0.4 F 2/5/2009 Child presented w. generalized hive
339168 2/6/2009 OK 66 66 M 2/6/2009 Pt. was given pneumovax shot (I.M.
339169 2/6/2009 WA 1 1 0.8 F 2/6/2009 aBOUT 10 MIN. AFTER SHOTS, BA
339170 2/6/2009 OH 20 20 F 2/6/2009 Patient fainted immediately after firs
339171 2/6/2009 SC 17 17 F 2/6/2009 None at time of Gardasil vaccine, bu
339172 2/6/2009 IL 0.2 0 0.2 M 2/6/2009 The day after my 2 month old son re
339173 2/6/2009 22 32 M 2/6/2009 Recieved booster anthrax on 2/2/09
339185 2/6/2009 NC 0.3 0 0.3 F 2/6/2009 Pt developed L sided seizures 24 ho
339186 2/6/2009 KY 67 67 M 2/8/2009 Patient started to feel tingling sensa
339187 2/6/2009 MO 0.3 0 0.3 F 2/6/2009 No adverse events. Medication give
339188 2/6/2009 PA 4 4 M 2/6/2009 Abdominal pain within 5 min after v
339189 2/6/2009 NY 3 3 F 2/6/2009 Mom reported severe local reaction
339190 2/6/2009 CA 0.4 0 0.4 M Hives all over. Hives. No respirator
339192 2/6/2009 NC 22 22 M 7/29/2008 22 y/o male pt. presents to clinic wi
339193 2/6/2009 WA 30 30 F 5/28/2008 "I got my first Anthrax vaccine and a
339196 2/6/2009 NC 36 36 M ### 36 y/o male with possible adverse re
339198 2/6/2009 VA 37 37 F 10/2/2008 The patient is a 38 year old female.
339199 2/6/2009 NJ 30 30 M 6/27/2008 34 y/o AD male with hx of hospitaliz
339200 2/6/2009 NC 36 36 F 5/25/2008 36 y/o female, spouse of retired SM
339201 2/6/2009 CA 32 32 M 2/6/2009 Itching, swelling, discoloration, sore
339202 2/6/2009 SC 0.2 0 0.2 F 2/4/2009 Patient received ROTATEQ ON 1/1
339203 2/6/2009 WI 0.7 0 0.7 M Developed emesis and cyanosis a f
339204 2/6/2009 OH 55 55 M 2/6/2009 2-6-09 Client phoned in and report h
339205 2/6/2009 GA 13 13 M 2/5/2009 Hep A site, fever 104, red, swollen i
339206 2/6/2009 WI 50 50 F 1/30/2009 Onset of symptoms began on 1-27-
339207 2/6/2009 NY 1.5 1 0.5 F 2/6/2009 After VARIVAX vaccine, developed
339208 2/6/2009 GA 1.8 1 0.8 F 2/5/2009 Febrile seizures, temp 103.2 degree
339209 2/6/2009 IN 40 40 F 2/3/2009 Pt. c/o L arm "tingling", numbness &
339210 2/6/2009 OH 1.2 1 0.2 F 2/3/2009 Per mom, patient developed fever 1
339211 2/6/2009 CO 0.3 0 0.3 F 2/6/2009 None stated.
339212 2/6/2009 PA 14 14 M 2/6/2009 Left upper arm with 10x7 cm faint e
339213 2/6/2009 WV 11 11 M 2/6/2009 Rapid onset of redness, pain, swelli
339214 2/6/2009 MO 12 12 M 2/6/2009 red, warm, indurated area left arm.
339215 2/6/2009 PA 75 75 F 2/6/2009 fever, chills, arm pain, warm to touc
339174 2/7/2009 PA 1.5 0 0.5 F 2/6/2009 At 8 days, large hive appeared first
339175 2/7/2009 MO 17 17 M 2/7/2009 Approximately 5 minutes after immu
339176 2/7/2009 MI 4 4 M 2/7/2009 r arm cellulitus requiring hospital ad
339177 2/7/2009 WA 0.3 0 0.4 U 2/7/2009 Thick mucus in mouth, wheezing,dif
339178 2/9/2009 CA 25 25 F 2/9/2009 I have lost at least 25% of my hair. I
339232 2/9/2009 VA U 11/6/2008 Initial information was received on 2
339234 2/9/2009 AZ F 2/5/2009 Initial information received on 29 Ja
339237 2/9/2009 MS 75 75 F 2/6/2009 Information has been received from
339241 2/9/2009 M 2/6/2009 Information has been received via a
339244 2/9/2009 NJ 6 M 2/6/2009 Information has been received from
339245 2/9/2009 7 M 2/6/2009 Information has been received from
339255 2/9/2009 VA 17 17 F 2/6/2009 On 6/16/00 the pt received HepB #1
339256 2/9/2009 21 F 1/19/2009 I took GARDASIL shot series, It did
339257 2/9/2009 16 16 F 2/5/2009 Daughter had second shot of GARD
339258 2/9/2009 NM 51 51 M 2/2/2009 Body aches, fever (>100 degrees),
339259 2/9/2009 VA 22 22 F 2/5/2009 Right arm swollen, red, and hot to to
339260 2/9/2009 WV 1.3 1 0.3 M 2/2/2009 Evening of vaccination developed ra
339261 2/9/2009 OH 22 22 F 2/5/2009 States hives on both arms & trunk d
339262 2/9/2009 TX 61 61 F 2/4/2009 Dec. 22, 2008, family medicine--Go
339263 2/9/2009 MO 1.1 1 0.1 F 2/4/2009 Morn after imm. child had fever 101
339264 2/9/2009 WI 17 17 F 2/5/2009 Alicia had complained of pain in her
339265 2/9/2009 WI 11 11 F 2/5/2009 Daughter complained of pain in her
339266 2/9/2009 WA 11 11 F 2/5/2009 I took patient to receive the 3rd sho
339268 2/9/2009 OR 42 42 F 1/26/2009 Fever of 101 degrees F > Broke out
339269 2/9/2009 WI 63 63 F 2/2/2009 Redness, swelling, pain.
339270 2/9/2009 WV 5 5 M 2/4/2009 Chicken pox
339271 2/9/2009 OK 41 41 M 2/9/2009 pt reported dog bite in am and need
339272 2/9/2009 MI 53 53 F 2/9/2009 Pruritus as soon as injection given t
339273 2/9/2009 UT 38 38 M 2/9/2009 Shot given Monday, February 2, 20
339274 2/9/2009 VA 4 4 F 2/9/2009 BREAKTHROUGH CHICKENPOX F
339275 2/9/2009 AZ 39 39 M 2/9/2009 Suspected spread of smallpox due
339276 2/9/2009 WA 19 19 F 2/7/2009 pt recieved yellow fever vaccination
339278 2/9/2009 IL 2 0M 2/9/2009 Mom Called in and states that child
339279 2/9/2009 TX 60 60 M 2/9/2009 After Zoster vaccination, varicella-zo
339280 2/9/2009 MT 49 49 M 2/9/2009 Pt experienced shoulder girdle pain
339281 2/9/2009 MD 62 62 F 2/9/2009 12/3/08 pt started with "strangled co
339282 2/9/2009 CA 0.5 0 0.5 M 2/9/2009 Diffuse upper and lower extremity s
339283 2/9/2009 TN 1.3 1 0.3 F 2/9/2009 Hives over entire body that itches.
339284 2/9/2009 4 4 M 2/9/2009 Patient contracted cellulitis in his lef
339285 2/9/2009 WI 18 18 F 2/9/2009 Persistent headaches and numbnes
339286 2/9/2009 CO 0.2 0 0.2 M 2/9/2009 Patient presented to clinic with moth
339287 2/9/2009 MD 1 0 0F 2/9/2009 103 Fever (48 hours later) Low-gra
339288 2/9/2009 CA 65 65 M 2/9/2009 An itchy, slightly swollen red rash (a
339289 2/9/2009 NC 3 3 F 2/9/2009 hives/raised rash at injection site, fe
339292 2/9/2009 IA 0.3 0 0.3 M 2/9/2009 None
339293 2/9/2009 CA 4 4 F 2/9/2009 Redness, swollen, & rash around va
339294 2/9/2009 DC 43 43 F Beginning 1/10/2009, red bumps ap
339295 2/9/2009 WA 1 1 0F 2/2/2009 Client was noted to have Red spots
339296 2/9/2009 IN 0.3 0 0.3 M 2/7/2009 Facial Swelling, rash prescribed Ora
339297 2/9/2009 NC 2 2 0.5 F 2/9/2009 Vaccine on 25-09 2-6-09 fever (ele
339298 2/9/2009 NY 4 4 M 2/9/2009 Hives on face, neck, groin area, bac
339299 2/9/2009 NJ 37 37 F 2/3/2009 On 2/3/09 student came in with c/o
339300 2/9/2009 CA 4 4 M 2/8/2009 Fever + Chills 5 hours after vaccine
339301 2/9/2009 IN 1.3 1 0.3 M 2/9/2009 After 10 days fever and runny nose.
339302 2/9/2009 CA 8 8 M 2/6/2009 Chills, lethargic 10 minutes after the
339303 2/9/2009 NC 9 9 M 2/9/2009 24-30 hours after vaccine pt broke o
339304 2/9/2009 NM 24 24 F 2/9/2009 During administration the patient ha
339305 2/9/2009 CO 28 28 F 2/9/2009 Pt contacted clinic on 2/6/09 (injecti
339306 2/9/2009 NH 18 18 F 2/6/2009 Patient states she had a S/E of righ
339307 2/9/2009 MI 58 58 F 2/6/2009 Tdap 1/30/09- Rx scarred immediat
339308 2/9/2009 NC 43 43 F 2/6/2009 Pt presented to ER c/o arm sorenes
339309 2/9/2009 PA 39 39 M Pt presented to office with erythema
339310 2/9/2009 WV 57 F 2/6/2009 Excessive swelling at injection site.
339313 2/9/2009 NC 34 34 M 12/9/2008 Whole body aches, anxiety, high Ch
339314 2/9/2009 NY 0.2 0 0.2 M 2/9/2009 After receiving the vaccinations, the
339325 2/10/2009 TX 13 13 M 2/6/2009 Initial information received on 02 Fe
339326 2/10/2009 NY 14 14 M 2/6/2009 Initial information received on 02 Fe
339344 2/10/2009 62 M 2/9/2009 Weakness
339345 2/10/2009 0.6 M 2/7/2009 Shot given: PENTACEL. persistent
339346 2/10/2009 WA 1.5 1 0.5 F 2/4/2009 Mom States child started becoming
339347 2/10/2009 MI 0.1 0 0.1 M 2/10/2009 On 01-26-09 patient presented to U
339348 2/10/2009 ID 12 12 M 2/9/2009 Mom states child was dizzy, nausea
339349 2/10/2009 AZ 4 4 M 2/9/2009 Patient received KINRIX (DTap and
339350 2/10/2009 MA 0.2 0 0.2 M 2/9/2009 Reported notability, poor feeding, le
339351 2/10/2009 NY 12 12 F 2/10/2009 Chronic headache pain. 2/18/09MR
339352 2/10/2009 CO 23 23 F 2/10/2009 Severe headache, head congestion
339353 2/10/2009 WI 5 5 M 2/9/2009 Redness at sight and swelling of leg
339355 2/10/2009 MI 39 M 2/10/2009 I feel that I am having an adverse re
339356 2/10/2009 MA 37 37 M 2/10/2009 Patient vaccinated on Friday 2/6/20
339357 2/10/2009 PA 0.5 0 0.5 M 2/10/2009 Mom noticed redness around neck
339359 2/10/2009 IL 60 60 F 2/10/2009 td administered on 01/29/09 left del
339360 2/10/2009 VA 24 24 M 2/10/2009 PATIENT HAS A RASH ON HIS FA
339361 2/10/2009 TX 7 7 F 2/10/2009 Right arm with 2 1/2" x 1 1/8" erythe
339362 2/10/2009 CA 48 48 F 2/10/2009 This patient present with a Swollen
339363 2/10/2009 VA 39 39 F 2/10/2009 Approximately 2 hours (10:00 AM)
339364 2/10/2009 OR 0.2 0 0.2 F 2/10/2009 2mmx2mm firm cystic lesion on Rt l
339365 2/10/2009 PA 9 9 F 2/10/2009 syncopal event fifteen minutes after
339366 2/10/2009 GA 35 35 F 2/10/2009 Left axillary lymphadenopathy: swol
339367 2/10/2009 TX 17 17 F 2/10/2009 Patient began having frequent UTI's
339368 2/10/2009 TX 40 40 F 2/10/2009 Patient states had problems with "le
339370 2/10/2009 HI 20 20 M 2/10/2009 Event dated 1 Jan 1992. Approxima
339371 2/10/2009 OH 25 25 F 2/10/2009 Severe pain after injection. Few min
339372 2/10/2009 IL 1.3 1 0.3 M 2/10/2009 rash that started on face 8 days afte
339373 2/10/2009 IL 0.4 0 0.4 M 2/10/2009 Within an hour of arriving home from
339375 2/10/2009 10 10 F 2/10/2009 In Spanish: The HPV vaccine Garda
339376 2/10/2009 51 M 2/10/2009 This case was reported by a law off
339383 2/10/2009 WI 34 34 F 2/10/2009 Approximately two hours after recei
339385 2/10/2009 CA 4 4 F 2/10/2009 Mom brought child to office 4 days a
339387 2/10/2009 CA 11 11 M 2/9/2009 Red, rash to right upper arm
339388 2/10/2009 CA 0.6 0 0.6 M Pt. given shots on Feb 02, 2009 - na
339389 2/10/2009 PA 0.2 0 0.2 M 2/10/2009 Fever, vomiting x 2 days, lethargic,
339390 2/10/2009 MI 15 15 F 2/10/2009 Pt seen for headaches on 1/21/09 -
339391 2/10/2009 CA 11 11 M 2/10/2009 He started to vomiting and diarrhea
339392 2/10/2009 MA 4 4 F 2/10/2009 3x4 inch area of ERYTHEMA
339393 2/10/2009 AR 11 11 M 2/10/2009 Per pediatrician who saw Pt in office
339394 2/10/2009 WA 0.2 0 0.2 M 2/6/2009 None Stated
339395 2/10/2009 NC 19 19 M 2/9/2009 19 Y/O White male ADSM is referre
339396 2/10/2009 LA 1.5 1 0.5 F 2/10/2009 5 minutes after receiving DTaP, HIB
339397 2/10/2009 OR 14 14 F Pt developed a pruritic rash starting
339398 2/10/2009 IA 61 61 F 2/10/2009 -Mild headache for 2 days. -Welt at
339399 2/10/2009 NC 0.3 0 0.3 M 2/10/2009 Misadministration of vaccine.
339400 2/10/2009 LA 17 17 F 2/3/2009 Reported back to clinic with report o
339401 2/10/2009 MO 0.8 0 0.8 M 2/10/2008 On 2/04/2007 Child received DTP #
339402 2/10/2009 MI 1 1 0F 2/9/2009 Child was suppose to receive MMR
339403 2/10/2009 WI 21 21 F 2/10/2009 Received dose Amox 2-5-09. C/o H
339404 2/10/2009 IL 68 68 F 2/10/2009 Mild allergic Reactions - Redness, s
339405 2/10/2009 AK 1.1 1 0.1 M 2/2/2009 Patient received vaccines at approx
339374 2/11/2009 OH 11 11 F 2/11/2009 My dughter became very ill when we
339415 2/11/2009 NM F 2/10/2009 Information has been received from
339417 2/11/2009 OR 18 18 F 2/10/2009 Information has been received from
339425 2/11/2009 NC 70 70 M 2/10/2009 Information has been received from
339426 2/11/2009 AZ 69 69 F 2/3/2009 Ophthalmic rash, vesicles, fever X 2
339427 2/11/2009 CA 41 41 M 2/9/09 = Red swollen left arm painfu
339428 2/11/2009 CA 38 38 U (L) arm pain, vomiting, malaise, R/O
339429 2/11/2009 CA 4 4 M 2/11/2009 6 cm x 6 cm red, warm, swollen are
339430 2/11/2009 IL 9 9 F 2/11/2009 Redness and swelling at site of inje
339431 2/11/2009 IA 17 17 F 2/10/2009 1-2 minutes after receiving vaccine
339432 2/11/2009 AZ 11 11 M 2/9/2009 Dizziness after injection
339433 2/11/2009 MA 0.2 0 0.2 F 2/9/2009 Severe crying/inconsolable and fuss
339434 2/11/2009 WA 3 3 F 2/11/2009 None
339435 2/11/2009 6 6 F 2/11/2009 < 50 crusted lesion Pt. had fever for
339436 2/11/2009 CA 0.2 0 0.2 F 2/12/2009 Really drowsy and dazed lasting ab
339437 2/11/2009 WI 4 4 M 2/11/2009 Swollen, red right arm (hyperimmun
339438 2/11/2009 AK 59 59 F 2/6/2009 Rash, itching, Rash spread all over
339439 2/11/2009 NE 8 8 F 2/2/2009 Swelling greater than 5cm w/ erythe
339440 2/11/2009 WI 45 45 F 2/11/2009 patient with pain, Erythema, warmth
339441 2/11/2009 CA 8 8 F 2/10/2009 Patient noticed a 4 in by 3 in area o
339442 2/11/2009 MA 10 10 M 2/11/2009 (8x4inch) itching, redness at site 2 d
339443 2/11/2009 TX 65 65 F 2/6/2009 Red, irritated blotchy rash at PNEUM
339444 2/11/2009 CO F 2/10/2009 24 hr after shot she developed redn
339445 2/11/2009 MI 46 45 F 2/11/2009 vaccine given 2/6/2009. patient sta
339446 2/11/2009 MD 49 48 M 2/11/2009 Pt woke up at 1:00 am with chills, th
339447 2/11/2009 AZ 56 56 F 2/11/2009 The patient called the Dept of Healt
339448 2/11/2009 GA 10 10 F 2/11/2009 4 CM x 4 CM SWOLLEN SPOT ON
339449 2/11/2009 PA 16 16 F 2/11/2009 Patient was in office for routine visit
339450 2/11/2009 PA 35 35 F 2/11/2009 Fever (102-103, severe arm pain an
339451 2/11/2009 NY 4 4 F 2/11/2009 She initially had fever and redness t
339452 2/11/2009 AZ 4 6 M 2/11/2009 ERYTHEMA APPROX. 4 CM IN SIZ
339453 2/11/2009 CA 34 34 M 2/11/2009 On 2/4/09 in received 1st dose of JE
339454 2/11/2009 NY 0.2 0 0.2 M 2/11/2009 Onset of diarrhea 4 days after 1st d
339455 2/11/2009 MI 1.8 1 0.9 M 2/11/2009 Parent reported increased swelling
339456 2/11/2009 KY 42 42 U 2/11/2009 Begab with weakness in right side o
339457 2/11/2009 MN 15 15 F 2/11/2009 Developed symptoms of severe hea
339458 2/11/2009 MI 55 55 M 2/11/2009 Within 2 hours of getting Pneumova
339459 2/11/2009 AZ 4 4 F 2/11/2009 HARD TIME BREATHING,NOT FEE
339460 2/11/2009 NE 50 50 M 2/11/2009 Joe called and reported about 15 m
339462 2/11/2009 OR 11 11 F 2/11/2009 PATIENT STOOD WITHIN A MINU
339463 2/11/2009 IA 0.3 0 0.4 M 2/11/2009 erythema at injection site.
339464 2/11/2009 MI 0.6 0 0.6 M 2/11/2009 Initial flu vaccine given 1-6-2009. H
339465 2/11/2009 CA 1 0 1F 2/11/2009 Presented on 02.02.2009 with rash
339466 2/11/2009 GU 32 32 M 2/11/2009 Redness, swelling, warm Fever 104
339467 2/11/2009 VA 14 14 F 2/11/2009 Pt was sitting on exam table after va
339468 2/11/2009 CO 53 53 F 2/11/2009 metallic taste in mouth, feeling of sw
339469 2/11/2009 TX 0.1 0 0.1 M 2/11/2009 Seizures/Spasms (they look like infa
339470 2/11/2009 CA 11 11 M 2/11/2009 GAVE Dtap INSTEAD OF Tdap
339471 2/11/2009 MD 17 17 F 2/11/2009 RASH ON HANDS< AND OVER FO
339472 2/11/2009 NM 1.5 1 0.5 M 2/11/2009 2/9/09 DTaP: Sanofi Pasture Limite
339473 2/11/2009 WA 47 47 M 2/11/2009 shot given 1600(Sun) by 1100 next
339474 2/11/2009 VA 30 30 F 2/11/2009 Patient received Merck's Gardasil v
339482 2/11/2009 WI 16 16 M 2/11/2009 This case was reported by a physici
339483 2/11/2009 TX 1.2 1 0.2 M 2/10/2009 Fever 102.3 (r) for 2 days morning a
339484 2/11/2009 KY 0.2 0 0.2 M 2/9/2009 Inconsolable crying for 3 days after
339485 2/11/2009 34 34 M 2/10/2009 From shot 1-3 of ANTHRAX I felt ha
339486 2/11/2009 CA 1.1 1 0.1 M 2/11/2009 Maculopapular rash over trunk, face
339488 2/12/2009 MI 0.1 0 0.1 M 2/11/2009 Information has been received from
339490 2/12/2009 AR 10 F 2/11/2009 Information has been received from
339495 2/12/2009 MI 58 U 2/12/2009 Subject in pneumococcal vaccine tr
339496 2/12/2009 NC 6 6 M 2/12/2009 5 MIN AFTER GETTING VARICELL
339497 2/12/2009 SC 37 37 F 2/12/2009 Client called and reported L arm "pu
339498 2/12/2009 TX 0 0 0M 2/12/2009 Extreme lethargy after Hepatitis B v
339499 2/12/2009 SC 0.3 0 0.2 M 2/12/2009 On 10/25/08, @ 8-9AM, mom obser
339500 2/12/2009 GA 8 8 M 2/12/2009 vaccine given 02/09/09. on 02/10/09
339501 2/12/2009 PA 72 71 F 2/12/2009 On 1/16/09, two days after vaccine
339502 2/12/2009 AZ 61 61 F 2/12/2009 temperature 102 deg. - hives - seve
339503 2/12/2009 FL 28 28 F 2/12/2009 client returned to clinic 2/9/09 statin
339504 2/12/2009 WA 14 14 F 2/12/2009 After the third dose my daughter go
339505 2/12/2009 OH 72 72 F 2/12/2009 Client states approximately ten days
339506 2/12/2009 CO 0.5 0 0.5 M 2/12/2009 The patient developed diarrhea (10
339507 2/12/2009 TX 28 28 F 2/12/2009 40mm x 35mm area of "bruising", er
339508 2/12/2009 CA 1.5 M 2/12/2009 MOM STATES "HAD FULL BODY R
339509 2/12/2009 CA 0.5 0 0.5 M 2/12/2009 urticarial rash onset 5 days after vac
339510 2/12/2009 MA 65 65 F 2/12/2009 Vaccine given 2/20/08. On about 2
339511 2/12/2009 WA 0.9 0 0.9 F 2/12/2009 PARENT CALLED AND REPORTE
339512 2/12/2009 CA 41 41 F 2/12/2009 I received the TDAP vaccine on the
339513 2/12/2009 WA 30 30 F 2/12/2009 pain at injection sight up into should
339514 2/12/2009 WA 30 30 F 2/12/2009 Erythema, pain at injection sight up
339515 2/12/2009 NC 55 55 F 2/12/2009 6.5 x 12 cm area of erythema, indur
339516 2/12/2009 WA 14 14 F 2/12/2009 2/6/2009 7:00 p.m. To E.R. by amb
339517 2/12/2009 OR 2 2 0.9 M 2/12/2009 Four inches long by three inches wi
339519 2/12/2009 IA 52 M 2/13/2009 We received from a health care prof
339525 2/12/2009 OK 16 16 F 2/12/2009 12/17/08 mom took patient to ER fo
339526 2/12/2009 NC 16 16 F 2/12/2009 Patient fainted within 2 minutes of v
339527 2/12/2009 UT 11 11 M 2/12/2009 Local rxn both sites - Erythema no f
339528 2/12/2009 SC 76 76 F 2/12/2009 Pt's face and neck turned red with a
339529 2/12/2009 WA 9 9 F 2/12/2009 Pt had severe bronchospasm and s
339530 2/12/2009 AL 12 12 M 2/12/2009 Patient started temp 1:30 am 2/12/0
339531 2/12/2009 MO 17 17 F 2nd shot left deltoid swollen and ten
339532 2/12/2009 RI 1.9 1 0.9 F 2/12/2009 Immediately after administering, Pt
339533 2/12/2009 OH 0.4 0 0.4 M 2/5/2009 2-5-09 mother reports fever 102 deg
339534 2/12/2009 OH 1.4 1 0.4 F 2/6/2009 Left thigh- 1/2 dollar sized red rash.
339535 2/12/2009 NY 10 10 F 2/12/2009 8x8 cm red, warm to touch. Local re
339536 2/12/2009 NY 15 15 M 2/12/2009 Zoster (shingles) developed # days
339537 2/12/2009 MO 3 3 M 2/12/2009 Administered FLUMIST with expirat
339538 2/12/2009 MO 2 2 0.2 M 2/12/2009 Administered FLUMIST with expirat
339540 2/12/2009 CO 1.3 1 0.3 F 2/12/2009 None stated
339541 2/12/2009 MO 1 0 1M 2/11/2009 Rash on chest, back, face, scalp, ar
339542 2/12/2009 VA 5 5 M 2/12/2009 Mother reported within 7 minutes of
339543 2/12/2009 MD 36 36 F 2/12/2009 ENGERIX B #2 administered at 11
339544 2/12/2009 FL 10 10 M 2/11/2009 Had emesis and upset stomach with
339539 2/13/2009 AZ 73 73 F 2/12/2009 Patient reports she got shingles from
339545 2/13/2009 VA 25 25 F 2/9/2009 Patient developed rash on neck, fac
339559 2/13/2009 PA 1 1 0M 2/12/2009 This case was considered medically
339566 2/13/2009 NY 1.5 1 0.5 M 2/13/2009 1/14/09 pt received vaccines (Dtap,
339567 2/13/2009 NJ 27 27 F 2/13/2009 Patient was vaccinated on 1/30/09 a
339568 2/13/2009 FL 61 61 M 2/13/2009 PT REPORT RED, BURNING ABDO
339569 2/13/2009 WI 1.3 1 0.3 F 2/13/2009 0945: given Varicella/DTaP 1530:
339570 2/13/2009 GA 23 23 F 2/13/2009 I received the Gardasil vaccine and
339571 2/13/2009 WA 60 60 M 2/13/2009 myalgias, fever, chills, loss of appet
339572 2/13/2009 OH 0.3 0 0.3 F 2/13/2009 High pitch shrill cry for 45 minutes (n
339573 2/13/2009 AZ 8 8 M 2/13/2009 8 year old male received 2nd doe o
339574 2/13/2009 NY 34 34 F 2/13/2009 Local injection site reaction to the R
339575 2/13/2009 CO 0.7 M 2/13/2009 Within 24 hours of Jeff's first DPT sh
339576 2/13/2009 NC 62 62 F 2/13/2009 PATIENTS HUSBAND PRESENTE
339577 2/13/2009 TX 66 66 M 2/13/2009 Severe arm pain upper arm, can't lif
339578 2/13/2009 SC 5 5 M 2/13/2009 2/5/2009--Back of L arm--upper are
339579 2/13/2009 NJ 3 3 M 2/13/2009 Mother states he started a fever@ 1
339580 2/13/2009 CA 0.3 0 0.3 M 2/13/2009 The child received his second immu
339581 2/13/2009 AL 14 14 F 2/13/2009 1st Gardasil vaccination on 2/19/08
339582 2/13/2009 NJ 11 11 M 2/13/2009 Morning after injection, child woke u
339583 2/13/2009 MO 0.3 0 0.3 M 2/13/2009 12/09/08 - patient was administered
339584 2/13/2009 CA 43 43 F 2/13/2009 1/14/09 afternoon began chest pain
339585 2/13/2009 CO 1.1 1 0.1 M 2/13/2009 TC from State Epidemiologist statin
339586 2/13/2009 CT 58 M 2/13/2009 4 hours after shot - mild malaise dev
339613 2/13/2009 CO 13 13 M 2/13/2009 Diffuse erythematous papular erupt
339614 2/13/2009 TX 67 67 F 2/13/2009 Moderate swelling and erythema
339615 2/13/2009 GA 16 16 F 2/13/2009 Minutes after vaccine admin., pt. wa
339616 2/13/2009 NC 1 1 0M 2/13/2009 rash, mildly pruritic chicken pox
339617 2/13/2009 PA 16 16 F 2/13/2009 Pt had Px exam 11-25-08. GARDA
339618 2/13/2009 WI 73 73 F 2/13/2009 With 4 hours stated arm was the siz
339619 2/13/2009 CA 53 53 F 2/12/2009 Patient called and notified that the d
339620 2/13/2009 CA 1.1 1 0.1 F 2/11/2009 Brief 1 minute seizure - tonic clonic
339621 2/13/2009 IN 1 1 0F 2/10/2009 Rash. Mom unsure of onset, but pt.
339622 2/13/2009 KY 58 58 F 2/5/2009 Pt. returned to office at 4:00 pm- wit
339623 2/13/2009 OR 5 5 F 1/30/2009 Child had Rec'd vaccines in AM and
339624 2/13/2009 OR 61 61 M 2/5/2009 Ringing in ears 1 hour post injection
339625 2/13/2009 GA 15 15 F 2/6/2009 Redness, swelling to site, itching. (V
339626 2/13/2009 NC 47 47 F 2/11/2009 2/15/09 Night of injection L arm bec
339627 2/13/2009 CT 5 5 F 2/13/2009 Swelling noticed next day- became
339628 2/13/2009 CT 1.5 1 0.5 M 2/13/2009 Swelling a redness noted same eve
339629 2/13/2009 TX 67 67 F 2/12/2009 24 hours after shot began headache
339630 2/13/2009 MO 8 8 F 2/13/2009 Scattered raised papulovasicular les
339631 2/13/2009 NY 0.5 0 0.5 M 2/13/2009 8 hours after vaccination, at 7 pm d
339632 2/13/2009 WA 41 41 M 2/6/2009 Pt states reoccurrence of Reitens D
339633 2/13/2009 WA 1.3 1 0.3 F 2/6/2009 fever w/seizure 24 hours post vaccin
339634 2/13/2009 PA 1.2 1 0.2 M 2/5/2009 About 2 weeks after vaccines given
339587 2/14/2009 OR 0.3 0 0.3 M 2/14/2009 A few hoursYafter his well child chec
339589 2/14/2009 NC 12 12 F 2/14/2009 Patient given 1st dose of Gardasil L
339590 2/14/2009 PA 81 81 M 2/14/2009 After Zostavax injection, patient's ar
339591 2/14/2009 TX 0.3 0 0.3 F 2/14/2009 She develop a fever, irrability, decre
339592 2/15/2009 PA 53 53 F 2/15/2009 24 hours after receiving D/T immuni
339593 2/15/2009 ME 20 20 M 2/15/2009 Guillian Barre requiring hospitalizati
339594 2/16/2009 U 2/16/2009 About 2 minutes after the shot I wal
339637 2/16/2009 F 2/12/2009 This serious case was received from
339642 2/16/2009 53 M 2/9/2009 States after flu injection 9/29/08, pt
339643 2/16/2009 SC 1.8 1 0.8 F 9/4/2008 Pt. Rx with VARICELLA on 9-4-08 v
339644 2/16/2009 SC 1.2 1 0.2 M ### Few vesicles over trunk x 4 days.
339645 2/16/2009 SC 5 5 M 9/19/2008 Mild VARICELLA - few vesicles on t
339646 2/16/2009 SC 4 4 F 12/9/2008 Few vesicles on trunk X 3 days Dx
339647 2/16/2009 IL 35 35 F 2/9/2009 2/02 5:30PM feet starting itching. 2
339649 2/16/2009 PA 4 4 M 2/16/2009 Received vaccines 2/3/09, 2 days la
339650 2/16/2009 OH 1 1 0F 2/16/2009 Fever started 02/13/09, highest was
339651 2/16/2009 NC 36 36 F 2/16/2009 Immediate onset of erythema, prurit
339652 2/16/2009 MO 17 17 F 2/16/2009 Headaches starting January 3rd. Na
339653 2/16/2009 AZ 6 6 F 2/16/2009 Developed Influenza A
339654 2/16/2009 LA 48 48 M 2/16/2009 Night after vaccine administered pa
339655 2/16/2009 PA 78 78 F 2/16/2009 PATIENT RECIEVED A SUB-Q DO
339656 2/16/2009 LA 17 17 F 2/16/2009 Patient received 1st dose of Gardas
339657 2/16/2009 FL 45 45 F 2/16/2009 Pt. developed burning, itching rash
339658 2/16/2009 CA 14 14 M 2/16/2009 Fever,dizziness & fast heart beat
339659 2/16/2009 16 F 2/16/2009 My daughter received Gardisil vacci
339660 2/16/2009 CO 11 11 F 2/16/2009 Patient experiences severe flushing
339661 2/16/2009 FL 0.2 0 0.3 M 2/16/2009 My son has had chronic constipatio
339662 2/16/2009 WY 22 22 F 2/16/2009 Fever, headache, nausea, joint pain
339672 2/16/2009 IL 1.4 1 0.4 F 2/16/2009 MMR given 1/21/09. Came in with s
339674 2/16/2009 SC 69 69 M 2/12/2009 Leg Pain
339675 2/16/2009 OH 61 61 F 2/12/2009 Fatigue, myalgia. Episode of tachyc
339676 2/16/2009 CA 8 8 M 2/5/2009 Diffuse abdominal pain after first do
339677 2/16/2009 WA 10 10 M 2/16/2009 DTap given outside guidelines. Per
339678 2/16/2009 FL 72 72 M Fever,chills, weakness, RUQ pain a
339679 2/16/2009 NY 1 1 0F 2/12/2009 Pink papule on L Tricep Area with w
339680 2/16/2009 KS 1 1 0F 2/6/2009 Infant had some sinus congestion a
339681 2/16/2009 NY 17 17 F 2/16/2009 Pt c/o feeling dizzy after shot. Pt to
339682 2/16/2009 IN 18 18 F 2/12/2009 Patient was given two tetanus inject
339683 2/16/2009 AZ 22 22 F 2/13/2009 Rash. swelling pain @ injection site
339663 2/17/2009 35 35 F 2/17/2009 Patient reported pain and swelling a
339687 2/17/2009 IA 17 17 F 2/13/2009 Information has been received from
339695 2/17/2009 MI 17 F 2/16/2009 Information has been received throu
339708 2/17/2009 NH 0.5 0 0.5 M 2/2/2009 Patient received the three doses of
339710 2/17/2009 CA 40 40 F 2/6/2009 Headache, emesis. 2 ED visits.
339711 2/17/2009 WA 55 55 F 1/27/2009 (L) arm/hand "pinging" when I tap th
339712 2/17/2009 NC 65 65 F 2/11/2009 None
339713 2/17/2009 VA 16 16 F 2/12/2009 GARDASIL injection given in left de
339714 2/17/2009 NM 10 10 F 1/29/2009 Rt Arm- 6.5X 8cm erythematous, ind
339715 2/17/2009 GA 0.8 0 0.8 M 2/11/2009 Patient was seen at the Emergency
339716 2/17/2009 OR 3 3 M 2/13/2009 morning after had HEP A shot had b
339717 2/17/2009 FL 79 79 U 2/17/2009 pT. STATES GENERALIZED RASH
339718 2/17/2009 IN 13 13 F 2/17/2009 Approx 3 weeks after getting 1st se
339719 2/17/2009 26 26 F 2/17/2009 Vaccinated during pregnancy. Preg
339720 2/17/2009 ND 5 5 M 2/17/2009 Mother called stated that child bega
339721 2/17/2009 OR 41 40 M 2/17/2009 Chronic fatigue, difficulty concentrat
339722 2/17/2009 NC 76 75 F 2/17/2009 pt contracted shingles 8 months s/p
339723 2/17/2009 IN 13 13 F 2/17/2009 Mom states that 4 hours after immu
339724 2/17/2009 MS 0.2 0 0.2 M 2/17/2009 He had a high
Y fever 4 days after ge
339725 2/17/2009 VA 68 68 F 2/17/2009 Red swollen Left arm. Patient came
339726 2/17/2009 SC 67 67 F 2/17/2009 Zostavax injection given on 2/10/20
339727 2/17/2009 CA 30 30 F 2/17/2009 Observed large reddened area appr
339736 2/17/2009 WI 1 1 0F 2/17/2009 Erythema multiforme
339737 2/17/2009 FL 80 F 2/16/2009 Patient developed vesicular rash in
339738 2/17/2009 PA 17 17 F 2/17/2009 Patient's mother called 2/17/09 repo
339739 2/17/2009 IN 1.8 1 0.8 F 2/17/2009 C/o rash on shoulders, back, (R) sid
339740 2/17/2009 VA 40 40 F 2/16/2009 Swelling, pain left index finger mcp
340200 2/17/2009 OH 30 F 1/23/2009 A non-serious, spontaneous report
340201 2/17/2009 NJ 3 3 F 1/15/2009 A non-serious spontaneous report o
340202 2/17/2009 NJ 4 4 M 1/15/2009 A non-serious spontaneous report o
340204 2/17/2009 KY 2.7 F 1/21/2009 A non-serious spontaneous report o
340205 2/17/2009 CA 5.7 M 1/19/2009 A non-serious spontaneous report o
340206 2/17/2009 TX 2 F 1/12/2009 A non-serious spontaneous report o
340207 2/17/2009 NJ 3.3 3 F 1/6/2009 A non-serious spontaneous report o
340208 2/17/2009 NJ 3.2 3 M 1/6/2009 A non-serious spontaneous report o
340210 2/17/2009 DC 2 2 0F 1/13/2009 A non-serious, spontaneous report
340211 2/17/2009 DC 2 2 0.4 M 1/13/2009 A non-serious, spontaneous report
340212 2/17/2009 AZ 2 2 0U 1/7/2009 A non-serious report of "six patients
340213 2/17/2009 MO 2 2 0.8 F 1/9/2009 A non-serious, spontaneous report
340214 2/17/2009 MO 3.8 3 F 1/9/2009 A non-serious, spontaneous report
340215 2/17/2009 AZ 4 4 U 1/7/2009 A non-serious report of "six patients
340216 2/17/2009 AZ U 1/8/2009 A spontaneous non-serious report o
340217 2/17/2009 AZ U 1/8/2009 A non-serious spontaneous report o
340218 2/17/2009 AZ U 1/8/2009 A spontaneous non-serious report
340219 2/17/2009 NJ 4 4 M 1/6/2009 Expired vaccine used Expired drug
340220 2/17/2009 NJ 2 2 0F 1/6/2009 A non-serious spontaneous report o
340221 2/17/2009 OH 4 4 M 1/2/2009 A non-serious report of "gave patien
339741 2/18/2009 IL 0.4 0 0.4 M Parent went to make f/u apt child no
339742 2/18/2009 OH 0.8 0 0.8 F 1/14/2009 Vomiting that started several hours
339743 2/18/2009 MN 24 24 F 12/1/2008 Soreness
339744 2/18/2009 NY 11 11 M 1/20/2009 11 year boy passed out suddenly af
339745 2/18/2009 29 29 F 2/6/2009 Several hours after receiving the va
339747 2/18/2009 CO 22 22 F 1/27/2009 Autoimmune-type disorder. Fever, jo
339748 2/18/2009 MA 17 17 F 1/29/2009 Immunizations given on 1/12/09 at a
339749 2/18/2009 CA 0.4 0 0.4 U Infant was seen 11/12/08 for pulling
339750 2/18/2009 IN 0.5 0 0.5 F 1/16/2009 24 hrs after shots had episode of vo
339751 2/18/2009 CA 1.3 1 0.3 M 1/28/2009 Convulsions, Shaking, High Fever.
339752 2/18/2009 HI 23 23 M 2/10/2009 After receiving the third series of An
339753 2/18/2009 TN 0.2 0 0.2 M 1/14/2009 Intussusception - open reduction aft
339754 2/18/2009 ME 50 50 F 1/20/2009 Sudden onset arthralgias 12/29/08.
339755 2/18/2009 GA 11 11 F ### Pain & swelling to the right deltoid a
339756 2/18/2009 NY 46 46 F 1/19/2009 Right after Tdap I started having nu
339757 2/18/2009 CA 25 25 F 1/16/2009 Weakness, nausea, tiredness, confu
339758 2/18/2009 CA 18 18 M 1/27/2009 Developed Guillain Barre Syndrome
339759 2/18/2009 NY 22 22 M 1/22/2009 Chest pain began 4 days after prima
339760 2/18/2009 MN 18 18 F 1/15/2009 Pt given GARDASIL vaccine about
339761 2/18/2009 FL 73 73 F 1/29/2009 Dead feeling in lower part of body.
339762 2/18/2009 OH 11 11 F 1/20/2009 Pt returned to office about 1 hour po
339763 2/18/2009 MI 0.2 0 0.2 F 1/20/2009 Baby previously well except noted t
339764 2/18/2009 OR 70 70 M 1/20/2009 Headache- intense Flu-like symptom
339765 2/18/2009 IN 40 40 M 1/29/2009 Pt suffer very severe local Rxn at si
339766 2/18/2009 WA 1 1 0F 2/5/2009 Developed petechiae 1/30/09. Diag
339767 2/18/2009 NJ 3 3 F 1/20/2009 Telephone call from parent - reports
339768 2/18/2009 KY 23 23 F 2/9/2009 1/6/09 - Vaccine administered. 1/19
339769 2/18/2009 OH 38 38 F 1/19/2009 I had received the Tdap shot in my
339770 2/18/2009 WY 25 25 M 2/10/2009 Syncope episode following injection
339771 2/18/2009 IL 13 13 F 2/9/2009 She developed
Y a pulmonary emboli
339772 2/18/2009 KY 0.3 0 0.3 M 2/6/2009 Patient found
Y in cardiopulmonary ar
339773 2/18/2009 UT 1.3 1 0.3 M 1/20/2009 About one week after shot. Fever 1
339774 2/18/2009 CO 59 59 F 2/3/2009 Hospitalization for numbness, pain,
339775 2/18/2009 MD 0.5 0 0.5 M 1/12/2009 Pt seen in ER twice for abdominal p
339776 2/18/2009 TN 0.3 0 0.3 M 1/12/2009 Intussusception. Required partial co
339777 2/18/2009 OH 34 34 F 1/15/2009 Noticed AM 1/15/09 - Right upper a
339778 2/18/2009 HI 26 26 F 1/12/2009 Patient vacant 15 minutes after the
339779 2/18/2009 CA 68 68 F ### Local area enduration, erythema &
339780 2/18/2009 CT 53 53 F 12/1/2008 On 10/24/08 pt. presented to office
339781 2/18/2009 AL 13 13 F 1/12/2009 Multiple lesions (>250) on extremitie
339782 2/18/2009 IL 20 20 F Approx 10min after injection while s
339783 2/18/2009 MO 67 67 F 1/12/2009 After approximately 8 minutes after
339784 2/18/2009 NY 54 54 M 1/14/2009 Approx 3 hours after vaccine pt repo
339785 2/18/2009 PA 47 47 F 1/13/2009 Achy, Chills, Diarrhea, Malaise follo
339786 2/18/2009 IL 42 42 M 1/13/2009 Fever (102 degrees F), severe left a
339787 2/18/2009 MA 0.3 0 0.3 M 1/14/2008 Rec'd PENTACEL, PCV7 and Rotav
339788 2/18/2009 VA 0.8 0 0.8 F 1/14/2009 Facial flushing & macular rash on th
339789 2/18/2009 NM 3 3 M 1/12/2009 Immunizations given on 1/8/09 at ap
339790 2/18/2009 WV 26 26 F 1/14/2009 Pt called office and c/o L upper arm
339792 2/18/2009 WA 64 64 M 12/23 ZOSTAVAX Received 12/25
339795 2/18/2009 FL 0.2 0 0.2 M 1/19/2009 Pt became very irritable Abd pain.
339796 2/18/2009 WI 39 M 2/17/2009 Information has been received from
339797 2/18/2009 TX 0.3 0 0.3 F 1/16/2009 dev. vomiting and diarrhea within 4
339800 2/18/2009 CA 21 21 F 1/12/2009 Patient complaints of wheezing at n
339801 2/18/2009 FL 0.2 0 0.2 F 1/14/2009 Prolonged crying - went to clinic. Se
339804 2/18/2009 FL 44 44 F 1/11/2009 Received TDAP vaccine 12/29/08 -
339806 2/18/2009 NE 0 0 0F 1/15/2009 Pt was given Influenza virus vaccine
339807 2/18/2009 M 2/17/2009 Information has been received rega
339808 2/18/2009 TN 43 43 F 2/9/2009 Client called my cell phone and left
339809 2/18/2009 MI 74 F 2/17/2009 Information has been received from
339810 2/18/2009 VA 68 68 F 1/15/2009 Started stiff and could not move righ
339812 2/18/2009 IL 49 49 F 2/10/2009 Arm became very swollen and red,
339813 2/18/2009 NJ 1 1 0F 2/10/2009 Chicken pox
339816 2/18/2009 PA 14 14 F 2/9/2009 Administered HEP A into R deltoid.
339818 2/18/2009 CA 5 5 F 2/3/2009 Patient brought back in office by gu
339821 2/18/2009 SC 43 43 F 2/2/2009 Patient was given inj f/m PNEUMOV
339823 2/18/2009 OR 1.6 1 0.6 M 2/3/2009 1 d after vaccines - on 1/16/09, low
339824 2/18/2009 ND 3 3 M 1/22/2009 First influenza vaccine given approx
339825 2/18/2009 PA 17 17 F 2/3/2009 Extensive macular rash extending m
339826 2/18/2009 GA 56 56 M 2/4/2009 MENACTRA was administered to 56
339827 2/18/2009 PA 52 52 F 2/2/2009 Left shoulder discomfort reported 11
339828 2/18/2009 WA 54 54 F 3/24/2008 Pt felt tingling in fingers, unable to li
339829 2/18/2009 HI 11 11 F 1/31/2009 Increased local redness/swelling wit
339830 2/18/2009 MS 0.2 0 0.2 M 1/15/2009 Fever 103.4 and red rash all over ar
339831 2/18/2009 WI 0.1 0 0.1 M 1/20/2009 Severe diarrhea after 1st ROTATEQ
339832 2/18/2009 MA 1.1 1 0.1 M ### Macular rash c/w RUBELLA. Irritab
339833 2/18/2009 FL 0.4 0 0.4 M 1/16/2008 Pt received PREVNAR vaccine 1-14
339834 2/18/2009 FL 1.3 1 0.3 M 1/16/2009 fever and rash
339835 2/18/2009 CA 1.1 1 0.1 F 1/17/2009 fever 103-104 X 3 days post vaccin
339836 2/18/2009 GA 16 16 F ### Within 10 minutes of receiving GAR
339837 2/18/2009 NY 35 35 M 2/18/2009 Patient came into the clinic complain
339838 2/18/2009 AL 17 17 F 2/18/2009 Approx. 30 minutes after injections
339839 2/18/2009 IL 69 69 M 2/18/2009 had 5 weeks of peripheral neuropat
339840 2/18/2009 24 24 M 2/18/2009 According to patient he was sufferin
339841 2/18/2009 TN 11 11 F 2/18/2009 Red,swollen warm touch left arm 2/1
339842 2/18/2009 MI U 2/18/2009 Received HPV Vaccine dose #3. D
339843 2/18/2009 IL 82 82 M 2/18/2009 On 2/11/09, patient called the health
339844 2/18/2009 NE 0 0 0F 2/18/2009 a newborn was given an Adacell va
339845 2/18/2009 CA 83 82 F 2/18/2009 Bilaterally symmetrical eruption of d
339846 2/18/2009 NY 62 63 F 2/18/2009 Client was taking oral Typhoid Feve
339847 2/18/2009 PA 33 32 M 2/18/2009 Arm Swollen burned and very hard
339848 2/18/2009 NM 11 11 F 2/18/2009 VACCINE GIVEN AT 0915 LD IM W
339849 2/18/2009 TX 1 1 0M 2/18/2009 on 12/06/08 Mom called provider of
339850 2/18/2009 CA 0.9 0 0.9 F 2/18/2009 Baby got vaccine, developed fever i
339851 2/18/2009 CA 30 30 F 2/18/2009 After the shot was given I had mild t
339852 2/18/2009 MN 1.8 1 0.8 M 2/18/2009 Dtap given right thigh, Hib given left
339853 2/18/2009 VA 62 62 F 2/18/2009 noticed spot about the size of a qua
339854 2/18/2009 GA 19 19 F 2/18/2009 3rd in the series of Guardasil on 7/2
339855 2/18/2009 MI 1 1 0F 1/21/2009 Pt was seen 11/16/09 & given VARI
339856 2/18/2009 OR 68 68 F 1/16/2009 Received Tdap, influenza and PNEU
339857 2/18/2009 WI 0.2 0 0.2 F 1/20/2009 Patient developed severe diarrhea a
339858 2/18/2009 WA 10 10 F 1/15/2009 Pt. received Varicella vaccine 1/12/0
339859 2/18/2009 MI 1 1 0M 2/9/2009 Patient was vaccinated on 1/22/09 (
339860 2/18/2009 WI 1 1 0M Rash-12-16 scattered red pin point
339862 2/18/2009 CO 34 34 F 2/6/2009 Received MMR#2 2/2/09 woke 2/3/0
339864 2/18/2009 CO 1 1 0F 4 hours after having 3 vaccines (VA
339865 2/18/2009 WA 35 35 F ### Pt's husband called for help Pt foun
339866 2/18/2009 IN 1 0 1M 2/2/2009 Pt had imm around 4:30PM. Went h
339867 2/18/2009 PA 1.5 1 0.5 F 2/4/2009 Febrile seizure.
339868 2/18/2009 MI 4 4 M 1/12/2009 None stated
339869 2/18/2009 PA 1.5 1 0.5 M 2/4/2009 Febrile seizure.
339870 2/18/2009 NY 4 4 F 1/27/2009 RT. arm red swollen - Hot to touch
339871 2/18/2009 AZ 4 4 M ### Fever of 104 and higher for seven d
339876 2/18/2009 PA 28 28 F 2/13/2009 Initial report received on 02 June 20
339878 2/18/2009 IN 24 24 F 1/12/2009 Left deltoid pain at injection general
339879 2/18/2009 HI 32 32 M 2/18/2009 Pt waited 10 min after receiving YF-
339880 2/18/2009 CA 3 3 F 2/18/2009 Dose #1 J-VAX given 2/10/09 (1cc g
339881 2/18/2009 MD 15 15 F 2/19/2009 Given 1st GARDASIL 1/7/09 at rout
339882 2/18/2009 NJ 12 12 M Received Flu and MENACTRA 10/3
339883 2/18/2009 MI 0.3 0 0.3 M 12/8/2008 4 hours post administration infant ve
339884 2/18/2009 TX 0.3 0 0.3 M 1/13/2009 Maternal grandmother described sta
339885 2/18/2009 IL 17 17 F 2/18/2009 Vaccine given 1/2/09 symptoms beg
339886 2/18/2009 MD 1 1 0F ### Infant began staring & jerking involu
339887 2/18/2009 TX M 2/12/2009 The evening after receiving the vacc
339888 2/18/2009 MI 1.6 1 0.6 M 1/13/2009 Left thigh swollen upper thigh to me
339889 2/18/2009 CA 1.2 1 0.2 F 2/18/2009 Patient received vaccines on 01/23/
339890 2/18/2009 MO 34 34 U Phone call received from family mem
339891 2/18/2009 KY 4 4 F 1/14/2009 Vaccines 1/5/9 no problems. 1/6/9 -
339892 2/18/2009 PA 0.2 0 0.2 M 1/14/2009 Patient received PENTACEL injectio
339893 2/18/2009 ME 1.6 1 0.6 F 1/14/2009 MMR given R upper arm - minutes l
339894 2/18/2009 NJ 6 6 F 1/12/2009 Patient received HEP B3 vaccine on
339895 2/18/2009 NJ 6 6 F 1/12/2009 Patient received HEP B vaccine on
339896 2/18/2009 IA 0.5 0 0.5 M 1/15/2009 1) Rash within 24 hrs. Started on le
339897 2/18/2009 NY 8 8 M 1/23/2009 Generalized lesions head to toe-not
339898 2/18/2009 TX 0.3 0 0.3 M 1/21/2009 Induration and redness over (L) leg
339899 2/18/2009 NY 4 4 M 1/23/2009 redness and swelling of right upper
339900 2/18/2009 SC 0.5 0 0.5 F 1/20/2009 PENTECEL given right thigh in am 1
339901 2/18/2009 CA 14 14 M 2/18/2009 Patient fainted after receiving vaccin
339902 2/18/2009 CA 17 17 F 2/17/2009 Patient was given vaccine. Approxim
339903 2/18/2009 FL 4 4 F 2/18/2009 Severe right deltoid pain and swellin
339904 2/18/2009 VT 1.2 1 0.2 F Intermittent fever and maculopapula
339905 2/18/2009 NC 65 65 F 2/18/2009 Pt received a PNEUMOVAX on 2/17
339906 2/18/2009 NY 61 61 F 2/18/2009 Pain, swelling, itching, rash, warmth
339907 2/18/2009 PA 1 1 0M 1/23/2009 Varicella vaccine breakthrough. Dia
339908 2/18/2009 OH 4 4 U 2/18/2009 At 48 hours had 3" diameter celluliti
339909 2/18/2009 MD 9 9 F 1/19/2009 Wheezing started within 10-15 min a
339910 2/18/2009 CA 1.9 1 0.9 F 1/22/2009 Pt is brought by Mom, had vaccinat
339911 2/18/2009 VA 22 22 F 1/16/2009 R cervical lymph swelling/tendernes
339912 2/18/2009 NV 2 2 0.4 M 1/16/2009 12 x 10 cm lesion R thigh around sh
339913 2/18/2009 1.6 1 0.6 F 1/22/2009 Pt has dime size swelling and tende
339914 2/18/2009 AZ 1.3 1 0.3 M 1/23/2009 Hives at injection site, gave BENAD
339915 2/18/2009 MO 66 66 M 12/5/2008 Pt c/o shock like sensations in his (L
339916 2/18/2009 CA 31 31 F 1/30/2009 Large redness area (4 1/2 inches x
339917 2/18/2009 HI 0.2 0 0.2 M 1/20/2009 At 2 months old patient received va
339918 2/18/2009 PA 9 9 F ### 2 day history of rash prior to presen
339919 2/18/2009 IL 21 21 M ### Had immunization at 12:15 pm on T
339920 2/18/2009 CA 72 72 F ### weakness-fell to the ground stomac
339921 2/18/2009 MO 71 71 F 1/13/2009 Noted 2" diameter, slightly elevated
339922 2/18/2009 NY 0.7 0 0.7 F 1/27/2009 Child became limp and unresponsiv
339923 2/18/2009 21 21 M 1/27/2009 Developed Ulcerative Colitis after A
339924 2/18/2009 DC 38 38 F 1/27/2009 She states she was well at the time
339925 2/18/2009 PA 13 13 M 1/23/2009 6 X 4 induration, pain on LT arm co
339926 2/18/2009 WA 6 6 F 1/26/2009 Vaccine administered on 1/23/09 - O
339927 2/18/2009 PA 22 22 F 1/23/2009 Vaccine given 1-12-09. Pt complain
339928 2/18/2009 KS 28 28 M 1/22/2009 Rash on (R) deltoid, fever, swelling
339929 2/18/2009 PA 1.7 M 1/26/2009 Red DTG bump on L legs. Shot 2 d
339930 2/18/2009 OH 12 12 F 1/23/2009 Urticarial rash - generalized RX - BE
339931 2/18/2009 SC 12.9 12 F 1/19/2009 Approx 5 hours after injection, pt c/o
339932 2/18/2009 NJ 58 58 F 1/13/2009 According to pt several hrs after inje
339933 2/18/2009 NY 49 49 F 1/21/2009 Increasing redness, itching + swellin
339934 2/18/2009 NY 0.8 0 0.8 F 1/9/2009 HEP A vaccine given to a patient un
339935 2/18/2009 NY 49 49 F 1/23/2009 Right arm became very painful, una
339936 2/18/2009 MT 59 59 F 1/23/2009 Felt like touch of flu- woke up with h
339937 2/18/2009 49 49 F 1/22/2009 3 days after receiving tetanus shot-
339938 2/18/2009 NY 1.1 1 0.1 F 1/23/2009 Dev'd rash that spread over body an
339939 2/18/2009 OK 64 64 F 1/22/2009 Pt reports redness and swelling. It r
339940 2/18/2009 CO 4 4 F 1/8/2009 None stated
339941 2/18/2009 PA 19 19 F 1/22/2009 Developed Rheumatoid Arthritis-- P
339942 2/18/2009 OR 11 11 F 2/6/2009 Client fainted approximately 5 min a
339943 2/18/2009 CA 0.6 0 0.6 F 2/6/2009 Woke up with a full body rash and fe
339944 2/18/2009 NJ 37 37 F 1/16/2009 Had flu shot 1/12/09. Also, exposed
339945 2/18/2009 MA 6 6 F 1/26/2009 Low grade fever, symmetric erythem
339946 2/18/2009 CA 10 10 F 1/29/2009 Chronic Headache (Migraine)
339947 2/18/2009 NH 12 12 F 1/23/2009 1/21/09 woke in AM with redness si
339948 2/18/2009 NH 10 10 F 1/23/2009 VARIVAX administered 1/21/2009 R
339949 2/18/2009 NM 29 29 F 1/26/2009 C/O pain, redness, inability to perfo
339950 2/18/2009 NY 8 8 M 2/5/2009 Patient is on STRATTERA. Mother
339952 2/18/2009 WI 15 15 F 1/30/2009 The phone call from Pt's mother sta
339953 2/18/2009 MN 69 69 F Bell's palsy 4/08 and 12/08 (Not cer
339954 2/18/2009 MS 38 38 M 12/5/2008 Developed hives (urticaria) in under
339955 2/18/2009 SC 16 16 F 2/3/2009 Onset severe bilateral knee pain, sp
339956 2/18/2009 TX 40 40 F 2/5/2009 Pt c/o rash 3 weeks after injection.
339957 2/18/2009 MO 61 61 F 1/21/2009 1/20/09 Client called to report 1/15 a
339958 2/18/2009 MN 9 9 M 1/20/2009 No adverse reaction known
339959 2/18/2009 PA 32 32 F 2/3/2009 Onset redness, swelling, discomfort
339960 2/18/2009 OR 24 24 F 1/21/2009 One day after receiving injection pa
339961 2/18/2009 PA 68 68 M 2/7/2009 Sicker than usual, cold or pains afte
339962 2/18/2009 MO 5 5 M 2/4/2009 The evening of the vaccines child st
339963 2/18/2009 TX 4 4 F 1/22/2009 Localized swelling and redness to in
339964 2/18/2009 CA 69 69 F 1/22/2009 Patient developed redness & swellin
339965 2/18/2009 FL 4 4 M 1/22/2009 Erythema & swelling @ injection site
339966 2/18/2009 AZ 18 18 F 1/22/2009 Syncope 3/3/09-records received-br
339967 2/18/2009 AZ 12 12 F 1/22/2009 Syncope
339968 2/18/2009 VT 4 4 M 1/19/2009 Patient developed itchy rash minute
339969 2/18/2009 AK 0.2 0 0.2 M 2/11/2009 1 hr after screamed. 5 1/2 hrs. after
339970 2/18/2009 NY 1 1 0F 1/19/2008 Dermatomial shingles left side T 3-6
339971 2/18/2009 NE 17 F 1/27/2009 Flushed fatigue chills fever - flu- like
339972 2/18/2009 WA 1.1 1 0.1 M 2/11/2009 high fever x 3 nights (night only) (hig
339973 2/18/2009 PA 1.6 1 0.6 F 1/17/2009 Onset of high fever, irritable beginni
339974 2/18/2009 MA 5 5 M 2/7/2009 The day after the immunization was
339975 2/18/2009 TX 0.5 0 0.5 F 2/12/2009 Patient was diagnosed with rotaviru
339976 2/18/2009 TN 0.4 0 0.4 F 1/13/2009 About 4 hours after immunization, h
339977 2/18/2009 DE 68 68 F 2/9/2009 Cellulitis in (R) arm.
339978 2/18/2009 VA 0.5 0 0.5 F 2/10/2009 "Low grade " temp 2/9/09 in PM. 2/1
339979 2/18/2009 ME 55 55 F 2/9/2009 2/4/09 Discomfort in (L) arm - 2/6/09
339980 2/18/2009 TX 63 63 F 2/9/2009 Patient called 24 hours after immun
339981 2/18/2009 FL 67 67 F Shingles itchy leaky rash on left side
339982 2/18/2009 NE 33 33 F 2/11/2009 Had Td and influenza vaccine on 2/
339984 2/18/2009 NC 4 4 F 2/6/2009 Swelling, redness and itching aroun
339985 2/18/2009 VA 51 51 F 2/13/2009 "Bad" headache, fatigue, general fu
339986 2/18/2009 WA 74 74 M 2/9/2009 Fever, temperature of 100.0 degree
339987 2/18/2009 21 21 M 1/23/2009 Rash on arms, legs, hands, &* feet.
339988 2/18/2009 ID 33 33 F 2/7/2009 Symptoms stated within 24 hrs. of th
339989 2/18/2009 DC 32 32 F 11/3/2007 Sinus & nasal congestion & pressur
339990 2/18/2009 WA 4 4 M 2/11/2009 None at this time
339991 2/18/2009 PA 79 79 F 2/12/2009 7:45 P.M. shortly after the injection
339992 2/18/2009 FL 4 4 U Hives @ injection site, raised, red, h
339993 2/18/2009 WA 64 64 F 2/12/2009 12 cm red area, slightly raised, firm,
339994 2/18/2009 AZ 45 45 F 2/10/2009 L Arm pain radiating to the neck. Pt
339995 2/18/2009 MO 17 17 F 2/13/2009 Shortly after vaccination c/o being li
339996 2/18/2009 VA 59 59 F Breathing problems -mucus spitting
339997 2/18/2009 MN F 2/12/2009 First dizzy, increased blood pressur
339998 2/18/2009 GA 56 56 F 2/10/2009 9:25 - TWINRIX + TDAP given 9:35
339999 2/18/2009 OK 17 17 F 1/21/2009 On 8/5/08 pt rec'd HPV-4. On 1/12/0
340000 2/18/2009 OK 25 25 F 2/4/2009 c/o pain numbness going down L ar
340002 2/18/2009 IL 0.4 0 0.4 F ### Approximately 24 hours after vaccin
340005 2/18/2009 GA 8 8 M 2/4/2009 Pt developed symptoms of chickenp
340011 2/18/2009 MO 30 30 F 2/6/2009 Pt stated she felt faint, nauseated, s
340021 2/18/2009 NJ 10 10 F 2/4/2009 Child developed varicella on 2/4/200
340023 2/18/2009 NV 1.6 1 0.6 F 2/2/2009 PREVNAR 1/28 - Next AM, thigh vis
340026 2/18/2009 NV 5 5 F 2/16/2009 2 days after DTaP and VARIVAX in
340030 2/18/2009 AK 44 44 F 2/10/2009 Patient stated she has had pain in h
340031 2/18/2009 SC 4 4 M 2/11/2009 (L) Thigh swelled within hrs of recei
340032 2/18/2009 ME 18 18 F 2/11/2009 Developed blurry vision within 24 h
340033 2/18/2009 WI 10 10 F 1/30/2009 Arm began itching in area of vaccin
340038 2/18/2009 1.5 1 0.5 F 2/6/2009 Pt had immunization 2-3-09 and wa
340039 2/18/2009 1 0F 1/28/2009 Within 4 hrs of receiving MMR/VZV/
340041 2/18/2009 CA 1.3 1 0.3 M 1/30/2009 Received DTaP at 2:30 pm. Per cal
340045 2/18/2009 WA 15 15 M 1/30/2009 C/o arm + generally hot feeling well
340048 2/18/2009 FL 1 1 0M 1/27/2009 Pt had VARIVAX immunization on 6
340054 2/18/2009 NJ 4 F 1/26/2009 Severe local reaction with 15 cm are
340056 2/18/2009 NY 6 6 F 1/29/2009 Mom said child had redness and are
340057 2/18/2009 WA 1.9 1 0.9 F 2/3/2009 R Lat, post thigh with mild erythema
340059 2/18/2009 MA 71 71 F 1/29/2009 red edematous rash cheek & peri or
340060 2/18/2009 TN 0.2 0 0.2 F 2/6/2009 Awoke from nap this p.m. screaming
340063 2/18/2009 AZ 64 F 2/13/2009 Redness at site, size of apple swelli
340064 2/18/2009 ME 24 24 F 2/10/2009 She developed varicella rash on tru
340066 2/18/2009 IN 25 25 M 1/29/2009 tender quarter size area left ECU te
340067 2/18/2009 AZ 33 33 F 2/10/2009 Immunization was received at 10:45
340068 2/18/2009 GA 12 12 M 2/12/2009 2 days after vaccine developed feve
340069 2/18/2009 CA 0.4 0 0.4 M 2/11/2009 Rt ear red/swollen Rt injection site s
340070 2/18/2009 IN 17 17 M 2/11/2009 Patient became nauseous, lighthea
340071 2/18/2009 PA 10 10 F 1/29/2009 Within 24 hrs had pain, swelling, low
340072 2/18/2009 16 15 M 2/11/2009 2/4/2009 body aches, headache, fe
340074 2/18/2009 OK 24 24 F 2/3/2009 She got a little light headed and sick
340075 2/18/2009 NV 9 9 F 2/2/2009 1/26 VARIVAX. That night after sho
340077 2/18/2009 MD 34 34 F 1/29/2009 Pt to ER c/o reaction to Varicella va
340080 2/18/2009 NE 1 1 0F 2/2/2009 (1/26) Subq VARIVAX given Rt lowe
340081 2/18/2009 GA 1.5 1 0.5 M 1/29/2009 101 degree fever - 2 hrs after shots
340082 2/18/2009 NC 1.3 1 0.3 F 2/2/2009 N/A
340083 2/18/2009 WI 3 3 M 2/2/2009 Around 10:00 AM - Fri morning - Ha
340084 2/18/2009 IN 5 5 M 1/16/2009 Pt. received his vaccines and when
340085 2/18/2009 PA 0.4 0 0.4 F 1/27/2009 Administration site with vesicular les
340222 2/18/2009 AL 0.2 0 0.2 M 2/13/2009 Information has been received from
340225 2/18/2009 FL 1.9 F 2/13/2009 Information has been received from
340226 2/18/2009 PA 0.3 0 0.3 M 2/13/2009 Information has been received from
340227 2/18/2009 MN 2 M 2/13/2009 Information has been received from
340228 2/18/2009 WY F 2/13/2009 Information has been received from
340229 2/18/2009 WI U 2/13/2009 Information has been received from
340230 2/18/2009 TN 0.2 0 0.2 F 2/13/2009 Information has been received from
340231 2/18/2009 TN 0.3 M 2/13/2009 Information has been received form
340232 2/18/2009 CT 1.3 U 2/13/2009 Information has been received from
340234 2/18/2009 WA 0.2 F 2/13/2009 Information has been received from
340235 2/18/2009 TX 0.7 U 2/13/2009 Information has been received from
340236 2/18/2009 CA U 2/13/2009 Information has been received from
340308 2/18/2009 VA U 2/13/2009 Information has been received from
340311 2/18/2009 F 2/13/2009 Information hs been received from a
340312 2/18/2009 WA F 2/13/2009 Information has been received from
340324 2/18/2009 IL U 2/13/2009 Information has been received from
340326 2/18/2009 NC 13 13 F 2/13/2009 Information has been received from
340354 2/18/2009 IL 17 F 2/13/2009 Information has been received from
340451 2/18/2009 NM 12 12 F 2/13/2009 Information has been received from
340459 2/18/2009 VA F 2/13/2009 Information has been received from
340462 2/18/2009 OH 13 F 2/13/2009 Information has been received from
340465 2/18/2009 OH F 2/13/2009 Information has been received from
340469 2/18/2009 AZ 18 F 2/13/2009 Information has been received from
340470 2/18/2009 KS 14 F 2/13/2009 Information has been received from
340471 2/18/2009 CA F 2/13/2009 Information has been received from
340476 2/18/2009 NJ U 2/13/2009 Information has been received from
340490 2/18/2009 CO 25 F 2/13/2009 Information has been received from
340494 2/18/2009 KY F 2/13/2009 Information has been received from
340600 2/18/2009 WV 1.3 M 2/13/2009 Information has been received from
340607 2/18/2009 19 F 2/13/2009 Information has bee received from a
340608 2/18/2009 OK F 2/13/2009 Information has been received from
340609 2/18/2009 OK 16 F 2/13/2009 Information has been received from
340611 2/18/2009 RI F 2/13/2009 Information has been received from
340613 2/18/2009 GA 19 F 2/13/2009 Information has been received from
340615 2/18/2009 NC 23 F 2/13/2009 Information has been received from
340625 2/18/2009 KY 15 F 2/13/2009 Information has been received from
340634 2/18/2009 AL F 2/13/2009 Information has been received from
340638 2/18/2009 NY F 2/13/2009 Information has been received from
340641 2/18/2009 AR F 2/13/2009 Information has been received from
340719 2/18/2009 AZ F 2/13/2009 Information has been received from
340720 2/18/2009 TN 21 21 U 2/13/2009 Information has been received from
340725 2/18/2009 MO F 2/13/2009 Information has been received from
340732 2/18/2009 NM 13 F 2/13/2009 Information has been received from
340735 2/18/2009 IN 14 14 F 2/13/2009 Information has been received from
340745 2/18/2009 LA 16 16 F 2/13/2009 Information has been received from
340747 2/18/2009 MA F 2/13/2009 Information has been received from
340764 2/18/2009 MN 16 16 F 2/13/2009 Information has been received from
340769 2/18/2009 F 2/13/2009 Initial and follow up information has
340770 2/18/2009 HI 23 23 F 2/13/2009 Information has been received throu
340772 2/18/2009 GA 25 F 2/13/2009 Information has been received throu
339951 2/19/2009 IL 1 1 0M 2/5/2009 10 days after vaccinations, he deve
340003 2/19/2009 WA 22 22 F Rash, shortness of breath. Rx- BEN
340004 2/19/2009 PA 80 80 F Patient received vaccine 01/19/09 (
340006 2/19/2009 UT 45 45 F 2/4/2009 - Hives reported - symptoms of Brac
340007 2/19/2009 NJ 34 34 M 2/4/2009 102 degree fever, chills, body ache,
340008 2/19/2009 IL 0.6 0 0.6 M 2/6/2009 Vaccine was given 1/30/09-same da
340009 2/19/2009 VA 45 45 F 1/30/2009 9 cm x 10 cm erythematous plaque,
340010 2/19/2009 WA 1 1 0F 1/26/2009 Quarter sized swelling @ injection s
340012 2/19/2009 MN U I had a tetanus shot in my right arm
340013 2/19/2009 CA 0.2 0 0.2 M 1/22/2009 Within 5-10 min of giving immunizat
340014 2/19/2009 MA 64 64 M 1/23/2009 Pt reported coldness, stiffness, chill
340015 2/19/2009 HI 0.6 0 0.6 M 1/26/2009 Developed hives approximately 12h
340016 2/19/2009 GA 27 27 F 1/27/2009 1/21/09 pm fever, hot to touch, pain
340017 2/19/2009 CA 0.6 F 1/12/2009 Given TDAP instead of DTAP
340019 2/19/2009 UT 0.6 0 0.6 F 1/29/2009 fever, seizure like activity
340020 2/19/2009 CA 17 17 F 1/28/2009 Gave vaccines, pt. was nervous, I le
340022 2/19/2009 OH 1.1 1 0.1 M 1/28/2009 patient received vaccines on 1-16-0
340024 2/19/2009 IL 5 4 F 1/29/2009 Upper arm with erythema, length of
340025 2/19/2009 MN 1.3 1 0.3 M 1/28/2009 high temp 103.5 degree F X 48 deg
340027 2/19/2009 NY 11 11 M 2/12/2009 Local inflammatory reaction to right
340028 2/19/2009 SC 1.3 1 0.3 U Pt had an onset of facial rash & rash
340029 2/19/2009 IL 1.3 1 0.3 M 1/22/2009 Seizure with fever - suspicious CT
340034 2/19/2009 MO 18 18 F 1/6/2009 Reported rash on (R) side of face a
340035 2/19/2009 WA 1.2 1 0.2 M 1/19/2009 Shingles- TX: BENADRYL TYLENO
340036 2/19/2009 PA 65 F 2/6/2009 Administered vaccine to patient. Pa
340037 2/19/2009 NJ 58 58 F 1/22/2009 Initial report received on 16 January
340042 2/19/2009 WI 34 34 F 1/26/2009 Numbness in right thumb that rapidl
340043 2/19/2009 WV 15 15 F 1/28/2009 Pt had brief near syncopal episode
340044 2/19/2009 PA 16 16 M 1/30/2009 Vomited x 2 since midnight. Fever to
340046 2/19/2009 OH 0.4 0 0.4 F 2/2/2009 Influenza vaccine given to child less
340047 2/19/2009 NC 74 74 F 1/29/2009 Erythematous, tender to palpitation.
340049 2/19/2009 ME 62 62 F 1/30/2009 Tired, chills, nausea, sore at inj site
340050 2/19/2009 PA 58 58 F 2/2/2008 Positive local cellulitis (L) deltoid tre
340051 2/19/2009 NY 60 60 F 1/30/2009 Received ZOSTAVAX 1/27/09. 1/30
340052 2/19/2009 NC 67 67 F 2/2/2009 Redness, tenderness, and warmth @
340053 2/19/2009 NJ 11 11 F 1/28/2009 Site of immunization red, swollen, te
340055 2/19/2009 WA 51 51 F 2/3/2009 Since receiving Tdap pt. had fever,
340058 2/19/2009 CO 4 4 F 1/30/2009 Redness, edema, itchiness @ site o
340061 2/19/2009 AZ 72 72 F 1/28/2009 Itchy. Red - warm area 2 days and g
340062 2/19/2009 FL 12 12 F 2/1/2009 Became dizzy while walking , fainte
340065 2/19/2009 PA 9 9 F 2/2/2009 Light headed, heart racing, palpitati
340073 2/19/2009 LA 0.2 0 0.2 M Parent states the child had diarrhea
340076 2/19/2009 WI 49 49 F 2/2/2009 2/2/09 TC from client states "upper
340078 2/19/2009 OH 2 2 0.5 F Patient with swelling, induration, wa
340079 2/19/2009 CA 17 17 F 1/21/2009 Pt had syncope within 3 min, fell to
340092 2/19/2009 MO U 2/18/2009 Information has been received from
340098 2/19/2009 MD 33 33 M 2/11/2009 2/2/09 11 PM Tongue "thick and ha
340099 2/19/2009 FL 66 65 F 2/1/2009 Received ZOSTAVAX - on 9/17/08
340100 2/19/2009 PA 1.9 1 0.9 M 2/14/2009 Ataxic gait on 12/3/08, Flu vaccine
340101 2/19/2009 WI 51 51 F 2/16/2009 Patient developed sore right arm the
340102 2/19/2009 69 69 F 2/3/2009 Pt. received ZOSTAVAX on 01/06/2
340103 2/19/2009 PA 0.8 0 0.8 F 2/13/2009 Pt developed urticaria (Hives) within
340104 2/19/2009 CT 0.2 0 0.2 M 2/12/2009 Vaccine @ approx 2 pm, slept for 6
340105 2/19/2009 OH 10 10 M 2/17/2009 Patient was given Hepatitis A and V
340106 2/19/2009 KY 4 4 M 2/13/2009 After getting 4 y/o shots, 1 day post
340108 2/19/2009 NY 38 38 F 2/19/2009 Lt deltoid area of vaccine MIN local
340110 2/19/2009 IN 19 19 M 2/19/2009 Generalized Vaccinia characterized
340111 2/19/2009 NH 13 13 M 2/19/2009 Patient has been running a fever up
340112 2/19/2009 CO 18 18 U 2/19/2009 Nausea, headaches, frequent illnes
340113 2/19/2009 TX 6 6 F 2/19/2009 Patient developed temperature of 1
340114 2/19/2009 MD 22 22 F 2/19/2009 February 17 started to get a papula
340115 2/19/2009 MD 64 64 F 2/19/2009 Per TC from pt: sx's began 2-17-09
340117 2/19/2009 FL 0.2 0 0.2 M 2/19/2009 Fever of 102.5 one hour after the D
340118 2/19/2009 IL 22 22 M 2/19/2009 That night( 2/12/09) he was shiverin
340119 2/19/2009 OH 16 16 F 2/19/2009 Two weeks before Thanksgiving, m
340120 2/19/2009 GA 56 56 F 2/19/2009 malaise, headache, right earache, le
340121 2/19/2009 PA 84 84 M 2/19/2009 Patient lost his hair- all of it over the
340122 2/19/2009 VA 54 54 F 2/19/2009 Left arm pain - stiff after receiving va
340123 2/19/2009 WA 1.8 1 0.8 F 2/19/2009 0 reaction-Pt received Fluzone MDV
340124 2/19/2009 WA 1.8 1 0.8 M 2/19/2009 0 reaction - Pt received Tdap instea
340125 2/19/2009 WA 2 2 0.1 F 2/19/2009 0 reaction- Pt received Fluzone MD
340126 2/19/2009 MI 62 62 F 2/19/2009 Patient called and questioned soren
340127 2/19/2009 AZ 7 7 M 2/19/2009 Right arm swollen and tender and h
340128 2/19/2009 TX 0.5 0 0.5 F 2/19/2009 Family noticed onset of partial seizu
340130 2/19/2009 CA U 2/19/2009 slept all day after receiving vaccines
340133 2/19/2009 68 68 F 2/19/2009 We received the following informatio
340135 2/19/2009 56 56 F 2/19/2009 This case was reported by a lawyer
340136 2/19/2009 TX -1 0.2 M 2/19/2009 This case was reported by a healthc
340138 2/19/2009 IN 17 17 M 2/17/2009 Rash on abdomen and spread to ba
340139 2/19/2009 WA 3 3 M 2/18/2009 None
340140 2/19/2009 CA 14 14 M 2/19/2009 Erythema and swelling at site, Dors
340141 2/19/2009 CA 1.1 1 0.1 F 2/19/2009 Rash fever all over body 10 days af
340142 2/19/2009 IA 1.5 1 0.5 M 2/19/2009 Rash - Hive like. Swollen Rt leg - re
340143 2/19/2009 IL 1.5 1 0.5 M 2/19/2009 Onset of chicken pox disease on 2-
340144 2/19/2009 MO 1.1 1 0.1 F 2/19/2009 Patient developed #3 1-2 mm papul
340145 2/19/2009 CA 1.1 1 0.1 M 2/18/2009 None stated. 7/7/09 Medical record
340146 2/19/2009 IL 23 23 F 2/18/2009 On 2-19-09 donor reported a rash s
340147 2/19/2009 OH 0.5 0 0.5 M 2/16/2009 High fever reported by parent to be
340148 2/19/2009 TX 32 32 U 2/19/2009 Multiple erythematous vesiculopapu
340149 2/19/2009 MI 14 14 M 2/18/2009 Pt was give 1 dose of MENACTRA
340150 2/19/2009 VA 0.8 0 0.8 M ### On 15 Oct 2008 his mother brought
340151 2/19/2009 41 41 F ### developed bilateral red eyes, itching
340152 2/19/2009 KS 51 51 M ### I received 3 AVA vaccinations in 20
340155 2/20/2009 WA 32 M 2/19/2009 Information has been received from
340164 2/20/2009 NM 19 F 2/19/2009 Information has been received from
340167 2/20/2009 MA 0.4 0 0.4 M 2/19/2009 None stated. Y 7/20/09 Autopsy repor
340168 2/20/2009 AR 18 18 F 2/6/2009 Paralysis - entire body - breathing o
340169 2/20/2009 NY 0.5 0 0.5 M 2/10/2009 Admitted to hospital 2/6/9 for intuss
340170 2/20/2009 FL 1.3 1 0.3 M 2/20/2009 Thursday Feb. 5, 2009 fever 102- C
340171 2/20/2009 FL M 2/20/2009 Red pruritic rash encircling entire ba
340172 2/20/2009 FL 26 26 F 2/20/2009 Fever, chills, muscle aches.
340173 2/20/2009 WV 4 4 F Redness & warmth of left thigh whe
340174 2/20/2009 PA 4 4 F 2/20/2009 Hives on inner thighs and lower bac
340175 2/20/2009 NY 39 39 F 2/20/2009 Dizziness, tight chest, hives, and dif
340176 2/20/2009 NC 74 F 2/15/2009 Nauseated, extremely cold chills, di
340177 2/20/2009 NC 41 41 F 2/16/2009 12:15 - Pt in today for yellow fever a
340178 2/20/2009 MD 21 21 M 2/17/2009 Pt received FLUMIST on 10-8-08, b
340179 2/20/2009 MD 18 18 F 2/17/2009 Pt received FLUMIST on 10-9-08, b
340180 2/20/2009 MD 21 21 M 2/17/2009 Pt received FLUMIST on 10-8-08, b
340181 2/20/2009 MD 17 17 M 2/17/2009 Patient received FLUMIST on 10-9-
340182 2/20/2009 NE 48 48 F 1/12/2009 Had flu shot in Oct - (first shot ever
340183 2/20/2009 OH 0.2 0 0.2 M 2/4/2009 5 hrs of unconsolable crying, poor fe
340184 2/20/2009 ME 47 47 F 2/12/2009 Right deltoid has 2cm annular red in
340185 2/20/2009 NY 0.3 0 0.3 F 2/16/2009 high pitch cry after PENTACEL vacc
340186 2/20/2009 VA 50 50 F 2/13/2009 3-4 hours after Vaccine given patien
340187 2/20/2009 WI 5 5 M 2/13/2009 Was given MMR & DTAP into left de
340188 2/20/2009 IN 74 74 F 2/16/2009 Patient called the pharmacy with co
340189 2/20/2009 SD 61 61 M 2/15/2009 I received the shingles vaccine 7-07
340190 2/20/2009 19 19 M 2/8/2009 Chest Pain
340191 2/20/2009 WI 61 61 U got the shot on Jan 7-09- my arm ac
340192 2/20/2009 AR 1.1 1 0.1 F 2/9/2009 Mother reports child with facial swel
340193 2/20/2009 OH 47 47 F 2/13/2009 Swelling/redness/warmth of (R) arm
340194 2/20/2009 KY 27 27 F 2/19/2009 Following 15 min. Wait after Hep B
340195 2/20/2009 WI 43 43 M 2/18/2009 Red, warm area longer than palm si
340196 2/20/2009 SC 32 32 M 2/17/2009 Patient complained of severe body
340197 2/20/2009 CO 4 4 M 2/14/2009 24 hr after injection, itching L deltoid
340198 2/20/2009 WI 50 50 F 2/13/2009 developed raised, red area at inject
340237 2/20/2009 IL 29 29 M 2/20/2009 High fever (103.6), sweats, chills, m
340238 2/20/2009 DE 5 5 F 2/20/2009 The Flu Vaccine was administered a
340239 2/20/2009 VA 14 14 F 2/20/2009 the day after the vaccine was given
340240 2/20/2009 IN 14 14 F 2/20/2009 Vomiting, headache and achy, a few
340241 2/20/2009 VI 24 24 F 2/20/2009 patient states she had itchy, red spo
340242 2/20/2009 IL 17 17 F 2/20/2009 Patient was given 4 vaccines on 2/1
340243 2/20/2009 KS 37 37 F 2/20/2009 Reported observing redness and sw
340244 2/20/2009 CO 16 16 F 2/20/2009 Patient C/O of headache, swelling r
340245 2/20/2009 FL 43 43 F 2/20/2009 FINE RED RASH ON UPPER TRUN
340246 2/20/2009 MI 1.3 1 0.3 M 2/20/2009 Grandmother called and spoke with
340247 2/20/2009 CA 11 11 F 2/20/2009 Local swelling and erythema 2 days
340248 2/20/2009 PA 0.2 0 0.2 F 2/20/2009 Approximately 10 minutes after imm
340249 2/20/2009 NY 38 38 M 2/20/2009 Injection site swollen, red, itchy and
340250 2/20/2009 HI 33 32 M 2/20/2009 Patient received Yellow Fever and H
340251 2/20/2009 NY 21 21 F 2/20/2009 Loss of balance, double vision, dizz
340252 2/20/2009 NH 2 2 0.2 M 2/20/2009 Developed entire body rash with les
340253 2/20/2009 NY 4 4 F 2/20/2009 Vaccine administered 2/6/2009 on f
340254 2/20/2009 LA 4 4 M 2/20/2009 Approximately 5 min after giving imm
340255 2/20/2009 CA 8 8 M 2/20/2009 LEFT UPPER ARM PAIN, SWELLIN
340256 2/20/2009 GA 66 66 F 2/20/2009 Pt came back to clinic today to repo
340257 2/20/2009 MI 0.2 0 0.2 M 2/20/2009 None at this time
340258 2/20/2009 NY 35 36 F 2/20/2009 14-16 days post Varivax immunizati
340259 2/20/2009 WA 49 0 0F ### "massive" headache. Facial swelling
340260 2/20/2009 FL 4 0 0F 2/20/2009 Emma passed out about 10 minutes
340261 2/20/2009 PA 16 15 F 2/20/2009 After giving Varicella vaccine, Tdap,
340262 2/20/2009 CA 10 10 M 2/20/2009 swelling, warmth, pain/soreness and
340263 2/20/2009 UT 11 11 F 2/20/2009 Increasing Fever and stomach ache
340264 2/20/2009 30 30 F 2/21/2009 Nov. 14, 08 pt received anthrax and
340285 2/20/2009 CA 0.3 0 0.3 M 2/20/2009 02/09/09, mother
Y of Pt said that 02/
340286 2/20/2009 CA 14 14 M 2/20/2009 Fever, cough.Y Diffuse bilateral pneu
340287 2/20/2009 VA 61 61 M 2/16/2009 Tingling both legs and arms with we
340289 2/20/2009 CA 4 4 F 2/21/2009 Received DTAP, IPR, MMR & VARI
340290 2/20/2009 60 60 F 2/19/2009 Rash on lower back bilateral 2 days
340291 2/20/2009 AZ 29 29 F 2/19/2009 2/12/09 - tiredness from 14:00pm -
340292 2/20/2009 MS 18 18 F 2/20/2009 Shots were given 2-09-09 (Monday)
340293 2/20/2009 MO 4 4 F 2/20/2009 Left thigh redden, hot to touch at inj
340294 2/20/2009 CA 77 77 F 2/20/2009 Pt reports that she had a flu shot he
340295 2/20/2009 IL 29 U Grand mal seizure. PMH negative.
340296 2/20/2009 VA 1.3 1 0.3 F 2/20/2009 4 days ago developed pinpoint red r
340297 2/20/2009 FL 67 67 F 2/20/2009 Local swelling & itching.
340298 2/20/2009 NC 8 8 M 2/13/2009 Child presents with pain in upper rig
340299 2/20/2009 MI 73 73 F 2/20/2009 Redness itching pain began 1 day p
340300 2/20/2009 FL 2 2 0.2 M 2/18/2008 Hardness at vaccine site with 3X4 c
340301 2/20/2009 CA 11 11 M 2/20/2009 Mom notice today 2/20/09 vaccine T
340302 2/20/2009 CA 5 5 F 2/20/2009 Today 2/20/09 mom saw arm swolle
340303 2/20/2009 MI 62 62 M 2/19/2009 72 hours after vaccine administered
340304 2/20/2009 IL 0.2 0 0.2 F 2/2/2009 Swollen reddened thigh with 1 1/2 2
340305 2/20/2009 OH 1.5 1 0.5 M 2/20/2009 Localized redness @ injection site-
340306 2/20/2009 OH 1.6 1 0.6 M 2/20/2009 Hives, redness @ injection site - (im
340307 2/20/2009 TN 47 47 F 2/20/2009 Complained of itching all over. Rash
340265 2/21/2009 OR 5 5 M 2/21/2009 Syncope approximately 5 minutes a
340266 2/21/2009 OR 0.2 0 0.2 M 2/21/2009 After his 2 month shots, my son dev
340267 2/21/2009 CO 26 26 F 2/20/2009 temp of 100, chills, redness behow
340268 2/21/2009 NC 1 1 0M 2/21/2009 Child immediately developed fever,
340269 2/21/2009 MI 0.2 0 0.2 F 2/21/2009 24hrs-lethargic, not eating well, not
340270 2/21/2009 FL 47 47 F 2/21/2009 EXPERIENCED ITCHING ,SHORTN
340271 2/21/2009 NE 67 67 F 2/21/2009 Redness occurred at site of adminis
340272 2/21/2009 OR 0.3 0 0.3 M 2/21/2009 After recieving the vaccines at his 4
340273 2/21/2009 MD 4 4 M 2/21/2009 The same day as receiving the com
340288 2/21/2009 TX 33 33 M 2/21/2009 Hiccups continuous non stop, nause
340274 2/22/2009 ID 4 4 F 2/22/2009 No reaction 5 hours post vaccinatio
340275 2/22/2009 NY 1.3 1 0.3 M 2/22/2009 Immediately after the proquad and h
340276 2/22/2009 M 2/20/2009 Contact tranfer from sharing towels/
340277 2/22/2009 CA 59 59 F 2/22/2009 Temperature of 102.6. Headache.
340278 2/22/2009 KY 1 0 1M 2/22/2009 loss of muscle control in both arms,
340279 2/22/2009 NC 60 61 F 2/22/2009 Single patch of shingles in C5 distrib
340333 2/23/2009 19 F 2/20/2009 Information was viewed on the Inter
340345 2/23/2009 OH 60 60 M 2/20/2009 Information has been received from
340356 2/23/2009 MN 10 F 2/17/2009 My daughter started to get restless
340357 2/23/2009 FL 15 15 F 2/13/2009 Patient received her 1st GARDASIL
340359 2/23/2009 20 F 2/19/2009 I was given the GARDASIL shot. A
340360 2/23/2009 11 11 F 2/19/2009 My daughter had the vaccine GARD
340361 2/23/2009 OH 1.1 1 0.1 M 2/18/2009 Pt developed trunkle red micropapu
340362 2/23/2009 OR 14 14 F 2/7/2009 pt c/o "fuzziness". Slumped in chair
340363 2/23/2009 CA 1 1 0F 1/30/2009 Blanchable nonspecific rash. Descri
340364 2/23/2009 CA 1 1 0F 2/16/2009 Blanchable non-specific rash descri
340365 2/23/2009 OH 0.3 0 0.3 M 2/18/2009 Fever, crying non stop x 1-2 hr. 2/18
340366 2/23/2009 OR 77 77 F 2/12/2009 Pt. began to have stiff neck on (L) s
340367 2/23/2009 OR 4 4 F 2/18/2009 2 days after receiving shots RT leg,
340368 2/23/2009 MT 67 67 F 2/10/2009 2 days after shot injection site itched
340369 2/23/2009 NC 56 56 F 2/16/2009 L arm sore and client dizzy evening
340370 2/23/2009 MI 65 65 F Acute onset of excruciating right sho
340371 2/23/2009 FL 0.4 0 0.4 M 2/16/2009 Ran fever after imm Fever 101.1
340372 2/23/2009 GA 2 2 0.4 M 2/18/2009 Mother called Health Dept @ 3:45p
340373 2/23/2009 VA 58 58 M 2/18/2009 Patient was given vaccines on 2/13
340374 2/23/2009 IA 1.5 1 0.5 F 2/16/2009 Hives started 2 days after flu vaccin
340376 2/23/2009 AL 16 16 F 2/16/2009 Pt received varicella vaccine RA SQ
340377 2/23/2009 AZ 14 14 F 2/6/2009 Pt learned she was pregnant 2 mon
340378 2/23/2009 GA 0.2 0 0.2 M 2/16/2009 Patient received Tdap instead of DT
340379 2/23/2009 MN 11 11 F 2/16/2009 Gave 3 immunizations, about 3-4 m
340380 2/23/2009 HI 1.1 1 0.1 F 2/11/2009 Fever (low grade) starting five days
340381 2/23/2009 WV 11 11 M 2/16/2009 Mom states erythema in shot area s
340382 2/23/2009 LA 0.3 0 0.3 F 2/13/2009 Pt administered 2nd dose of ROTAT
340383 2/23/2009 LA 0.2 0 0.2 F 2/13/2009 Pt administered 1st dose ROTATEQ
340384 2/23/2009 PA 15 15 F 2/12/2009 Headache - post immunization even
340385 2/23/2009 NC 28 28 F 2/17/2009 Local reaction - mild redness, soren
340386 2/23/2009 FL 29 29 M 2/21/2009 Soon after receiving the tetanus, inf
340387 2/23/2009 MA 0.7 M 2/20/2009 Mistakenly gave DTAP #4 to 8 mon
340388 2/23/2009 AR 1.2 1 0.2 F 2/23/2009 Parent's report on 2/21/09 at 1 pm p
340389 2/23/2009 OH 11 11 F 2/19/2009 Pt with initial syncope, nausea, lasti
340390 2/23/2009 U 2/19/2009 Although GSK labels their pre-filled
340391 2/23/2009 MN 3 3 M 2/19/2009 Temp 103 degrees within hours of i
340392 2/23/2009 OR 8 8 F 2/18/2009 Received DTD on 2/7/09. Mom up
340393 2/23/2009 UT 42 42 M 1/28/2009 Client returned 7 days after immuniz
340394 2/23/2009 CO 75 75 M 2/13/2009 Received Hepatitis A inoculation on
340395 2/23/2009 MI 29 29 M 2/10/2009 Severe headache day of vaccine, th
340396 2/23/2009 PR 39 39 M 2/11/2009 Rash on skin.
340397 2/23/2009 NY 36 36 M 2/14/2009 2/9/09 started with rash, fever and H
340398 2/23/2009 AK 28 28 F 2/10/2009 Discomfort started around 2pm. Slig
340405 2/23/2009 AZ 12 12 F 2/23/2009 PATIENT FAINTED IMMEDIATELY
340406 2/23/2009 MT 45 45 M 2/23/2009 Dizziness, nausa, shakiness increas
340407 2/23/2009 NC 14 14 F 2/23/2009 After receiving 2 IM injections in left
340408 2/23/2009 PR 4 4 F 2/23/2009 TWENTY SECONDS AFTER VACC
340409 2/23/2009 OR 61 61 F 2/23/2009 Injection site became red, swollen, s
340410 2/23/2009 PR 0.6 0 0.6 F 2/23/2009 MOTHER REFERS THE CHILD SU
340411 2/23/2009 WI 1 1 0.1 F 2/23/2009 Redness & swelling at injection sites
340412 2/23/2009 CO 1.8 1 0.8 M 2/23/2009 Per father of child= developed high
340413 2/23/2009 MN 0.5 0 0.5 F 2/23/2009 Day after vaccine child had general
340414 2/23/2009 NM 37 38 F 2/23/2009 PAIN AND SWELLING AT INJECTI
340416 2/23/2009 NY 12 12 F 2/23/2009 Varicella vaccine administered in a
340417 2/23/2009 TX 69 69 M 2/23/2009 bump, redness, rash (2"x1"), itching
340418 2/23/2009 TX 66 66 F 2/23/2009 bump, redness, rash (1"x1"), itching
340419 2/23/2009 FL 76 76 F 2/23/2009 Patient woke up the morning of 2/19
340420 2/23/2009 CA 0.3 0 0.4 M 2/23/2009 Reported today to our Health Cente
340421 2/23/2009 OH 14 14 F 2/23/2009 Client became pale and complained
340422 2/23/2009 GA 52 52 F 2/23/2009 Redness, soreness, and swelling at
340423 2/23/2009 NC 1.7 1 0.7 F 2/23/2009 itching began 4 days after receiving
340424 2/23/2009 MD 1 0 1F 2/23/2009 Patient was running a fever on and
340425 2/23/2009 IL 31 31 M 2/23/2009 Patient states, awakened with fever
340426 2/23/2009 CT 11 11 M 2/20/2009 Received ADACEL @ 10:30 am - w
340427 2/23/2009 MA 19 19 F 2/23/2008 Pt called @ 10:20 AM stating she h
340428 2/23/2009 NY 5 5 M 2/23/2009 Per mom-since the vaccines pt. has
340429 2/23/2009 PA 49 49 M 2/23/2009 Tdap given on 2/18. C/o sitting sore
340430 2/23/2009 PA 1.5 1 0.5 F 2/18/2009 Vomited <1hr post immunization an
340432 2/23/2009 LA 4 M 2/23/2009 This case was reported by a physici
340440 2/23/2009 MO 24 24 F 2/23/2009 Pt received GARDASIL injection 1/2
340441 2/23/2009 CA 1.2 1 0.2 M 2/20/2009 Urticarial rash that resolved with ora
340442 2/23/2009 TX 78 78 F 1/26/2009 Called the patient and she states th
340495 2/24/2009 MA 0.2 0 0.2 F 2/23/2009 Information has been received from
340500 2/24/2009 DE 23 F 2/23/2009 Initial and follow-up information has
340503 2/24/2009 14 F 2/23/2009 Information was viewed on the inter
340508 2/24/2009 ME 49 F 2/19/2009 Initial information received on 21 Ja
340509 2/24/2009 PA 64 64 F 2/17/2009 At time weakness in extremities, nu
340510 2/24/2009 OK 11 11 F 2/19/2009 Left arm was swollen from shoulder
340511 2/24/2009 CA 1.1 1 0.1 M 2/18/2009 None stated
340512 2/24/2009 MD 0.2 0 0.2 F 2/19/2009 vomited immediately following rotov
340513 2/24/2009 OR 13 13 F 2/17/2009 Fever same day, then stomach ups
340514 2/24/2009 MA 45 45 F 2/20/2009 Received ADACEL, in Left delt and
340515 2/24/2009 UT 60 60 M 2/11/2009 According to patient he was seen by
340516 2/24/2009 IA 1.3 1 0.3 M 1/19/2009 Rash appeared 2 days after shot lig
340517 2/24/2009 CA 67 67 F 2/18/2009 Pt. received ZOSTAVAX 12/18/09;
340518 2/24/2009 IL 11 11 M Left sided facial paralysis began da
340519 2/24/2009 FL 12 12 F Quick fever up to 103.3 degrees F,
340520 2/24/2009 MN 1.1 1 0.1 F 2/17/2009 Within 1 hr of vaccines being given
340521 2/24/2009 VA 0.2 0 0.2 M 2/19/2009 Inconsolable crying, pallor, & loss o
340522 2/24/2009 SD 1 1 0F 2/19/2009 Rash on face, stomach, back, legs s
340523 2/24/2009 OR 17 17 F 2/18/2009 < 1 hr post vaccine admin. Pt c/o lig
340524 2/24/2009 MT 17 17 F 2/19/2009 TC from pt one hour after recurring
340525 2/24/2009 OR 12 12 F 2/17/2009 Swollen glands, (femoral), redness
340526 2/24/2009 MA 31 31 M 2/17/2009 12/27/08 - Presented with 3 weeks
340527 2/24/2009 IN 8 8 F 2/19/2009 Received flu shot 2-16-09 came to o
340528 2/24/2009 PA 18 18 F 2/17/2009 1 hour after receiving MENACTRA d
340529 2/24/2009 OR 12 12 F 2/18/2009 C/O feeling hot, HA, eyes burning th
340530 2/24/2009 MI 50 50 M 9/24/2008 Pain and warmth and firmness felt a
340531 2/24/2009 PA 1 1 0M 2/19/2009 Has red bumps on stomach, legs &
340532 2/24/2009 OR 10 10 F 2/18/2009 DTaP+IPV combo administered 2-1
340533 2/24/2009 VT 74 74 F 1/27/2009 Developed Bells Palsy 8/12/08 rece
340534 2/24/2009 OR 9 9 F 2/17/2009 Pt given HEP A (VAQTA) on 2/11/0
340535 2/24/2009 NC 11 11 M 2/18/2009 02-07-09 (L) arm 8X8 in redden- wa
340536 2/24/2009 FL 1.6 1 0.6 M 2/16/2009 Rash after antibiotics + MMR. Face
340537 2/24/2009 MI 39 39 F Had knot & a lot of pain after receiv
340538 2/24/2009 TX 77 77 M 2/18/2009 4 days after receiving the shingles v
340539 2/24/2009 KY 16 16 F 2/17/2009 Hyperpigmentation on (L) arm (Line
340540 2/24/2009 AZ 76 76 F 2/17/2009 Itching at injection site urthen 1 hr.
340541 2/24/2009 OH 48 48 F Extreme muscle pain, edema to 3x
340542 2/24/2009 OH 32 32 M 2/17/2009 Rabies immunization given 2/15/09
340543 2/24/2009 WA 48 48 F 2/18/2009 Appointment for Hep-B vaccine. Prio
340544 2/24/2009 CA 37 37 F Localized Rxn. Redness, Swelling &
340545 2/24/2009 TN 0.2 0 0.2 F 2/21/2009 Right side of her face red and swoll
340546 2/24/2009 CA 0.2 0 0.2 F 2/19/2009 Swollen Right thigh.
340547 2/24/2009 CA 2 2 0M 2/19/2009 Fever temperature 105 core.
340548 2/24/2009 PA 76 76 M 2/24/2009 Vesicular lesions around left flank
340549 2/24/2009 SD 56 56 M 2/24/2009 Diarrhea, gas, distended stomach. p
340550 2/24/2009 NY 11 11 F 2/24/2009 Has had a dull frontal headache sin
340551 2/24/2009 TX 14 14 M 2/24/2009 6-7 hours after Tdap given had 101
340552 2/24/2009 NE 64 64 F 2/24/2009 Pt was given two injections in the le
340553 2/24/2009 NY 25 25 F 2/24/2009 pt states after she received 2nd vac
340554 2/24/2009 MS 1.4 1 0.4 F 2/24/2009 Urticaria to anterior and posterior tru
340555 2/24/2009 OR 1 1 0.1 M 2/24/2009 DTAP administered to Left deltoid a
340556 2/24/2009 MI 60 60 F 2/24/2009 Started hurting when given and nev
340557 2/24/2009 CA 1.4 1 0.4 F 2/23/2009 Infant patient started having fevers
340558 2/24/2009 IN 0.2 0 0.2 M 2/24/2009 Received first
Y set of baby shots, left
340559 2/24/2009 4 4 F 2/24/2009 DEVELOPED SIGNIFICANT ERYT
340560 2/24/2009 UT 4 4 M 2/24/2009 Rt. thigh became erythematous, wa
340561 2/24/2009 AZ 0.5 0 0.5 F 2/24/2009 Patient had hives all over body few
340562 2/24/2009 NC 69 69 F 2/24/2009 2 hours after vaccination patient exp
340563 2/24/2009 CA 4 4 M 2/24/2009 Redness swelling L arm
340564 2/24/2009 UT 68 68 F 2/24/2009 Pneumococcal vaccination given on
340565 2/24/2009 AL 0.2 0 0.2 M 2/24/2009 Patient had seizures and had to be
340566 2/24/2009 MI 0.1 0 0.1 M 2/24/2009 Advised parent of error.Will call in A
340567 2/24/2009 CA 4 4 M 2/24/2009 Redness of face around eyes; no sw
340577 2/24/2009 TN 0.7 0 0.7 M 2/24/2009 Reported from mother: Pt was admi
340578 2/24/2009 WA 1.4 1 0.4 M 2/24/2009 Cellulitis Right thigh
340579 2/24/2009 MA 37 37 F 2/24/2009 Day # 12 post immunization with 2 s
340580 2/24/2009 SC 0.3 0 0.3 M 2/23/2009 Melena
340581 2/24/2009 NE 0.5 0 0.5 F 1/11/2009 Left leg - red, swollen, warm to touc
340582 2/24/2009 NE 31 31 F 2/24/2009 ADACEL shot given right arm 2/15.
340583 2/24/2009 NE 28 28 F 2/24/2009 ADACEL given 2/14 2/17 - arm puf
340584 2/24/2009 NC 24 24 F 2/23/2009 Patient calls VHC x 3 in past week.
340585 2/24/2009 KY 73 73 F 2/24/2009 Injection was on 02/19. On 02/22 in
340586 2/24/2009 MT 30 30 M 2/23/2009 Patient called 6 days following vacc
340587 2/24/2009 SD 81 81 F 2/24/2009 Pt complained to dentist about sore
340588 2/24/2009 MD 14 14 F 2/23/2009 2/19/09. Local Reaction with contin
340589 2/24/2009 MO U 2-10-09 MMR & VARICELLA given.
340590 2/24/2009 MN 67 67 M 2/23/2009 Had ZOSTAVAX injection 2-12-09.
340591 2/24/2009 MA 0.4 0 0.4 F 2/24/2009 Erythematous nodule app 0.5 cm in
340592 2/24/2009 CA 1.1 1 0.1 F 2/23/2009 Received MMR and VARIVAX on 1/
340593 2/24/2009 VA 0.4 0 0.4 F 2/24/2009 4 month-old female who came for a
340594 2/24/2009 MD 17 17 F 2/24/2009 3rd dose of GARDASIL administere
340595 2/24/2009 NY 32 32 M 2/23/2009 Developed fever < 12 alter shot swo
340568 2/25/2009 27 27 M 2/25/2009 Early in the morning following the va
340659 2/25/2009 MI 46 46 F 2/23/2009 This non-serious event was reported
340668 2/25/2009 NY 18 18 F 2/23/2009 Abdominal pain, diahrrea, general il
340669 2/25/2009 MA 11 11 F 2/20/2009 Received a BOOSTRIX vaccine (R)
340670 2/25/2009 TX 23 23 M 2/25/2009 within 24 hours, urticarial rash on ch
340671 2/25/2009 NC 56 56 F 2/25/2009 approximately 12 hrs after reaction,
340672 2/25/2009 OH 1 1 0F 2/23/2009 Per parent, Kitra Woodall, child had
340673 2/25/2009 VA 1.3 1 0.4 M 2/25/2009 seizure
340674 2/25/2009 KY 26 26 F 2/25/2009 Local reaction and cellulitis at inject
340675 2/25/2009 FL 11 11 F 2/25/2009 10 days following the vaccine, pt be
340676 2/25/2009 NJ 11 11 F 2/25/2009 fainting episode which lasted for ap
340677 2/25/2009 SC 11 11 F 2/25/2009 mild nausea immediately following G
340678 2/25/2009 FL 12 12 F 2/25/2009 Fainted shortly after administration o
340679 2/25/2009 GA 13 F 2/25/2009 Mom calling office c/o site where va
340680 2/25/2009 MI 59 59 M 2/25/2009 Within 24 hours of receiving vaccine
340681 2/25/2009 CA 48 F 2/25/2009 Tellow Fewver, Polio and oraL 7/14
340682 2/25/2009 TX 3 3 F 2/23/2009 On 10/17/09 patient was taken to ho
340683 2/25/2009 CA 51 F 2/25/2009 fever,myalgia. pt received rabies va
340684 2/25/2009 NH 29 29 F 2/25/2009 Very ill with fever, chills, severe mya
340685 2/25/2009 CA 62 62 F 2/25/2009 In January patient reported pain on
340686 2/25/2009 RI 1.9 1 0.9 M 2/25/2009 redness and tenderness where sho
340687 2/25/2009 MO 15 15 F 2/25/2009 Patient was administered the Merck
340688 2/25/2009 MA 0.5 0 0.6 M 2/25/2009 On 1/30/09 Pt presented with a tem
340689 2/25/2009 PA 17 17 M 2/25/2009 Mother called office today and repo
340690 2/25/2009 CA 1 1 0M 2/25/2009 Injec. site became red and indurate
340691 2/25/2009 TX 74 74 M 2/25/2009 PT RECEIVED ZOSTAVAX ON 2/2
340698 2/25/2009 PA 0.2 0 0.2 M 2/24/2009 Two days after the shot was admini
340700 2/25/2009 NM 11 11 F 2/25/2009 About 1 wk after 1st GARDASIL, my
340701 2/25/2009 IL 16 16 F 2/25/2009 Pt had an episode of syncope, swea
340702 2/25/2009 OR 33 33 M 2/24/2009 2/24/09 At 9am Donor started havin
340703 2/25/2009 WA 9 9 M 2/25/2009 Rash on back & face.
340704 2/25/2009 CA 10 10 M 2/25/2009 - Large firm (3 inch wide) round tend
340705 2/25/2009 CA 4 4 F 2/24/2009 Large Erythema, hyperemia and pru
340706 2/25/2009 MI 50 U Injection administered 10-17-08, on
340707 2/25/2009 NY 8 8 F 2/21/2009 Within 5 minutes of injection into rig
340708 2/25/2009 WA 4 4 F 2/24/2009 Redness at injection site (L) thigh, h
340709 2/25/2009 KY 0.5 0 0.5 F 2/25/2009 Staring, rolled eyes back of head ?
340710 2/25/2009 CA 15 15 F 2/24/2009 Pt seen on 2/23/09. Complaining of
340711 2/25/2009 AZ 67 67 F 2/25/2009 Vaccines administered on 2-17-09 -
340712 2/25/2009 IN 4 4 M 2/24/2009 Within 30 minutes patient experienc
340713 2/25/2009 KY 4 4 M 2/25/2009 Fever of 102 degree at home the ni
340714 2/25/2009 MO 1 1 0M 2/25/2009 None stated.
340715 2/25/2009 KY 29 29 F 2/20/2009 Noticed 30 min after while on elevat
340716 2/25/2009 FL 10 10 F 2/25/2009 Left arm SQ swelling, local reaction
340717 2/25/2009 IN 24 24 F 2/25/2009 Information received from patient's m
340718 2/25/2009 TX 41 41 F 2/25/2009 Fever, nausea, vomiting; patient rec
340773 2/26/2009 MI 32 32 F Received Hepatitis B & MMR vaccin
340775 2/26/2009 NJ 4 4 F 2/26/2009 Redness, swelling 5"X51/2"
340776 2/26/2009 IN 0.5 0 0.5 M 2/20/2009 Received vaccines on 2-17-09 No b
340777 2/26/2009 CA 17 17 F 2/19/2009 Patient's mother informed clinic on 0
340778 2/26/2009 OR 13 13 M 2/18/2009 Pt fainted after receiving vaccines, a
340779 2/26/2009 OR 93 93 F 2/10/2009 2/9/09 Call from pt that she had acu
340780 2/26/2009 OR 12 12 M 2/17/2009 Mother called 2-13-09 reporting ash
340781 2/26/2009 WI 17 17 F 2/24/2009 About 1 month after vaccination dev
340782 2/26/2009 54 F 2/24/2009 Patient received a flu vaccine on 10
340783 2/26/2009 WV 12 12 F 2/26/2009 Erythema, edema around immuniza
340784 2/26/2009 MN 47 47 F 2/18/2009 Swelling & erythema of left upper ar
340785 2/26/2009 FL 24 24 F 2/12/2009 Migraine headache for 11-13 days f
340786 2/26/2009 PA 0.6 0 0.6 M 2/20/2009 Fever - Tmax 104.8 oral per parent;
340787 2/26/2009 ME 1.1 1 0.1 F 2/20/2009 Pt with runny nose, fuzziness and 2
340788 2/26/2009 IL 1 0.5 F 2/20/2009 Severe nausea and vomiting.
340789 2/26/2009 64 M 2/24/2009 Symptoms: 1. Pain and swelling.
340790 2/26/2009 CA 69 69 F 2/23/2009 2/13 Vaccine given in left arm. On 2
340792 2/26/2009 PA 61 61 F 2/26/2009 I received a pneumonia shot on Mo
340793 2/26/2009 MI 1 1 0M 2/26/2009 PT GIVEN VARICELLA VACCINE O
340794 2/26/2009 MI 31 31 M 2/26/2009 Client called with c/o pain and swell
340795 2/26/2009 TN 61 61 F 2/26/2009 Swelling and heat at injection site
340796 2/26/2009 AZ 3 29 M 2/26/2009 After the vaccine he stated starring
340797 2/26/2009 FL 24 M 2/26/2009 Pain, swelling w/ warm to the touch
340798 2/26/2009 AR 52 52 M 2/26/2009 Shot adminstered at work. A week a
340799 2/26/2009 FL 12 12 F 2/26/2009 Temp 102.6 12:20 pm 2/26/09
340800 2/26/2009 FL 16 16 M 2/26/2009 Vaccine administered on 1/14/2009
340801 2/26/2009 FL 1.5 1 0.5 F 2/26/2009 Mother complained that baby vomiti
340802 2/26/2009 OH 1.3 1 0.3 M 2/26/2009 On 2/18/09 at about 9:30PM, his ey
340803 2/26/2009 MI 31 31 F 2/26/2009 2-25-2009 at 6pm pt stated had nau
340804 2/26/2009 TX 0.9 0 0.9 M 2/26/2009 Pt's mother c/o diahrrea, decreased
340805 2/26/2009 MN 65 65 F 2/26/2009 Given Pneumonvax Immunization o
340806 2/26/2009 FL 3 3 M 2/26/2009 AFter recieving the pentacel in his le
340807 2/26/2009 CO 16 16 F 2/26/2009 chronic debilitating headaches, chro
340808 2/26/2009 MI 36 36 M 2/26/2009 One day after receiving the injection
340809 2/26/2009 MA 67 94 M 2/26/2009 within 24 hours after injection Pain a
340815 2/26/2009 VA 1.3 1 0.3 F 2/26/2009 Seizure like activity, Loss of conscio
340816 2/26/2009 FL 3 3 F 2/24/2009 5-8 min after receiving CODEINE ch
340817 2/26/2009 FL 43 43 F 2/26/2009 Pt. reports LUE arm, shoulder pain
340818 2/26/2009 WI 59 59 F 1/8/2009 Pt called clinic reporting SOB, throa
340819 2/26/2009 MO 5 5 F 2/26/2009 Raised spots - back abd, 12/26/09 s
340820 2/26/2009 WA 10 10 M 2/11/2009 None Phenyl & Pt sister PKU + mom
340821 2/26/2009 CA 0.2 0 0.2 F 2/26/2009 High pitched screaming started ~45
340822 2/26/2009 CA 10 10 M ### Upon leaving the clinic per mother,
340823 2/26/2009 ID 3 3 F 1/26/2009 Phone call - Employee stated recei
340824 2/26/2009 ID 47 47 F ### Rash, itching, took BENADRYL 50m
340825 2/26/2009 ID 37 37 F ### L arm injection site with large redde
340826 2/26/2009 ID 40 40 F ### Site of injection hot to touch, red an
340827 2/26/2009 NC 1 1 0M 2/26/2009 Received MMR, VARIVAX, and PRE
340829 2/26/2009 MD 1.2 1 0.2 F 2/26/2009 The child is a 14 month old female w
340830 2/26/2009 CO 11 11 F 2/26/2009 Pt c/o headaches, severe @times (6
340810 2/27/2009 AR 0.3 0 0.3 F 2/27/2009 Less than 24 hours after administra
340833 2/27/2009 ME 15 F 2/26/2009 Information has been received from
340835 2/27/2009 TX 14 14 F 2/26/2009 Information has been received from
340848 2/27/2009 MN 68 68 F 2/12/2009 On 2/12/2009 Pt. talked with PHN +
340849 2/27/2009 CO 13 13 F 2/25/2009 Pt with extreme discomfort following
340850 2/27/2009 NC 0.8 0 0.8 F 2/23/2009 Patient was administered diluent for
340851 2/27/2009 CA 72 72 F 2/13/2009 Patient noticed patch of red skin in a
340852 2/27/2009 WI 9 9 F 2/23/2009 patient inadvertently received Tdap
340853 2/27/2009 AZ 11 11 F 2/16/2009 Day after vaccinations, Pt develope
340854 2/27/2009 TX 4 4 F 2/19/2009 10 minutes after the shots where ad
340855 2/27/2009 FL 1 1 0F 2/23/2009 Mom noted few itch spots on abd 4
340856 2/27/2009 WI 26 26 M 2/24/2009 This service member contacted the
340857 2/27/2009 OR 12 12 F 2/20/2009 Mother called to report pt c/o "loosin
340858 2/27/2009 MN 62 62 F 1/30/2009 Histamine-like reaction. Hives - seve
340859 2/27/2009 NY 31 31 F 2/26/2009 Shaking chills, fever X 24 hrs. (X hrs
340860 2/27/2009 WI 57 57 F 2/23/2009 The day after shot employee experi
340861 2/27/2009 RI 55 55 F 7/7/2008 Headache, Flu- like symptoms, low
340862 2/27/2009 WI 11 11 M 2/19/2009 Hives, throughout, injection site arm
340863 2/27/2009 IN 4 4 F 2/26/2009 Local Right - swelling redness- cove
340867 2/27/2009 VA 18 18 M 2/27/2009 C/o dizziness and weakness approx
340868 2/27/2009 NY 1 1 0.1 F 2/27/2009 Mom reported child got puffy around
340869 2/27/2009 VA 20 20 F 2/27/2009 C/O arm soreness and hand and fin
340870 2/27/2009 VA 19 19 F 2/27/2009 C/O dizziness and vomiting (4-5X) a
340871 2/27/2009 30 30 F 2/27/2009 On 08 NOV 2005 around noon, swo
340872 2/27/2009 GA 8 8 M 2/27/2009 2-3 minutues following administratio
340873 2/27/2009 IN 1 1 0M 2/27/2009 Each time my identical twin sons we
340874 2/27/2009 ND 58 58 M 2/27/2009 Pt called and spoke with RN on 2/19
340875 2/27/2009 PA 1 1 0M 2/27/2009 Seen 2/24/09 at 2pm due to rash ov
340876 2/27/2009 CT 22 22 F 2/27/2009 Was given the Gardasil shot in Dece
340877 2/27/2009 FL 60 60 M 2/27/2009 Generalized joint/body ache, weakn
340927 2/27/2009 KY 35 35 F 2/26/2009 Pain at injection site, diffuse myalgia
340928 2/27/2009 CA 4 4 F 2/27/2009 Redness Swollen on L deltoid uppe
340929 2/27/2009 CO 11 11 F 2/27/2009 Pt rec. vaccine on 2/24, called office
340930 2/27/2009 AR 20 20 F 2/27/2009 Pt experienced HA which was const
340931 2/27/2009 NY 13 13 F 2/12/2009 Persistent LUQ pain, fatigue and we
340933 2/27/2009 VA 54 54 F 2/27/2009 Low grade fever, dizziness, pain an
340878 2/28/2009 WI 43 43 F 2/28/2009 Severe Muscle pain to the extent of
340879 2/28/2009 IN 40 40 F 2/28/2009 Extensive pain in upper left arm at i
340880 2/28/2009 TX 2 2 0.5 M 2/28/2009 Patient received the MMR vaccine o
340881 2/28/2009 NJ 13 13 F 2/28/2009 Syncope,fainting loss of consciousn
340882 2/28/2009 NV 17 17 F 2/28/2009 AFTER FIRST GARDASIL VACCIN
340883 3/1/2009 MI 53 53 F 3/1/2009 Fever, myalgias, Arthus reaction
340884 3/2/2009 IL 35 35 F 2/24/2009 Itching and Hives over entire body e
340885 3/2/2009 ME M 3/2/2009 received pneumoccal/flu vaccine 2 d
340886 3/2/2009 AZ 58 57 F 3/2/2009 1/29/09--Pt. stated did not feel shot
340887 3/2/2009 WA 13 13 M 3/2/2009 Loss of eyesight startin at about two
340888 3/2/2009 WI 60 60 M 3/2/2009 Severe pain swelling and redness a
340889 3/2/2009 KS 1 0 0F 3/2/2009 Pt has large reddish purple area wit
340890 3/2/2009 AL 5 5 F 3/2/2009 PATIENT STATED VACCINES WE
340891 3/2/2009 CO 5 5 F 3/2/2009 Two weeks and two days after rece
340892 3/2/2009 TX 63 63 M 3/2/2009 64 yr old white male presents with c
340893 3/2/2009 WA 0.2 0 0.2 F 3/2/2009 Local reaction with redness and swe
340894 3/2/2009 CA 20 20 M 3/2/2009 **suspected** case of progressive v
340895 3/2/2009 1 1 0M 3/2/2009 Severe raised and hot rash on torso
340896 3/2/2009 TX 0.2 0 0.2 M 2/27/2009 Information has been received from
340897 3/2/2009 MD 11 11 F 2/27/2009 Initial report received on 17 Februar
340899 3/2/2009 MD 10 10 F 2/27/2009 Initial report received on 17 Februar
340911 3/2/2009 43 F 2/27/2009 Report 2001005622-1 described "lo
340920 3/2/2009 CA 4 4 F 3/2/2009 Infection to left thigh where IPV and
340921 3/2/2009 IL 14 14 M 3/2/2009 Pt c/o bad HA that started at back o
340922 3/2/2009 FL 1 1 0M 3/2/2009 Erythemia Multiform Minor, etiology
340923 3/2/2009 MO 1.6 1 0.6 M 2/27/2009 local allergic reaction. Redness som
340924 3/2/2009 IN 15 15 F 3/2/2009 Costochondritis R side > 1wk.
340925 3/2/2009 TX 0.5 0 0.5 F Patient diedYof influenza A on 2/10/0
340926 3/2/2009 MA 40 40 F 1/28/2009 Severe headache, chest pain, incre
340932 3/2/2009 CA 9 9 M 2/27/2009 Varicella Breakthrough by baby sist
340934 3/2/2009 AZ 70 70 F 3/3/2009 Local (around area of injection) swe
340935 3/2/2009 FL 0.1 0 0.1 M 3/2/2009 Vaccine given 930 AM on 3/2/09: w
340936 3/2/2009 HI 25 25 M 3/2/2009 Local reaction to the R forearm. red
340937 3/2/2009 GA 1 1 0M 3/2/2009 See notes.
340938 3/2/2009 NC 1.4 1 0.4 F 3/2/2009 Multiple vesicles
340939 3/2/2009 GA 62 62 F 3/2/2009 2 hours after office & receiving PNE
340940 3/2/2009 CO 4 4 F 2/23/2009 Shots given 2/18/09. MOC called 2/
340941 3/2/2009 FL 1.4 1 0.4 M Grandmother states rashes appears
340942 3/2/2009 MO 9 9 F 3/2/2009 reddened are L upper arm BENADR
340943 3/2/2009 66 66 F 3/2/2009 Multiple lumps - deltoid strength dec
340944 3/2/2009 MT 9 9 F 2/27/2007 Redness, swelling of R upper arm 4
340945 3/2/2009 NE 53 53 M 9/21/2008 Pt was over 50 yo. and received the
340946 3/2/2009 NY 5 5 M 2/19/2009 8" x 5" area of slight erythema and p
340947 3/2/2009 CA 57 57 F 2/24/2009 Immediate and excessive pain cont
340948 3/2/2009 MA 10 10 F 2/10/2009 Left arm-2cm area of erythema and
340949 3/2/2009 WI 48 48 F 2/16/2009 Patient presented to Employee Hea
340950 3/2/2009 TN 4 4 M 2/25/2009 L upper arm just below axillae has w
340951 3/2/2009 MI 42 42 M 2/9/2009 Pain, swelling, dizziness, nauseous
340952 3/2/2009 16 F 2/15/2009 My daughter received her 3rd inject
340954 3/2/2009 13 13 U 2/26/2009 My daughter received GARDASIL v
340955 3/2/2009 NY 0.4 0 0.4 F 2/8/2009 Daughter started throwing up, could
340956 3/2/2009 62 62 F 2/27/2009 On 2/24 patient started with breathin
340957 3/2/2009 NJ 5 5 F 2/24/2009 Within 24 hrs of being given MMR p
340958 3/2/2009 VA 4 4 M 2/27/2009 Mother called advising pt's arm whe
340971 3/3/2009 CO U 2/27/2009 Initial reportYreceived on 20 Februar
340976 3/3/2009 65 M 2/26/2009 Initial information received on 20 Fe
340977 3/3/2009 NC 14 14 M 2/27/2009 Initial report received 19 February 2
340978 3/3/2009 AL 48 48 M 2/27/2009 Initial information received on 18 Fe
340979 3/3/2009 OK 29 29 F 2/24/2009 30 min after shot- hives, pain shooti
340980 3/3/2009 IL 1.3 1 0.3 M 1/21/2009 At 2:30 pm on 7/22/2008, fever star
340981 3/3/2009 OH 32 32 M 2/24/2009 10/28 flu shot @ store. 10/29 flu-like
340982 3/3/2009 VA 34 34 M 2/26/2009 Felt sharp pain in chest approx 3 da
340983 3/3/2009 LA 17 17 F 2/25/2009 Tdap and Varicella administered wh
340984 3/3/2009 NY 12 12 M 2/26/2009 Crusty and itchy: topical skin reactio
340985 3/3/2009 OR 7 7 F 2/25/2009 Client in today with sister who are g
340986 3/3/2009 CA 4 4 M 2/24/2009 Redness, induration L deltoid 6cm x
340987 3/3/2009 WA 69 69 F 2/27/2009 A week after immunization started w
340988 3/3/2009 MN 0.1 0 0.1 M 2/23/2009 Patient here today for Right thigh re
340989 3/3/2009 NY 0.2 0 0.2 M 2/26/2009 Profuse diarrhea for 7-8 days on da
340990 3/3/2009 FL 4 4 F 2/27/2009 Sudden onset of fever 103.9 with co
340991 3/3/2009 NM 66 66 F 2/26/2009 7"-8" wheal, redness, tender to touc
340992 3/3/2009 CA 25 25 F 2/24/2009 Redness-trial of ZYRTEC, and if wo
340993 3/3/2009 CA 29 29 F 2/25/2009 Redness - ZYRTEC/allergy med, an
340994 3/3/2009 FL 60 60 F 2/26/2009 Redness, swelling, pain, itching at s
340995 3/3/2009 TX 1.1 1 0.1 F 2/25/2009 On 2/24/09- Rash all over, fever, co
340996 3/3/2009 IL 1.6 1 0.6 F 2/25/2009 Mother stated red and swollen right
340997 3/3/2009 NY 1.3 1 0.3 M 2/27/2009 Hives noted 7mm took Benadryl non
340998 3/3/2009 MD 68 68 F 2/25/2009 Itch and rash on left side of neck arm
340999 3/3/2009 TX 20 20 M 3/3/2009 Immediately got left sided eye pain
341000 3/3/2009 UT 54 54 M 3/3/2009 Client received immunizations for tra
341001 3/3/2009 IN 21 21 M 3/3/2009 nodular, pustular, follicular eruption
341003 3/3/2009 MN 66 66 M 3/3/2009 None - vaccine given outside age ra
341004 3/3/2009 MI 35 35 F 3/3/2009 2-26-2009 Right Deltoid Red, Swolle
341005 3/3/2009 TX 62 61 F 3/3/2009 left arm swellimg at injection site, wi
341006 3/3/2009 OH 62 62 F 3/3/2009 Patient developed sores on lip appr
341007 3/3/2009 TX 11 11 M 3/3/2009 Patient received Menactra vaccine o
341008 3/3/2009 UT 1.3 1 0.4 M 3/3/2009 High Fever 106
341009 3/3/2009 UT 1 1 0M 3/3/2009 fever for 5-6 days.
341010 3/3/2009 CA 5 5 F 3/3/2009 Redness, swelling, warm and hard @
341011 3/3/2009 NY 13 13 F 3/3/2009 Patient had pain and swelling at inje
341012 3/3/2009 TX 2 2 0.5 F 3/3/2009 Mild swelling and redness of the left
341013 3/3/2009 MI 13 13 F 3/3/2009 Within 2 days of injection client pass
341014 3/3/2009 NY 17 17 F 3/3/2009 Fainting episode within 5 minutes o
341015 3/3/2009 CO 5 5 F 3/3/2009 1) Extreme anxiety - moody and irrit
341016 3/3/2009 4 4 M 3/3/2009 Pt was given his 4 year old immuniz
341017 3/3/2009 ID 7 7 F 2/17/2009 A serious spontaneous report of sei
341018 3/3/2009 PA 69 69 M 3/1/2009 Patient had shingles like rash that it
341019 3/3/2009 NH 1 1 0F 3/3/2009 General hives BENADRYL. Observe
341020 3/3/2009 CA 41 41 F 3/3/2009 Severe local erythema, swelling, stif
341021 3/3/2009 RI 48 48 F 3/3/2009 Per patient- She had a rash + fever
341022 3/3/2009 NY 1.3 1 0.3 M 2/27/2009 Swelling of leg with a fine urticarial r
341023 3/3/2009 PA 15 15 F 3/3/2009 Patient experienced a syncope epis
341024 3/3/2009 WV 11 11 M 1/16/2009 Received Tdap and meningitis vacc
341025 3/3/2009 CA 66 66 F 3/3/2009 - Red itchy injection site rash that sp
341026 3/3/2009 OH 40 40 M 3/3/2009 Deep muscle pain @ injection site,
341027 3/3/2009 CA 4 4 F 2/27/2009 Localized reaction to vaccines. MO
341028 3/3/2009 OH 69 69 F 3/2/2009 Area around vaccine became red.
341029 3/3/2009 TX 34 34 F 3/2/2009 Temp to 102, with R shoulder swelli
348881 3/3/2009 MI 42 42 F 2/11/2009 Redness, swelling and warmth at in
348884 3/3/2009 MI 26 26 M 2/11/2009 Received a haircut on 4/15/08. At th
348886 3/3/2009 WI 26 26 F 2/11/2009 Reporter contacted manufacturer in
348887 3/3/2009 OH 22 22 F 2/11/2009 Subject experienced moderate (7x6
348888 3/3/2009 MI 56 56 M 2/11/2009 Subject reports that at approximatel
348889 3/3/2009 MI 22 22 F 2/11/2009 Subject reports being tired on the fir
348890 3/3/2009 FL 26 26 M 2/11/2009 Palm-sized dry rash localized to the
348891 3/3/2009 MI 36 36 F 2/11/2009 Redness at injection site at 24 hour
348892 3/3/2009 MI 26 26 F 2/11/2009 Subject reports that approx 5 hours
348893 3/3/2009 MI 23 23 F 2/11/2009 Subject reports that three days after
348894 3/3/2009 M 2/11/2009 Recd via e-mail: Subject has a latex
348895 3/3/2009 MI 24 24 M 2/11/2009 Soreness of muscle, left leg, from m
348896 3/3/2009 MI 34 34 F 2/11/2009 Pain at injection site, itching at injec
341031 3/4/2009 1.5 1 0.5 M 3/3/2009 Information has been received from
341049 3/4/2009 MO 4 4 F 3/2/2009 Initial report received 23 February 2
341050 3/4/2009 MO 8 8 M 3/2/2009 Initial report received 23 February 2
341051 3/4/2009 OH 4 F 3/2/2009 Initial report received on 27 Februar
341052 3/4/2009 MN 13 13 F 2/25/2009 4-21 - 4-22-08 was in hospital for sy
341053 3/4/2009 FL 1.1 1 0.1 F 2/27/2009 Red raised spots that started on tor
341054 3/4/2009 GA 0.3 0 0.3 F 3/4/2009 DIARRHEA AND VOMITING
341055 3/4/2009 SC 29 29 F 3/4/2009 Pt c/o pain and swelling in L arm the
341056 3/4/2009 MI 52 F 3/4/2009 Subject in pneumococcal vaccine tr
341057 3/4/2009 MN 90 M 3/4/2009 Subject in pneumococcal vaccine tr
341058 3/4/2009 MN 69 F 3/4/2009 Subject in pneumococcal vaccine tr
341059 3/4/2009 UT 12 12 F 3/4/2009 Patient was vaccinated for meningit
341062 3/4/2009 MI 66 66 M 3/4/2009 Sore throat-WATERY EYES-RUNN
341063 3/4/2009 TX 1.7 1 0.7 F 3/4/2009 Erythema and edema localized at in
341064 3/4/2009 SC 15 15 F 3/4/2009 She recived Gardisil in left arm then
341065 3/4/2009 ME 27 27 F 3/4/2009 Patient called and states she has ha
341066 3/4/2009 IL 51 51 F 3/4/2009 arm soreness
341067 3/4/2009 IL 50 50 F 3/4/2009 no adverse reaction Administer
341068 3/4/2009 NY 0.2 0 0.2 M 3/4/2009 Pt. received 2 month vaccines in off
341069 3/4/2009 IL 22 22 F 3/4/2009 no adverse event Administered
341070 3/4/2009 IL 41 41 F 3/4/2009 sore throat for 24 hours. Adminis
341071 3/4/2009 IL 24 24 F 3/4/2009 no adverse events. Administered D
341072 3/4/2009 IL 49 49 F 3/4/2009 no adverse reaction. Administere
341073 3/4/2009 AL 11 11 M 3/4/2009 Approximately 2 weeks after receivi
341074 3/4/2009 IL 36 36 F 3/4/2009 Patient self reported sore arm for 3
341075 3/4/2009 IL 35 35 F 3/4/2009 no adverse reaction. Administered
341076 3/4/2009 IL 43 43 F 3/4/2009 no adverse reaction. Administered
341077 3/4/2009 ID 15 15 F 3/4/2009 Immediately following vaccination g
341078 3/4/2009 NJ 34 34 F 3/4/2009 Complained of itchy throat, "patient
341079 3/4/2009 CA 6 6 F 3/4/2009 SITE OF INJECTION WITH REDNE
341080 3/4/2009 CA 4 4 M 3/4/2009 Exagerate local reaction. Painful wit
341092 3/4/2009 CA 44 44 F 3/4/2009 This case was reported by a physici
341093 3/4/2009 OK F 3/4/2009 This case was reported by a lawyer
341097 3/4/2009 MO M 3/4/2009 This case was reported by a physici
341098 3/4/2009 CA 0.3 0 0.3 M 3/4/2009 Pt experienced vomiting and 1 bloo
341101 3/4/2009 CA 1.1 1 0.1 M 3/4/2009 Right thigh began to get red and sw
341102 3/4/2009 CA 50 50 F 3/4/2009 Initially redness, soreness at injectio
341103 3/4/2009 CA 4 4 M 3/4/2009 Swelling of Right thigh and vomiting
341104 3/4/2009 TN 5 5 M 3/4/2009 1.3.5 inches X 3 inches round, red,
341105 3/4/2009 WA 4 4 M 3/4/2009 Pt developed fever 101.7. 15 cm are
341106 3/4/2009 MI 18 18 M 3/3/2009 T-101.3, achy at site of injection, ten
341107 3/4/2009 CO 53 53 F Swelling in tongue - Labored breath
341108 3/4/2009 MN 5 5 F 3/5/2009 5 yr injections given - mom calling s
341109 3/4/2009 MN 11 11 F 3/3/2009 None
341110 3/4/2009 MO 13 13 M 3/3/2009 Severe headache-fever-dizziness. D
341111 3/4/2009 WI 13 M 3/4/2009 Mother called 2 days after immuniza
341112 3/4/2009 MA 1.5 1 0.5 M 8/31/2007 Fever after receiving Tdap at 03/02
341113 3/4/2009 PA 3 F 2/24/2009 Cellulitis at injection site dx by CHO
341114 3/4/2009 WI 50 50 F 3/3/2009 Pt received flu shot at clinic on 11/3
341115 3/4/2009 NJ 66 66 F 3/4/2009 PNEUMOVAX vaccine administered
341116 3/4/2009 NJ 57 57 F 3/4/2009 Within 1/2 of immunization, patient r
341117 3/4/2009 PA 4 4 F 3/4/2009 (L) thigh has 2.5 X 2.5 cm indurated
341118 3/4/2009 PA 0.5 0 0.5 M 3/4/2009 Child became limp, unable to hold h
341119 3/4/2009 MI 14 14 F 3/3/2009 Child rcvd ADACEL, MENACTRA, F
341120 3/4/2009 FL 0.7 0 0.7 F 2/26/2009 Per Mom and Dad; reporting to us t
341121 3/4/2009 NJ 13 13 M 3/2/2009 22 hours later had fever of 102.5 de
341134 3/5/2009 0.5 U 3/3/2009 This case was reported by a healthc
341136 3/5/2009 CA 0.2 0 0.2 F 3/3/2009 This case was reported by a physici
341143 3/5/2009 22 22 F 3/3/2009 I had the 1st GARDASIL vaccination
341144 3/5/2009 PA 54 54 M 3/2/2009 Guillian-Barre Syndrome with loss o
341145 3/5/2009 CT 0.2 0 0.2 M 2/27/2009 Vaccines administered 2/05/09 in m
341146 3/5/2009 AZ 66 66 F 3/2/2009 Approximately 4 days after immuniz
341147 3/5/2009 NM 14 14 F 2/26/2009 Student dropped off at Mall. At 5:30
341148 3/5/2009 82 F 3/3/2009 Pt received ZOSTOVAX vaccine on
341149 3/5/2009 CA 0.3 0 0.3 M 3/2/2009 Pt received IZ on 2/18/2009, mothe
341150 3/5/2009 VA 1.1 1 0.1 M 3/2/2009 See attached. Neurologist's assessm
341151 3/5/2009 OR 12 12 M 2/23/2009 Fainting after vaccines given.
341152 3/5/2009 OR 14 14 M 2/23/2009 After 2 shots, pt complained of feeli
341153 3/5/2009 OR 11 11 M 2/18/2009 Afternoon after am shot, mom called
341154 3/5/2009 OH 41 41 F 2/1/2009 3 days post immunization pt. c/o wh
341155 3/5/2009 PA 14 14 F 2/16/2009 Onset of fever, generalized aching 2
341156 3/5/2009 TN 28 28 M 2/27/2009 PNEUMOVAX given IM Left deltoid
341157 3/5/2009 NY 83 U Shingles broke out at 4:30 pm 11/08
341158 3/5/2009 NC 49 49 F 2/27/2009 Came in today stating that the day a
341159 3/5/2009 OH 34 34 F 3/2/2009 Hive like rash across abdomen with
341160 3/5/2009 KS 39 F 3/2/2009 Pt got a large reddened area with ra
341161 3/5/2009 MI 12 12 M R arm with severe redness/swelling
341162 3/5/2009 IL 1.3 1 0.3 M 2/27/2009 Left thigh cellulitis. Treated with Om
341163 3/5/2009 GA 55 55 M 3/2/2009 Hemorrhagic purpura - developed 4
341164 3/5/2009 MA 5 5 F 2/27/2009 Left cervical lymphadenitis.
341165 3/5/2009 MI 26 26 F 3/5/2009 I went in for the 1st of three Guardis
341166 3/5/2009 PA 77 77 M 3/5/2009 Developed grouped papules and ve
341167 3/5/2009 CA 12 12 F 3/5/2009 Within 5 minutes of injection, arms f
341168 3/5/2009 NC 49 49 F 3/5/2009 49 yo WF was given IM Pneumovax
341169 3/5/2009 TX 67 67 M 3/5/2009 redm wram swollen right bicep. trea
341170 3/5/2009 MA 25 25 F 3/5/2009 RECEIVED YELLOW FEVER VACC
341171 3/5/2009 MS 1 1 0F 3/5/2009 Localized wheal (3 cm x 1 cm) and
341172 3/5/2009 CA 4 4 M 3/5/2009 PATIENT DEVELOPED REDNESS
341173 3/5/2009 CA 65 F 3/5/2009 Patient received flu shot at unknown
341174 3/5/2009 IL 1.3 1 0.3 F 3/5/2009 Developed swelling of right eye with
341175 3/5/2009 NC 1.3 1 0.4 U 3/5/2009 localized redness for two days at sit
341176 3/5/2009 GA 16 16 F 3/5/2009 Mother called and reported that pati
341177 3/5/2009 CA 3 3 M 3/5/2009 multiple wheals around injection site
341178 3/5/2009 AZ 14 14 M 3/5/2009 Austen was very anxious when give
341179 3/5/2009 CA 4 4 F 3/5/2009 5cm x 5 cm Red, Swollen, Hardness
341180 3/5/2009 TX 62 62 F 3/5/2009 received the vaccine at 3pm, februa
341181 3/5/2009 WA 0.2 0 0.1 F 3/5/2009 Unconsolable crying for 6 hours afte
341195 3/5/2009 NC 62 62 M 1/26/2009 Patient received pneumococcal vac
341196 3/5/2009 CA 1.3 1 0.3 M 3/5/2009 Erythema and swelling of L upper th
341197 3/5/2009 CA 13 13 F 3/4/2009 Pt had seizure while sitting and eati
341198 3/5/2009 IL 4 4 M 3/5/2009 3/4/2009 at 7:30pm child had a seiz
341199 3/5/2009 PA 10 1 0.3 F 3/5/2009 Had 2 doses of VARIVAX, develope
341200 3/5/2009 CA 0.2 0 0.2 F 2/26/2009 After receiving all ten shots - PENTA
341201 3/5/2009 CT 57 57 M 2/19/2009 Pain, tingling and weakness in legs,
341202 3/5/2009 CT 1.6 1 0.6 M 3/5/2009 2 days later (after 3rd DTaP) leg fro
341203 3/5/2009 FL 15 15 F 3/4/2009 None stated
341204 3/5/2009 SC 61 61 F 3/3/2009 Patient had swelling and soreness t
341182 3/6/2009 WA 66 66 F 3/6/2009 Hives all over body, very large and r
341225 3/6/2009 IA 0.3 0 0.3 M 3/5/2009 Information has been received from
341233 3/6/2009 WI 60 60 M 1/30/2009 Lightheadedness. Malaise. Chills. H
341234 3/6/2009 PA 16 16 F 2/10/2009 Pt described chest heaviness, naus
341235 3/6/2009 CA 4 4 M 2/25/2009 L arm swelling and redness at sight
341236 3/6/2009 NM 84 84 F 3/2/2009 Patient received shingles vaccine o
341237 3/6/2009 MI 4 4 F 3/3/2009 Left arm red day after vaccines adm
341238 3/6/2009 MD 16 16 M 2/27/2009 Pt got FLUMIST and came down wi
341239 3/6/2009 WI 1 1 0F 3/2/2009 Rash beginning one week after rece
341240 3/6/2009 WA 0.3 0 0.3 F 3/2/2009 Pt was given PEDIARIX at 4mo. WC
341241 3/6/2009 WA 3 3 M 2/18/2009 Pt was given Hep A vaccination, no
341242 3/6/2009 FL 12 12 F 2/24/2009 Patients received HPV # 1 6-26-07.
341243 3/6/2009 PA 21 21 F 2/28/2009 2/13/09 stabbing head pain, 2/14/09
341244 3/6/2009 NJ 15 15 F 2/11/2009 Tingling/numbness in left leg, move
341245 3/6/2009 OH 16 16 F 3/2/2009 Mother stated generalized Rash in A
341247 3/6/2009 CO 16 16 F 2/4/2009 Ongoing dizziness, dysautonomia, f
341248 3/6/2009 GA 5 5 M 3/3/2009 My son age 5 was given the MMR/V
341249 3/6/2009 NJ 16 16 F 2/27/2009 Broke out in hives on 2/22/09. Wor
341250 3/6/2009 WI 70 70 F 1/30/2009 Low grade fever, muscle aches, nau
341251 3/6/2009 WI 7 7 M 1/30/2009 Swelling red hot left arm pain Tyleno
341252 3/6/2009 AZ 16 16 M 3/3/2009 Patient c/o nausea immediately afte
341253 3/6/2009 OR 1.4 1 0.4 M 3/3/2009 3/1 Febrile seizure. about 0300 -> E
341254 3/6/2009 WA 9 9 M 2/28/2009 Patient stood up after injection, walk
341255 3/6/2009 MT 33 33 F 2/11/2009 Clt first noticed a blister at site of inj
341256 3/6/2009 61 F 3/4/2009 Received shingles vaccine- ZOSTA
341257 3/6/2009 40 M 2/21/2009 Attached.
341258 3/6/2009 NC 38 F 2/27/2009 N/A
341259 3/6/2009 TX 1.3 1 0.3 M 2/25/2009 Redness & swelling at injection site.
341260 3/6/2009 TX 0.5 0 0.5 F 2/27/2009 Fussy, congestion, cough, decrease
341261 3/6/2009 IL 1.2 1 0.2 M 2/28/2009 Pt presented to office on 2/28/09 wi
341262 3/6/2009 FL 0.8 0 0.8 U Had swelling at site of injection
341263 3/6/2009 AR 1.1 1 0.1 M 3/2/2009 Received PREVNAR injection 2/23/
341264 3/6/2009 NY 62 62 F 3/2/2009 Significant swelling, redness, erythe
341265 3/6/2009 OH 74 74 M 3/2/2009 Redness & induration 10 inches aro
341266 3/6/2009 WV 1.3 1 0.3 M 2/25/2009 Local reaction redness swelling 4 cm
341267 3/6/2009 WI 4 4 M 3/3/2009 Patient c/o sore arm on 2-28-09. M
341268 3/6/2009 NJ 3 3 M 2/27/2009 Mild reaction right upper arm 2 - PN
341269 3/6/2009 MN 65 65 F 2/20/2009 Phone call -> Per note from/by Dr. :
341270 3/6/2009 NY 9 13 M 3/6/2009 3/5/2009 - Telephonce call from sch
341271 3/6/2009 OK 11 11 F 3/6/2009 Approximately 24 hours after admin
341272 3/6/2009 MA 4 4 M 3/6/2009 MMR Vaccine was administered on
341273 3/6/2009 NY 47 47 M 3/6/2009 Headache, lymph node reacted and
341274 3/6/2009 CO 70 70 M 3/6/2009 On 3/2/09 6 PM vacine given- head
341275 3/6/2009 PA 60 60 F 3/6/2009 Pt noted a rash 2 days after adminis
341276 3/6/2009 AZ 62 62 F 3/6/2009 Severe headache from back of neck
341277 3/6/2009 GA 17 17 F 3/6/2009 RED WARM AREA TO RIGHT ARM
341278 3/6/2009 LA 1 1 0M 3/6/2009 Red bumps all over body that starte
341279 3/6/2009 GA 11 11 F 3/6/2009 RED WARM AREA AROUND THE
341280 3/6/2009 OR 5 5 F 3/6/2009 Patient received 4 vaccinations on 0
341281 3/6/2009 NY 80 80 M 3/6/2009 PT. REC'D ZOSTER VAX. ON 1/29
341282 3/6/2009 NC 36 35 M 3/6/2009 UNKNOW
341283 3/6/2009 OK 12 12 F 3/6/2009 Patient received Gardasil and Mena
341284 3/6/2009 CA 32 32 F 3/6/2009 The morning after receiving the Tda
341285 3/6/2009 TX 47 48 F 3/6/2009 area became swollen and red, seve
341286 3/6/2009 CA 5 5 M 3/6/2009 Patient developed fever and light se
341287 3/6/2009 CA 16 16 F 3/6/2009 Sudden onset full body myalgia and
341299 3/6/2009 CA 69 69 F 3/6/2009 Local side effect at injection site (R
341300 3/6/2009 CA 0.4 0 0.4 M 3/6/2009 10 min after administrating ROTATE
341301 3/6/2009 CA 11 11 F 3/6/2009 The day post vaccine child c/o pain
341302 3/6/2009 AZ 7 U None stated.
341303 3/6/2009 GA 0.6 0 0.6 M 3/6/2009 At 2 months, patient had rash at loc
341304 3/6/2009 WA 25 25 F 3/5/2009 Pt received #2 GARDASIL vaccine
341305 3/6/2009 AL 1.3 1 0.3 M 3/6/2009 Vomiting occurred after having vacc
341306 3/6/2009 AL 1.3 1 0.3 M 3/6/2009 Vomiting and low grade fever occur
341307 3/6/2009 VA 34 34 M 3/6/2009 8 days post yellow fever vaccination
341308 3/6/2009 VA 26 26 F 3/4/2009 Left upper arm cellulitis - treated wit
341309 3/6/2009 CA 46 46 F 2/4/2009 Arthralgia - severe, malaise- severe
341310 3/6/2009 AZ 15 M 3/6/2009 Pt received TDAP. He developed fe
341311 3/6/2009 CA 66 66 M 2/3/2009 Approx 4 hours after injection patien
341288 3/7/2009 GA 1.1 1 0.1 F 3/7/2009 Moderate fever for several days the
341289 3/8/2009 9 9 M 3/8/2009 Crystallia sudamina rash developed
341290 3/8/2009 NJ 46 46 F 3/8/2009 Stiffness, very painful and swollen w
341298 3/8/2009 KS 20 20 M 3/8/2009 Became highly anxious after vaccin
341322 3/9/2009 AZ 67 67 F 3/6/2009 Information has been received by a
341329 3/9/2009 TX U 3/4/2009 Initial report received 24 February 2
341333 3/9/2009 MI 14 14 F 3/5/2009 Given TDAP & VARIVAX 3/3 0900 A
341334 3/9/2009 TN 17 17 F 2/11/2009 Swelling at site of injection- Sorenes
341335 3/9/2009 TN 17 17 M 1/22/2009 Pt received TDAP, HEP A, MENAC
341336 3/9/2009 MI 52 52 F 2/27/2009 Client states onset of soreness + "S
341337 3/9/2009 MD 4 4 F 2/26/2009 Pt received flu shot and came down
341338 3/9/2009 MD 5 5 M 2/26/2009 Pt received flu shot and came down
341339 3/9/2009 CA 64 64 F 2/23/2009 Shoulders up to neck-soreness still
341340 3/9/2009 MO 17 17 F 3/3/2009 C/o frontal headache, neck pain, bo
341341 3/9/2009 NJ 14 14 M 3/6/2009 Severe leg pain, particularly in knee
341342 3/9/2009 OH 11 11 F 2/27/2009 After 5th injection, pt. felt nauseated
341343 3/9/2009 OH 13 13 F 2/27/2009 Immediately after 4th injection (HPV
341344 3/9/2009 CT 0.5 0 0.5 F 3/5/2009 Fever approximately 7 PM 1/23. Ab
341345 3/9/2009 CA 16 16 F 2/25/2009 Left arm/chest area pain and rednes
341346 3/9/2009 TN 12 12 F 2/20/2009 10:00, nurse practitioner at clinic ph
341347 3/9/2009 FL 1.7 1 0.7 M 3/4/2009 Rash covering body.
341348 3/9/2009 TN 68 68 F 3/9/2009 Vaccine administered 0945 1/28/09
341349 3/9/2009 SC 8 6 F 3/9/2009 Received flu shot on Thursday. Frid
341350 3/9/2009 MO 26 26 F 2/27/2009 Immediately flushed and hot with in
341351 3/9/2009 GA 23 23 F 3/9/2009 Pt presented on 2/11/09 and had a
341352 3/9/2009 MO 1 1 0F 10/1/2008 Child started having a rash on face
341353 3/9/2009 MO 3 3 M ### 10-10 a.m. - swollen right thigh, red
341354 3/9/2009 MN 1.3 1 0.3 M 3/9/2009 patient received vaccine on 3/3/09 i
341355 3/9/2009 IA 1.3 1 0.3 M 3/9/2009 Diarrhea since 3-6-09; Bloody nose
341356 3/9/2009 CO 4 4 F 3/9/2009 pain, swelling, erythema, itching, sig
341357 3/9/2009 MI 17 17 F 3/9/2009 HAD HEADACHE AND GENERALI
341358 3/9/2009 MA 60 60 F 3/9/2009 Vaccine administered 3/5/2009 3 pm
341359 3/9/2009 DE 1 1 0F 3/9/2009 Patient developed high fever, erythe
341360 3/9/2009 NC 14 14 M 3/9/2009 Redness,swelling,heat and firmness
341361 3/9/2009 NC 1 1 0F 3/9/2009 Mom reports a blister, smaller than
341362 3/9/2009 TX 62 62 M 3/9/2009 i got the shingles vaccine that my D
341363 3/9/2009 CA 23 23 F 3/9/2009 Left deltoid area swollen, tender and
341368 3/9/2009 NV 2 2 1M 3/9/2009 A week after DTAP given mom repo
341369 3/9/2009 NV 3 3 M 3/9/2009 72 hours offer IPV given child has d
341370 3/9/2009 CA 66 66 F 3/9/2009 3/05- shot given. 3/06- arm swelled
341371 3/9/2009 AZ 4 4 M 3/9/2009 Swollen red R upper area > resolve
341372 3/9/2009 IN 2 2 0.8 F 3/6/2009 Cellulilitis L thigh around vaccine ad
341373 3/9/2009 WI 64 64 F 3/9/2009 Pt reports she saw Dr for "horrible b
341374 3/9/2009 OH 22 22 M 3/9/2009 Approx 10-15 minutes after injection
341376 3/9/2009 CA 1 1 0F 2/26/2008 Redness, induration and warmth at
341377 3/9/2009 CA 1 1 0M 2/26/2008 Redness, induration and warmth at
341378 3/9/2009 CA 1 F 2/26/2009 Redness, induration and warmth at
341379 3/9/2009 CA 1.7 1 0.7 F 3/4/2009 Broke out small rash over left upper
341382 3/9/2009 GA 4 4 M 3/6/2009 Child developed a tight cough and p
341383 3/9/2009 AZ 11 11 F 2/24/2009 C/O join pain, and pain in arm of AD
341384 3/9/2009 CA 1.2 1 0.2 F 3/9/2009 Warm to touch, redness 6 1/2cm X
341385 3/9/2009 CA 4 4 M 3/9/2009 3/4 vaccine; 3/5 arm swelling redne
341386 3/9/2009 CA 4 4 F 3/8/2009 Local redness, 2"/3" on Rt. thigh. M
341387 3/9/2009 GA 15 15 F 9:15 am 3/3/09 Pt. received HEP A
341388 3/9/2009 MO 5 5 M 3/9/2009 Local reaction to IMM. Left deltoid x
341389 3/9/2009 NY 1.5 1 0.5 F 3/9/2009 Developed generalized pink maculo
341390 3/9/2009 WA 75 75 F 10/1/2008 11 x 19 cm raised, red urticarial-app
341391 3/9/2009 WA 65 65 F 10/8/2008 Pt experienced pain, redness and s
341392 3/9/2009 WA 51 51 F 9/26/2008 Client walked into clinic stating she
341393 3/9/2009 IN 1 1 0F 2/26/2009 Rash
341394 3/9/2009 FL 4 4 F 3/9/2009 Left leg with Baseball sized knot wa
341395 3/9/2009 TN 5 5 M 3/9/2009 Temperature has been normal, it is
341396 3/9/2009 FL 12 12 M 3/7/2009 Patient developed rash to left chest
341397 3/9/2009 TX 56 56 M 3/6/2009 Fever, myalgias, N/V and arthralgia
341365 3/10/2009 NC 2 2 0M 3/10/2009 Fourteen days after his vaccine he r
341406 3/10/2009 KS 60 60 M 3/9/2009 Information has been received from
341418 3/10/2009 NY 8 8 F 3/4/2009 Bilateral weakness in legs and urina
341419 3/10/2009 NH 12 12 F 2/12/2009 8/1/08- 1st shot- fainting began, hea
341420 3/10/2009 63 63 F 3/6/2009 Patient was given ZOSTAVAX vacc
341422 3/10/2009 WV 17 17 F 3/5/2009 Within 5 minutes after vaccination c
341423 3/10/2009 CO 0.5 0 0.5 M 2/27/2009 Pt had no adverse rxn, doctor did no
341424 3/10/2009 NC 17 17 F 2/25/2009 Pt has a history of tic disorder in Jan
341425 3/10/2009 CA 14 14 F 2/26/2009 Dizzy episode after 1st GARDASIL
341426 3/10/2009 WI 4 4 F 3/4/2009 4-6 cm redness left deltoid & soft tis
341427 3/10/2009 VT 1.5 1 0.5 M 3/5/2009 Patient spike a fever of 102, becam
341428 3/10/2009 GA 54 54 F 2/19/2008 Patient experienced nausea and itc
341429 3/10/2009 NM 59 59 F 3/6/2009 Red Rash covering 5 inch Diameter
341430 3/10/2009 TX 77 77 U None Stated
341431 3/10/2009 OR 11 11 F 3/5/2009 Painful red and swollen x 4 days; be
341432 3/10/2009 PA 66 66 F 3/6/2009 Large, red, swollen, itchy lump hurts
341433 3/10/2009 13 13 F 3/5/2009 Around February of this year my da
341434 3/10/2009 63 F 3/5/2009 Recd vaccine on Tues. 3/2/09 abou
341435 3/10/2009 MA 24 24 F None Stated 3/18/09-records receiv
341436 3/10/2009 NY 31 31 F 3/5/2009 Headache, nausea, vomiting, fatigu
341437 3/10/2009 NJ 5 5 M 2/25/2009 Per father - child experienced occas
341438 3/10/2009 MN 12 12 F 2/24/2009 Day #1 following vaccinations finger
341439 3/10/2009 NM 2 2 0F 3/2/2009 Red rash & small vesicles on neck,
341440 3/10/2009 MN 32 32 M 3/3/2009 Mild dizziness.
341441 3/10/2009 CA 61 61 F 3/5/2009 Swelling and puffy red @ site and a
341442 3/10/2009 NJ 4 4 F 3/7/2009 DTAP shot to my 4 yr old within 8 hr
341443 3/10/2009 VA 71 71 M 3/5/2009 Onset of redness only 1hr after sho
341444 3/10/2009 OK 57 57 F 1/30/2009 Fever 100.5, myalgias, with redness
341445 3/10/2009 NC 13 13 M 3/6/2009 Hives.
341446 3/10/2009 MD 44 44 M 3/10/2009 This case was reported by a lawyer
341447 3/10/2009 CT 53 53 F 3/10/2009 This case was reported by a lawyer
341455 3/10/2009 VA 42 42 M 3/10/2009 Flu Mist administered as part of ann
341456 3/10/2009 FL 7 7 M 3/10/2009 sudden paleness, weakness, dizzin
341457 3/10/2009 OK 30 30 F 3/10/2009 This Tdap was given as no history o
341458 3/10/2009 PR 14 14 F 3/10/2009 PATIENT REFERS DIZZINESS, PE
341459 3/10/2009 IN 1 1 0F 3/10/2009 Developed 4cm red hive with centra
341460 3/10/2009 FL 29 29 F 3/10/2009 Developed shortness of breath, hive
341461 3/10/2009 MI 17 17 F 3/10/2009 Within 1 minute of receiving Menact
341462 3/10/2009 PA 16 16 F 3/10/2009 After getting the gardasil vaccine th
341463 3/10/2009 NY 1.3 1 0.3 M 3/10/2009 RECEIVED 15 MONTH SHOTS 4 D
341464 3/10/2009 OR 0.6 0 0.6 M 3/10/2009 Patient started jerking/seizure for ab
341465 3/10/2009 NC 61 61 F 3/10/2009 injection site reaction: redness and
341467 3/10/2009 PA 52 52 M 3/10/2009 Subject in pneumococcal
Y vaccine tr
341468 3/10/2009 MN 20 20 F 3/10/2009 Fever, Nausea and vometing, ment
341469 3/10/2009 HI 33 33 M 3/10/2009 Onset of bilateral profound bilateral
341470 3/10/2009 IN 1.3 1 0.3 F 3/10/2009 At 4:45 PM child felt warm. Mother
341471 3/10/2009 IA 5 5 F 3/10/2009 Less than 5 mins after Varivax given
341472 3/10/2009 MO 2 2 0.7 F 3/10/2009 Mother presented to office with child
341473 3/10/2009 GA 42 42 F 3/10/2009 On 03/10/2009 at approximately 2:4
341474 3/10/2009 WI 24 24 M 3/10/2009 Pt c/o extremely sore arm with mild
341475 3/10/2009 CA 1 1 0F 3/10/2009 Child seen in health center on 03/04
341476 3/10/2009 WA 15 15 F 3/10/2009 Pt felt dizzy a few minutes after HPV
341477 3/10/2009 CO 0.2 0 0.2 F 3/10/2009 The patient received 0.4cc of Infant
341478 3/10/2009 CA 26 26 F 3/10/2009 I received my first and only dose of
341479 3/10/2009 NJ 0.3 0 0.2 M 3/10/2009 Immediately after vaccination, a few
341480 3/10/2009 IL 7 7 F 3/10/2009 Within 16 hrs, had sore arm, legs, h
341481 3/10/2009 CO 57 57 F 3/10/2009 Patient was given her first flu shot w
341482 3/10/2009 TX 66 66 F 3/10/2009 Onset 3/10/09 2 red areas 1 to inne
341483 3/10/2009 OR 40 40 F 3/10/2009 TDAP given 2/27/2009. (left deltoid)
341484 3/10/2009 AZ 73 73 M 1/7/2009 Rash on trunk and local swelling, pa
341486 3/10/2009 WA 1.6 1 0.6 M 5/14/2008 Swollen x 48 hours-entire leg 2x NL
341487 3/10/2009 AK 19 19 F 3/4/2009 12/8/08 - Rt shoulder tenderness, p
341488 3/10/2009 AL 15 15 F 3/9/2009 None stated
341489 3/10/2009 AK 72 72 F 3/5/2009 Localized redness and tenderness t
341491 3/11/2009 KY 0.4 0 0.4 M 3/10/2009 Information has been received from
341499 3/11/2009 CA U 3/11/2009 This case was reported by a healthc
341510 3/11/2009 U 3/10/2009 This case was considered medically
341514 3/11/2009 FL 55 55 F 3/6/2009 Initial information was received on 2
341516 3/11/2009 FL 53 53 F 3/3/2009 I was told by the hospital that I had
341517 3/11/2009 CA 53 53 M 3/11/2009 Swelling to injection site, no rednes
341518 3/11/2009 TX 32 32 F 3/11/2009 Pt. reported: Had L) upper arm swe
341519 3/11/2009 TX 67 67 F 3/10/2009 Left SQ red area size of 1/2 dollar -
341520 3/11/2009 NC 25 25 M 3/11/2009 26 y/o male ADMS is referred to the
341521 3/11/2009 FL 1.2 1 0.2 M 3/11/2009 About 10 minutes after vaccines ad
341522 3/11/2009 MO 1.1 1 0.1 F 3/11/2009 Came in 3-9-09 with 101-102 degre
341523 3/11/2009 NY 12 12 F 3/11/2009 Given HPV & MENACTRA @ 08:30
341524 3/11/2009 TX 0.2 F 3/9/2009 Lethargy, poor feeding for 7-10 day
341525 3/11/2009 MA 17 17 M 3/6/2009 Site of injection started to ache 3/5/
341526 3/11/2009 CO 14 14 F 3/6/2009 Vaccine administered 3-3-09, on 3-4
341527 3/11/2009 FL 16 16 F 3/5/2007 After administering Tdap vaccine th
341528 3/11/2009 WA 4 4 M 3/5/2009 10 x 8cm area of erythema/tenderne
341529 3/11/2009 WI 8 8 F 3/4/2009 Rash and cellulitis secondary to imm
341530 3/11/2009 OH 0.2 0 0.2 F 3/9/2009 Excessive (inconsolable) crying ove
341531 3/11/2009 WV 12 12 F 3/8/2009 Vasovagal syncope- twice, oral fluid
341532 3/11/2009 TX 11 11 M 3/9/2009 Immediate itching/hiving @ site & lip
341533 3/11/2009 CT 35 35 M 3/6/2009 Felt hot and sweaty about 30 min af
341534 3/11/2009 TX 1.5 1 0.5 M 3/6/2009 Fever high of 104 degree F vomiting
341535 3/11/2009 MO 1.3 1 0.3 F 3/2/2009 Received Dtap + PREVNAR on 2-5
341536 3/11/2009 NC 0.2 0 0.2 M 2/19/2009 High pitched scream, inconsolable f
341537 3/11/2009 NC 37 37 F 3/4/2009 Fever and chills started about 9 hou
341538 3/11/2009 GA 31 31 F 3/5/2009 2/23/09- Dizziness, body aches, fev
341539 3/11/2009 TX 1 1 0F 3/6/2009 Developed VARICELLA lesions 9 d
341540 3/11/2009 KS 7 7 F 3/10/2009 Rash on arms and torso consistent
341541 3/11/2009 KS 11 11 M 3/10/2009 Rush on checks, forearms, hands s
341542 3/11/2009 NC 71 71 F 3/10/2009 Patient thought she had shingles, n
341543 3/11/2009 AL 1.3 1 0.3 F Vomiting onset 3 hrs after vaccine la
341544 3/11/2009 MN 48 48 F 3/10/2009 Received TDAP 3/6/09. Within 1-2 d
341545 3/11/2009 NY 13 13 M 2/5/2009 Patient received a 3rd dose of varic
341546 3/11/2009 AL 79 79 F 3/10/2009 Small red rash around injection site,
341547 3/11/2009 CT 4 4 F 3/11/2009 8X11 cm induration at site of KINRI
341548 3/11/2009 IL 0.4 0 0.4 M 3/9/2009 None stated
341549 3/11/2009 WA F 3/5/2009 On 3/2 pneumonia vaccine was give
341550 3/11/2009 KY 23 23 F 3/10/2009 Employee complains of dizziness ap
341551 3/11/2009 OR 1.5 1 0.5 F Mother reports evening 3/05/09 Pt d
341552 3/11/2009 WI 21 21 F 3/11/2009 Self innoculated self on Right index
341553 3/11/2009 OH 4 4 F 3/11/2009 Mom reports pt with hard red area 2
341554 3/11/2009 MN 13 13 F 3/11/2009 October, 2007 - Back and Hip pain
341555 3/11/2009 AZ 1 0.2 M 3/11/2009 EXPOSE TO CHICKEN POX AT DA
341556 3/11/2009 CA 21 21 F 3/11/2009 I got a concussion and with the stitc
341557 3/11/2009 ID 22 22 F 3/11/2009 Patient vaccinated with Flu vaccine
341558 3/11/2009 WA 41 41 F 3/11/2009 pain, swelling, redness, hotness, ha
341559 3/11/2009 ND 70 70 F 3/11/2009 Red- blistery patches and itchy with
341560 3/11/2009 PA 22 22 F 3/11/2009 Following Tdap vaccine patient dev
341561 3/11/2009 KY 63 64 F 3/11/2009 Herpes zoster rash 2 x 4 cm right th
341562 3/11/2009 CA 0.5 0 0.5 F 3/11/2009 Death 7 days Y later 4/20/-09-autopsy
341563 3/11/2009 MD 1.3 1 0.3 F 3/11/2009 VACCINATION SITE BECAME RED
341564 3/11/2009 IL 0.5 0 0.5 F 3/11/2009 On 3/7/09, pt developed intermitten
341565 3/11/2009 IA 30 30 M 3/11/2009 Approximately 7 hours after vaccina
341566 3/11/2009 MO 3 2 0.9 F 3/11/2009 Kinrix was given to this patient. No r
341567 3/11/2009 IL 1 1 0M 3/11/2009 developed area of erythema (1 cm d
341568 3/11/2009 TX 43 43 F 3/11/2009 PATIENT CLAIMS THAT AS SOON
341569 3/11/2009 AK 0.5 0 0.5 F 3/11/2009 10m 3 wk old had INTUSSUSCEPT
341570 3/11/2009 CA 35 35 F 3/11/2009 MONDAY(9 MARCH 2009): EVENIN
341572 3/11/2009 CA 43 43 M 3/11/2009 Patient just wanted to touch basis w
341573 3/11/2009 OR 64 F 3/2/2009 (1) welt / swelling at site 5" long X 2
341574 3/11/2009 CA 4 4 M 3/10/2009 Erythematous, edematous at vaccin
341575 3/11/2009 CA 46 46 F Non stated.
341576 3/11/2009 GA 18 18 F 12/9/2008 8-19-08 Slurred speech. 8-13-08 Eq
341577 3/11/2009 NJ 0.5 0 0.5 F 3/11/2009 Head bobbling; Questionable seizur
341578 3/11/2009 MO 17 17 M 3/11/2009 Following Immunizations client sittin
341579 3/11/2009 IL 25 25 M 3/11/2009 No adverse events
341580 3/11/2009 IN 5 5 F 3/11/2009 Patient received DTaP, IPV, MMR a
341581 3/11/2009 OH 1 1 0F 3/10/2009 Rash and fussy 20 days after admin
341582 3/11/2009 IL 38 38 M 3/9/2009 Generalized rash similar to classic m
341775 3/11/2009 NY U 5/12/2008 This report was received from a hea
341778 3/11/2009 PA 5 5 M ### Initial report was received 04 Septe
341779 3/11/2009 PA 5 5 M ### Initial report received on 15 Septem
341780 3/11/2009 DE 1.5 1 0.5 M 10/7/2008 Initial information was received from
341781 3/11/2009 PA 2 2 0.4 F ### Initial report was received 17 Octob
341782 3/11/2009 NY 1.3 1 0.3 F 7/18/2008 This case was received from a cons
341783 3/11/2009 IN 26 26 F 9/26/2008 Initial report received on 22 Septem
341970 3/11/2009 TX 13 13 F 1/9/2009 A 13-year-old female patient with a
341971 3/11/2009 TX 14 14 F ### Initial report was received 12 Decem
341973 3/11/2009 TN F ### Initial report received from a physici
341974 3/11/2009 MD 12 12 F ### Initial information was received on 1
341571 3/12/2009 IN 26 26 F 3/12/2009 Head to toe rash, respiratory distres
341593 3/12/2009 IN 1.1 1 0.1 F 3/10/2009 Patient diedY1-11-09. Had received
341599 3/12/2009 KY 65 65 F 3/5/2009 Kidney involvement, nerve inflamma
341600 3/12/2009 U 3/6/2009 Red Lumps all over.
341601 3/12/2009 PA 4 4 F 3/9/2009 Lump under surface of skin. Small a
341602 3/12/2009 TX 68 68 F 3/6/2009 Localized redness and itching past
341603 3/12/2009 VA 4 4 F 3/5/2009 7" area of induration, warmth, erythe
341604 3/12/2009 CA 68 68 M 3/6/2009 Malaise, anorexia, SOB on mild exe
341605 3/12/2009 NC 1.5 1 0.5 F 3/3/2009 None. Tdap given instead of DTap #
341606 3/12/2009 OH 16 16 F 3/9/2009 Patient began noticing rash on ches
341607 3/12/2009 ME 4 4 F 3/9/2009 Vaccines administered to patient. P
341608 3/12/2009 WI 5 5 F 3/10/2009 Low grade 99 degree-102.4 degree
341609 3/12/2009 WI 13 13 F 3/6/2009 Father reports his daughter has had
341610 3/12/2009 NJ 15 15 F 3/10/2009 Rt arm red, swollen, firm, hot @ are
341611 3/12/2009 FL 1.1 1 0.1 F 3/6/2009 Rash all over.
341612 3/12/2009 U 3/6/2009 Bumps all over.
341613 3/12/2009 IL 1 1 0F 3/7/2009 Vaccine > PREVNAR / VARIVAX a
341614 3/12/2009 NC 1.9 1 0.9 M 3/6/2009 Approx. 1 hr after receiving immuniz
341615 3/12/2009 TX 4 4 F 3/6/2009 1) Pt. comes in 3 days later. Her VA
341616 3/12/2009 VA 0.8 0 1M 3/12/2009 vomiting x 1 day; afebrile and fine th
341617 3/12/2009 OK 2 2 0.7 M 3/12/2009 erythematous swelling at the site of
341618 3/12/2009 CT 15 15 M 3/12/2009 MOM CALLED STATING CHILD HA
341619 3/12/2009 FL 2 2 0.2 F 3/12/2009 Pt. mother state child had a fever, h
341620 3/12/2009 MO 0.5 0 0.5 M 3/12/2009 PENTACEL IMMUNIZATION GIVEN
341621 3/12/2009 DC 40 40 F 3/12/2009 Patient with difficulty breathing, itch
341622 3/12/2009 NE 30 30 F 3/12/2009 Had Tdap on 3-10-09, right deltoid.
341623 3/12/2009 NY 27 27 F 3/12/2009 Appoximately 25 minutes after Stac
341624 3/12/2009 GA 11 11 F 3/12/2009 03/11/2009 13:45 Immunization adm
341625 3/12/2009 NC 19 19 M 3/12/2009 1. PT hospitalized 4 months prior to
341626 3/12/2009 NC 18 18 M 3/12/2009 PT recieved anthrax shot and one h
341627 3/12/2009 WA 64 64 M 3/12/2009 Received Shingles Vaccine Zostava
341628 3/12/2009 IN 25 F 3/12/2009 I never had any types of warts. Afte
341629 3/12/2009 WA 56 56 F 3/12/2009 Got Bronchitis and flu like symptom
341630 3/12/2009 AZ 0.3 0 0.3 F 3/12/2009 Diagnosed with intussusception 8 d
341631 3/12/2009 MO 0.5 0 0.5 F 3/12/2009 PENTACEL IMMUNIZATION GIVEN
341632 3/12/2009 CA 1 1 0F 3/12/2009 ON 2/24/09, AN MMR AND A VARI
341633 3/12/2009 NC 3 3 F 3/12/2009 swelling and redness of left deltoid r
341634 3/12/2009 OR 60 60 M 3/12/2009 Developed shingles 19 days followin
341635 3/12/2009 TX 11 11 F 3/12/2009 MOM STATE FEW MINUTES AFTE
341636 3/12/2009 NC 37 37 F 3/12/2009 Major pain at and around injection s
341638 3/12/2009 VT 13 13 F 3/12/2009 Mom is requesting VAERS done...o
341639 3/12/2009 CA 13 13 M ### Pt has severe headache and was a
341640 3/12/2009 MA 4 4 M 3/12/2009 Local reaction w/ erythematous rash
341641 3/12/2009 TX 11 11 M 3/12/2009 Injection of VARIVAX (L) shoulder -
341642 3/12/2009 CA 47 47 F 3/11/2009 Headache, joint aches/pains, chills
341643 3/12/2009 IL 1.3 1 0.3 M 3/12/2009 Rash and fever developed 1 week a
341644 3/12/2009 65 F 3/12/2000 Pt was given Td & pneumonia vacc
341645 3/12/2009 VT 1.2 1 0.2 M 3/12/2009 Red, swollen, hard, lump "the size o
341646 3/12/2009 AK 5 5 M 3/5/2009 Immunization, INFANRIX, given on
341647 3/12/2009 CA 1.2 1 0.2 M 3/12/2009 3/9/09 IZ received @ bedtime T-101
341648 3/12/2009 CA 4 4 M 3/10/2009 Pt brought in by aunt to have PPD r
341649 3/12/2009 OR 62 62 F 3/10/2008 Pt states her (L) arm has been sore
341650 3/12/2009 OH 20 20 F 3/12/2009 Headache, vertigo, tingling in arms,
341651 3/12/2009 IL 7 7 F 3/12/2009 Dad noted late on 3-9-09 a red swo
341652 3/12/2009 NM 4 4 F 3/12/2009 One hour after injection c/o severe p
341653 3/12/2009 PA 15 15 M 3/12/2009 24 hours after shot given swollen fo
341654 3/12/2009 AZ 6 6 F 3/12/2009 (L) swollen arm.
341655 3/12/2009 71 71 F Pt. had adverse RXN to PCV Pt. req
341656 3/12/2009 VA 33 33 U 3/12/2009 Pt woke with tingling in the heel sur
341657 3/12/2009 NJ 74 74 F 15 min after ZOSTAVAX numbness
341658 3/12/2009 IA 20 20 F 3/10/2009 Within Minutes of receiving HPV vac
341659 3/12/2009 GA 0.4 0 0.4 F 3/11/2009 5 days after receiving PENTACEL, P
341661 3/12/2009 SC 61 61 F 3/12/2009 Redness, swelling at site of vaccina
341662 3/12/2009 NY 4 4 M 3/12/2009 Left deltoid area, red, swollen and w
341663 3/12/2009 NC 42 42 M 3/12/2009 PNEUMOVAX administered SQ R a
341664 3/12/2009 NH 11 11 M 3/11/2009 (L) hive shaped 9 x 9 cm erythema
341665 3/12/2009 PA 8 8 F 3/12/2009 Administered KINRIX as "catch up"
341666 3/12/2009 CO 19 19 F 3/12/2009 Pt developed mild case of pyelonep
341668 3/12/2009 AZ 0.5 0 0.5 F 2/24/2009 Initial and follow up information has
341669 3/12/2009 64 F 2/18/2009 Information has been Roche Pharm
341671 3/12/2009 CA 16 F 2/27/2009 Initial report received on 24 Februar
341672 3/12/2009 PA 18 18 F 2/27/2009 Initial report received 23 February 2
341673 3/12/2009 CO 15 15 F 3/4/2009 Initial report received 23 February 2
341674 3/12/2009 UT 13 F 2/24/2009 This non serious case was received
341675 3/12/2009 IN 17 17 F 2/20/2009 Initial report received on 11 Februar
341693 3/12/2009 NC 0.8 0 0.8 M 2/18/2009 Initial and follow-up information has
341694 3/12/2009 NM 1.2 1 0.2 F 2/18/2009 Information has been received from
341696 3/12/2009 NY 2 M 2/18/2009 Information has been received from
341698 3/12/2009 CT 3 F 2/18/2009 Initial and follow up information has
341699 3/12/2009 5 5 F 2/18/2009 Initial and follow-up information has
341700 3/12/2009 CA 1.1 1 0.1 M 2/18/2009 Information has been received from
341701 3/12/2009 MI 1.5 1 0.5 F 2/18/2009 Information has been received from
341702 3/12/2009 GA 1.3 F 2/18/2009 Information has been received from
341703 3/12/2009 NY 0.3 F 2/18/2009 Information has been received from
341705 3/12/2009 NY 0.2 0 0.2 M 2/18/2009 Information has been received from
341706 3/12/2009 MO 0.2 0 0.2 M 2/18/2009 Information has been received from
341710 3/12/2009 0.4 0 0.4 F 2/18/2009 Information has been received for a
341711 3/12/2009 IN 0.2 0 0.2 F 2/18/2009 Information has been received from
341713 3/12/2009 MD 0.2 0 0.2 F 2/18/2009 Information has been received from
341714 3/12/2009 SD 0.3 0 0.3 M 2/18/2009 Information has been received from
341715 3/12/2009 MO 0.2 0 0.2 F 2/18/2009 Information has been received from
341717 3/12/2009 NE F 2/18/2009 Information has been received from
341718 3/12/2009 MO 0.2 0 0.2 F 2/18/2009 Information has been received from
341720 3/12/2009 NE 0.4 0 0.4 M 2/18/2009 Information has been received from
342122 3/12/2009 M 4/3/2008 This adult male (unknown age) took
342123 3/12/2009 NY 9 U Initial report was received on 22. Ju
342676 3/12/2009 CO 5 5 M 3/12/2009 This case was reported by a physici
341637 3/13/2009 WA 1.7 1 0.7 F 3/13/2009 Geneva was given vaccines on 2/25
341676 3/13/2009 IL 48 48 F 3/13/2009 First symptoms was my left arm whe
341677 3/13/2009 NV 5 5 M 3/6/2009 MOC (mother of child) called to clini
341678 3/13/2009 NY 4 4 M 3/9/2009 E. multiforme rash in palms and pla
341679 3/13/2009 TX F Red rash around shot area. Tingling
341680 3/13/2009 WA 65 65 F 3/6/2009 Developed fever 101.8 with chills; re
341681 3/13/2009 NY 31 31 M 2/9/2009 Induration and erythema 10X13 cm
341687 3/13/2009 IN 72 M 3/12/2009 Information has been received from
341691 3/13/2009 IL M 3/11/2009 Initial information was received on 0
341727 3/13/2009 FL 4 4 M 3/13/2009 RIGHT THIGH BECAME RED, WAR
341728 3/13/2009 OH 26 26 F 3/13/2009 MEMBER RECIEVED ANTHRAX V
341729 3/13/2009 OK 36 36 F 3/13/2009 reddness, swelling, nausea, headac
341730 3/13/2009 CO 1.3 1 0.3 M 3/13/2009 Mother reports the following: Child h
341731 3/13/2009 AK 55 55 F 3/13/2009 10/31/08 5pm c/o sore right armpit,
341732 3/13/2009 CA 0.3 0 0.4 M 3/13/2009 URTICARIA PRESENTED ITSELF
341733 3/13/2009 IA 1 1 0F 3/13/2009 DEVELOPED HERPES ZOSTER 5
341734 3/13/2009 MI 49 49 F 3/13/2009 One week after immunization she n
341735 3/13/2009 NC 5 5 M 3/12/2009 LOCAL REATION OF LEFT ARM. A
341736 3/13/2009 MI 18 18 F 3/13/2009 Pt has experienced pain in R arm co
341737 3/13/2009 NC 50 50 F 3/13/2009 terrible back, neck shoulder and hea
341738 3/13/2009 OK 4 4 F 3/13/2009 MOTHER BROUGHT PATIENT IN
341739 3/13/2009 PA 62 62 M 3/13/2009 Rash - 2-3" long by 1&1/2" oval. It i
341740 3/13/2009 CA 4 4 F 3/13/2009 RASH & REDNESS ON VACCINAT
341741 3/13/2009 OH 23 23 F 3/13/2009 Rash of small blisters in a circular p
341742 3/13/2009 VA 3 M 3/13/2009 Difficulty with balance within an hou
341751 3/13/2009 KY 0.2 0 0.2 M 3/12/2009 Mother stated baby cried nonstop fo
341752 3/13/2009 CT 17 17 F 3/12/2009 5 x7 cm induration approx 12 hrs af
341753 3/13/2009 KY 4 4 F 3/12/2009 Child was given DAPTACEL on 3-5
341754 3/13/2009 OR 59 59 F 3/13/2009 Approximately 24 hours after admin
341756 3/13/2009 PA 70 F 2/14/2008 Swollen injection site - repeated Be
341757 3/13/2009 CA 1.1 1 0.1 M 3/13/2009 rash on body x 2 weeks. Pt got chic
341758 3/13/2009 CA 1.4 1 0.4 F 3/13/2009 Localized redness, swelling at site o
341759 3/13/2009 CA 11 11 F 3/13/2009 Localized redness, swelling at site o
341760 3/13/2009 MD 42 42 F 3/13/2009 On 3/11 in eve., pt. noted onset "sti
341761 3/13/2009 OR 2 2 0.5 F 3/13/2009 Pt received HIB and DTAP into left
341762 3/13/2009 AK 0.3 0 0.3 M 3/11/2009 102 Rectal temp Friday eve 3/06/09
341763 3/13/2009 CA 4 4 F 3/13/2009 Approximately 24 hours after receiv
341764 3/13/2009 CA 5 5 M 3/13/2009 Large erythematous hyperemic plaq
341765 3/13/2009 VA 12 12 M 3/1/2009 12:30 Hives developed on right sho
341766 3/13/2009 NC 4 F 3/13/2009 Sx: Vessicular erruption with subse
341767 3/13/2009 WI 4 4 F 3/13/2009 Generalized rash - hives on chest, b
341768 3/13/2009 KY 1.3 1 0.3 M 3/13/2009 Mom noticed he had hives / whelps
341769 3/13/2009 IA 22 22 F 3/12/2009 Lt arm swollen, hives (Lt arm), Lt ar
341770 3/13/2009 MA 14 F 3/13/2009 Received ADACEL 430 PM. 3/11 T
341771 3/13/2009 AZ 0.2 0 0.2 F 3/12/2009 Within 24 hrs after receiving ROTAV
341772 3/13/2009 ME 16 F After GARDASIL #3 Pt. c/o stomach
341773 3/13/2009 NJ 4 4 M 3/12/2009 Approximately 10 minutes following
341743 3/14/2009 VA 24 24 M 3/14/2009 Localized Urticaria around (L) Delto
341744 3/14/2009 MD 1.4 1 0.5 F 3/14/2009 small amount of hives noted in groin
341745 3/14/2009 KS 12 12 F 3/14/2009 dizziness and seizures. 4/16/09 MR
341746 3/15/2009 VA 20 20 F 3/15/2009 encephalitis 24 h after guardasil vac
341747 3/15/2009 NC 28 28 F 3/15/2009 Vaccine administered as part of rou
341748 3/15/2009 CA 0 0 0F 3/15/2009 Was administered Hep B vaccinatio
341749 3/15/2009 TN 26 26 F 3/15/2009 After recieving first round of Gardas
341750 3/15/2009 PA 70 70 F 3/15/2009 Severe red burning rash on arm 4in
341755 3/15/2009 WA 6 6 M 3/15/2009 L upper thigh with erythematous, te
341788 3/16/2009 CO F 3/12/2009 Initial report received from another m
341793 3/16/2009 PA 84 84 M 3/13/2009 Information has been received from
341796 3/16/2009 LA 4 M 3/13/2009 This report was received from Glaxo
341802 3/16/2009 PA 0.3 0 0.3 M 3/10/2009 About 2 weeks s/p ROTATEQ vacci
341803 3/16/2009 OH 0.3 0 0.3 F Immunizations given 2-26-09 had n
341804 3/16/2009 GA 11 11 F 3/10/2009 Left arm- 5.5 - 6.5cm SL. red soft ar
341805 3/16/2009 CA 0.4 0 0.4 M 3/10/2009 None at this time
341806 3/16/2009 NC 48 48 F 3/12/2009 On 2-18-09 sudden onset of knot in
341807 3/16/2009 NJ 1.1 1 0.1 M 2/19/2009 Developed urticarial lesions on back
341808 3/16/2009 WA 0.3 0 0.3 M 3/11/2009 Mom stated child cried 4-5 hours aft
341809 3/16/2009 FL 11 11 M 3/13/2009 Pt had episode of a fainting spell/?s
341810 3/16/2009 SC 1.1 1 0.1 F 3/10/2009 Had shots 3/4/09 (MMR, VARIVAX,
341811 3/16/2009 OH 5 5 F 3/10/2009 C/O sore left arm at 8am, around 9-
341812 3/16/2009 CA 4 4 F 3/5/2009 Mother states noticed L arm swollen
341813 3/16/2009 NY 15 15 M 3/9/2009 Pt c/o right arm pain started 24 hou
341814 3/16/2009 CO 1.6 1 0.6 M 3/9/2009 Acute cerebellar ataxia
341815 3/16/2009 65 65 F 3/3/2009 Pt had severe outbreak of herpes zo
341816 3/16/2009 12 F 3/12/2009 GARDASIL injection, fever headach
341817 3/16/2009 62 62 F 3/10/2009 THIS IS AN UNEXPECTED GOOD
341818 3/16/2009 PA 18 18 M 3/11/2009 Immediately after receiving Hepatitis
341819 3/16/2009 CO 3 3 M 3/12/2009 Swollen area of shot. immobility - m
341820 3/16/2009 CA 9 9 M 3/5/2009 Lip/ facial/ oropharyngeal swelling. V
341821 3/16/2009 FL 1 1 0F 3/11/2009 Itchy rash covering body.
341822 3/16/2009 CA 1.3 M 3/4/2009 5x11 cm erythema with induration a
341823 3/16/2009 TX 48 48 F 3/9/2009 The pneumonia vaccine was given
341824 3/16/2009 WV 81 81 F 3/10/2009 Left clinic after injection + returned t
341825 3/16/2009 31 31 M 2/23/2009 None Stated
341826 3/16/2009 MA 0.4 0 0.4 M 3/16/2009 Patient had an ileo-colic intussusce
341827 3/16/2009 SD 6 6 M 3/16/2009 High fever, hysterical laughing, non
341828 3/16/2009 MO 1.2 0 0.3 F 3/10/2009 3-3-09 Child's mom reported fever,
341829 3/16/2009 MO 1 1 0F 3/16/2009 Rec telephone call on 3/11/09 from
341830 3/16/2009 CA 1.1 1 0.1 M 3/16/2009 This child received 2 doses of Varic
341831 3/16/2009 LA 13 13 F 3/16/2009 Returned to facility approximately on
341832 3/16/2009 WI 5 5 F 3/16/2009 Mother reported very hard, red, war
341833 3/16/2009 OH 46 46 F 3/16/2009 Received Boostrix in right arm on 03
341834 3/16/2009 WI 43 43 M 3/16/2009 Developed area cellulitis at innocula
341835 3/16/2009 WI 43 43 M 3/16/2009 Developed Cellulitis at innoculation
341836 3/16/2009 NY 11 11 M 3/16/2009 L arm 3x4cm induration, redness, itc
341837 3/16/2009 TX 44 44 F 3/16/2009 Severe sharp pain and swelling righ
341838 3/16/2009 MN 58 58 F 3/16/2009 Sore, swollen left arm. Fever, nause
341839 3/16/2009 KS 57 55 F 3/16/2009 Has continued L upper arm pain an
341840 3/16/2009 FL 25 25 F 3/16/2009 PT STATES ONE WEEK AFTER VA
341841 3/16/2009 HI 12 1 0M 3/16/2009 Fever, mild generalized diffuse mac
341842 3/16/2009 NC 30 30 F 3/16/2009 Received PPV shot around 10:45 a
341844 3/16/2009 IL 42 42 F 3/16/2009 Swelling and pain at axilla on left sid
341845 3/16/2009 ID 12 12 M 3/16/2009 Pain, swelling, redness at injection s
341846 3/16/2009 CA 19 19 F 3/16/2009 Fever, headaches, myalgias, sore th
341847 3/16/2009 NY 0.2 0 0.2 F 3/16/2009 Lethargic, listless, not self for 1 wk p
341848 3/16/2009 IN 5 5 F 3/16/2009 Notice hive like 1 cm raised area 1 i
341849 3/16/2009 IN 4 4 M 3/16/2009 Mom notified us 48 hours after vacc
341850 3/16/2009 CA 54 54 F 3/16/2009 Pt C/O redness / itch on L mid arm u
341851 3/16/2009 WI 16 16 F 3/16/2009 C/O itchiness on nape of neck @ H
341852 3/16/2009 NY 11 11 F 3/16/2009 Approx 10 min after immunizations
341853 3/16/2009 CA 5 5 M 3/21/2009 As per dad they noticed redness on
341854 3/16/2009 IL 10 10 M 3/16/2009 Pt developed a large red swollen (1
341855 3/16/2009 MA 3 3 M 3/16/2009 Pt presented with 30-50 lesions on
341856 3/16/2009 DE 22 22 F 3/16/2009 Pt had, chest pains, heaviness on c
341857 3/16/2009 TX 59 59 F 3/16/2009 Left arm pain, Fatigue, and nausea.
341858 3/16/2009 CA 0.4 0 0.4 M 3/16/2009 Rash at bilateral injection site.
341859 3/16/2009 VA 3 3 M 3/16/2009 Was anxious after - then tired/fatigu
341860 3/16/2009 TX 38 38 M 3/16/2009 BELL's Palsy 2 weeks after MCV4 v
341861 3/16/2009 NY 1.6 1 0.6 M 3/16/2009 Generalized erythema multiforme ex
341862 3/16/2009 TN 5 5 F 3/15/2009 Redness and swelling around inject
341863 3/16/2009 KY 53 53 M 3/16/2009 Lymphadenopathy of R axillary nod
341864 3/16/2009 MI 11 11 F 3/13/2009 Fatigue, joint pain after immunizatio
341865 3/16/2009 FL 15 15 F 3/12/2009 Swelling/hematoma at injection site.
342061 3/16/2009 CA 0.6 U 3/13/2009 Information has been received from
342064 3/16/2009 TN 0.8 M 3/13/2009 Information has been received from
342065 3/16/2009 NH 0.5 0 0.5 M 3/13/2009 Information has been received from
342066 3/16/2009 IN 0.8 M 3/13/2009 Information has been received from
342067 3/16/2009 IL 1.1 U 3/13/2009 Information has been received from
342068 3/16/2009 OH 0.1 U 3/13/2009 Information has been received from
342069 3/16/2009 NH 0.5 0 0.5 M 3/13/2009 Information has been received from
342070 3/16/2009 NC 0.3 M 3/13/2009 Information has been received from
342071 3/16/2009 TX 0.3 M 3/13/2009 Information has been received from
342076 3/16/2009 PA U 3/13/2009 Information has been received from
342078 3/16/2009 TX 0.6 U 3/13/2009 Information has been received from
342129 3/16/2009 MN 13 F 3/13/2009 Information has been received from
342150 3/16/2009 14 F 3/13/2009 Information has been received initia
342203 3/16/2009 PA F 3/13/2009 Information has been received from
342208 3/16/2009 MA F 3/13/2009 Information has been received form
342209 3/16/2009 HI F 3/13/2009 Information has been received from
342214 3/16/2009 GA 23 23 F 3/13/2009 Information has been received form
342246 3/16/2009 KS 16 16 F 3/13/2009 Information has been received from
342403 3/16/2009 MI F 3/13/2009 Information has been received from
342415 3/16/2009 NV F 3/13/2009 Information has been received from
342428 3/16/2009 CO F 3/13/2009 Information has been received from
342609 3/16/2009 PA 15 15 U 3/13/2009 Information has been received from
342613 3/16/2009 WA 13 13 F 3/13/2009 Information has been received from
342617 3/16/2009 NC F 3/13/2009 Information has been received from
342631 3/16/2009 CT 15 F 3/13/2009 Information has been received from
342641 3/16/2009 TN F 3/13/2009 Information has been received from
342643 3/16/2009 WV 18 18 F 3/13/2009 Information has been received from
342760 3/16/2009 21 21 F 3/13/2009 Initial and follow up information has
342761 3/16/2009 DE 24 24 F 3/13/2009 Initial information and follow up has
342763 3/16/2009 MN 20 20 F 3/13/2009 Information has been received throu
342764 3/16/2009 TX 17 17 F 3/13/2009 Initial information has been received
342765 3/16/2009 MN 23 23 F 3/13/2009 Initial and follow-up information has
341843 3/17/2009 CA 0.3 0 0.3 F 3/17/2009 redness, swelling, heat and hard sp
341877 3/17/2009 0.2 U 3/16/2009 InformationYhas been received form
341878 3/17/2009 VT 90 90 F 3/16/2009 Information has been received from
341879 3/17/2009 NJ 64 64 M 3/16/2009 Information has been received from
341884 3/17/2009 VA 1.4 1 0.4 M 3/16/2009 Information has been received from
341888 3/17/2009 WA 0.2 0 0.2 M 3/12/2009 Apnea 12-24 hours after vaccines. I
341889 3/17/2009 IL 5 5 M 3/1/2009 By 11/28 evening upper left arm wa
341890 3/17/2009 NY 0.2 0 0.2 M 3/4/2009 "Night tremor" type incident "weird c
341891 3/17/2009 22 22 F 3/15/2009 Fever of 103 for 72 hours, severe so
341892 3/17/2009 TX 75 75 F 3/11/2009 Increased her neuropathy symptom
341893 3/17/2009 CA 5 5 M 3/9/2009 No adverse effects observed. Fathe
341894 3/17/2009 WA 53 53 F Pt states her Rt arm has been hurtin
341895 3/17/2009 TX 4 4 F 3/12/2009 Pt received shots Monday afternoon
341896 3/17/2009 CA 1.8 1 0.8 M 3/11/2009 Malar rash erupted day post vaccina
341897 3/17/2009 NC 35 M 3/13/2009 None stated.
341898 3/17/2009 MI 36 36 M 3/5/2009 lymph node in the deltoid region and
341899 3/17/2009 HI 66 66 F 3/10/2009 Itch: 2-21-09. Severe welts (red, pu
341900 3/17/2009 WA 56 56 M 3/2/2009 My back of head left side bottom sta
341901 3/17/2009 IN 12 12 M 3/11/2009 Began vomiting approx 6-8 hr post i
341902 3/17/2009 CA U Weakness, Dizziness, Mild Nausea
341903 3/17/2009 OR 55 55 F 3/12/2009 Injection site was warm/hot to touch
341904 3/17/2009 CO 12 12 F 3/11/2009 Immediately after shot, had onset o
341905 3/17/2009 AL 0.4 0 0.4 F 3/10/2009 N&V, diarrhea, Pale, Lethargic, Wea
341906 3/17/2009 IN 0.8 0 0.8 F 3/5/2009 On 3-2-09 parent called and reporte
341907 3/17/2009 CA 4 4 M 3/10/2009 Half hour after vaccines were admin
341908 3/17/2009 PA 18 U Day after injection of MENACTRA. P
341909 3/17/2009 NY 10 10 F 3/11/2009 Local cellulitis at site of injection res
341910 3/17/2009 WA 17 M 3/12/2009 Patient was given 3 GARDASIL vac
341911 3/17/2009 IL 21 21 F 3/2/2009 See attached medical records.
341912 3/17/2009 ID 7 7 M 3/3/2009 DTaP given to a 7yr old will count a
341913 3/17/2009 IN 48 48 M 3/10/2009 Rubella rash - maculopapular, fine,
341914 3/17/2009 MD 0 0 0F 3/14/2009 None - just to report accidental (unin
341915 3/17/2009 44 44 M 3/17/2009 Diarrhea, GI upset, "flare of Ulcerati
341917 3/17/2009 TX 15 15 M 3/17/2009 headache, dizziness, stiff and sore
341918 3/17/2009 MD 18 18 M 3/17/2009 Patient informed nurse that he usua
341920 3/17/2009 FL 16 16 F 3/17/2009 Within several days of her second s
341921 3/17/2009 NH 1 1 0M 3/17/2009 1 week after patient was given the F
341922 3/17/2009 NJ 21 21 M 3/17/2009 Pt is a member on Mobilization Orde
341923 3/17/2009 NJ 43 43 F 3/17/2009 Pt is a member of the military. Vacc
341924 3/17/2009 NC 1 1 0M 3/17/2009 pATIENT PRESENTED WITH RED
341925 3/17/2009 OR 19 19 F 3/17/2009 Menactra, Varivax, and Havrix admi
341926 3/17/2009 CT 20 20 F 3/17/2009 Received Yellow Fever vaccine 2/27
341927 3/17/2009 TX 38 38 M 3/17/2009 Day after administration: myalgias, s
341928 3/17/2009 SD 0.8 0 0.8 M 3/5/2009 Rash on neck, swelling and redness
341929 3/17/2009 MA 7 7 F 3/17/2009 Patient is well appearing and presen
341930 3/17/2009 TX 36 36 F 3/17/2009 Immunizations given 3/16/09. Client
341931 3/17/2009 CA 31 31 F 3/17/2009 The member was examined in flight
341932 3/17/2009 WA 15 15 F 3/17/2009 Pt was given #2 HPV and left area w
341933 3/17/2009 CA 62 62 F 3/17/2009 She dies onY12/31/08 - clinicians lis
341934 3/17/2009 KY 24 24 M 3/17/2009 Service member was a basic trainee
341946 3/17/2009 PA 19 19 F 3/17/2009 Nausea, Dizzy, Weak
341947 3/17/2009 PA 4 4 M 3/17/2009 3/10 2pm - immunization administer
341948 3/17/2009 CA 0.7 0 0.7 M 3/17/2009 Sterile abscess left thigh.
341949 3/17/2009 IL 0.2 0 0.2 F 3/17/2009 Intussusception
Y (ileo-cecal) requirin
341950 3/17/2009 MA 1 1 0F 3/17/2009 Dermal infiltrate L anterior thigh: ind
341951 3/17/2009 LA 5 5 M 3/17/2009 Approximately 30min after receiving
341952 3/17/2009 IL 23 23 U None stated.
341953 3/17/2009 NC 46 46 F 3/17/2009 Patient was given pneumococcal va
341954 3/17/2009 GA 47 47 F 3/16/2009 Patient reports developing a pruritic
341955 3/17/2009 IN 1 1 0M 3/17/2009 Febrile seizure - ER visit treated wit
341956 3/17/2009 PA 15 15 F 3/16/2009 Fatigue, severe muscle aches all ov
341957 3/17/2009 MN 1 1 0M 3/17/2009 High fever - up to 103- March 13-14
341958 3/17/2009 SC 11 0 1M 3/16/2009 Dx with chicken pox.
341986 3/18/2009 1 0 1M 3/17/2009 Information has been received from
341989 3/18/2009 1.4 M 3/17/2009 It was reported in a published repor
342001 3/18/2009 73 73 F 3/16/2009 Got shingles vaccine last week. Got
342002 3/18/2009 KY 0.4 0 0.4 F 3/12/2009 Rash to head and neck 2 hours afte
342003 3/18/2009 GA 6 6 F 1/7/2009 Phone call from mom- stated when
342004 3/18/2009 GA 52 52 F ### About 1 1/4 hrs post pneumonia vac
342005 3/18/2009 GA 17 17 M 2/26/2009 Dr from mother, reports client had e
342009 3/18/2009 0.4 0 0.4 F 3/18/2009 This case was reported by a physici
342010 3/18/2009 OH U 3/18/2009 This case was reported by a physici
342012 3/18/2009 7 M 3/18/2009 This case was reported in a literatur
342016 3/18/2009 GA 67 67 M 3/17/2009 Pt received TDAP instead of rec. TD
342017 3/18/2009 KY 10 10 F 2/26/2009 Soon after administer- flushed chee
342018 3/18/2009 TX 4 4 F 3/5/2009 L Thigh with swelling / Erythema.
342019 3/18/2009 KS 25 25 M 3/18/2009 Member has small bump on chest, b
342020 3/18/2009 AR 11 11 F 3/18/2009 2 days post vaccination, pt presente
342021 3/18/2009 TX 1 1 0M 3/18/2009 Fever for 2 days. Red spots on face
342022 3/18/2009 ME 38 38 F Err:508
342023 3/18/2009 TX 1.3 1 0.3 F 3/17/2009 firm, hard knot at injection site R up
342025 3/18/2009 NC 22 22 M 3/13/2009 24 y/o male ADSM is referred by Re
342026 3/18/2009 33 33 F 3/18/2009 Pt called at 10:20 to Immunization c
342027 3/18/2009 ME 64 64 M 3/18/2009 Pt given varicella vaccine in error, s
342028 3/18/2009 KS 17 17 M 3/18/2009 Nausea, vomitting, headache, pain,
342029 3/18/2009 TX 29 29 F 3/18/2009 Local reaction. 40mm X 26mm area
342030 3/18/2009 MO 25 25 F 3/18/2009 Patient complained of a itchy, painfu
342031 3/18/2009 MD 40 40 U 3/18/2009 Received Tdap vaccine. Approx. 18
342032 3/18/2009 MO 13 13 F 3/18/2009 Approximately one hr. after receivin
342033 3/18/2009 MO 13 13 F 3/18/2009 Approximately three hours following
342034 3/18/2009 WA 5 5 F 3/18/2009 Pt developed a rash, resembling ch
342035 3/18/2009 LA 13 13 F 3/18/2009 She has not had a period after rece
342036 3/18/2009 IL 1 1 0F 3/18/2009 Right thigh where vaccine was adm
342037 3/18/2009 MO 0.3 0 0.3 F 3/18/2009 Patient recieved vaccines on 3/17/0
342038 3/18/2009 ID 23 23 F 3/18/2009 Bilateral arms red, raised rash. Wa
342039 3/18/2009 PA 45 45 M 3/18/2009 Pt awoke at 7AM on 3/12/2009 with
342040 3/18/2009 IN 4 4 F 3/18/2009 Patient presented day after vaccina
342041 3/18/2009 NY 1.3 1 0.3 M 3/18/2009 Approximately 1 week after shot wa
342042 3/18/2009 PA 18 18 M 3/18/2009 syncopal episode condition and vita
342043 3/18/2009 MS 0.8 0 0.8 M 3/18/2009 pt returned to clinic 2 days after vac
342044 3/18/2009 MS 1.3 1 0.3 M 3/18/2009 PT RETURNED TO CLINIC WITH R
342045 3/18/2009 TN 13 13 F 3/18/2009 Fever, severe abdominal pain; musc
342046 3/18/2009 OK 0.2 0 0.2 F 3/18/2009 Baby died 4Ydays after vaccines we
342047 3/18/2009 CA 4 4 F 3/18/2009 left deltoid swollen and reddness no
342048 3/18/2009 TX 3 M 3/6/2009 A serious, spontaneous report of sta
342049 3/18/2009 AK 23 23 F 3/18/2009 Client reported of experiencing heav
342050 3/18/2009 CT 4 4 M 3/18/2009 swelling, redness, pain, increased te
342051 3/18/2009 GA 1.3 1 0.3 F 3/18/2009 Had Hep B # 3, DTaP # 4, PCV # 4
342052 3/18/2009 NJ 53 53 M 3/16/2009 Started with cough 1900 15MAR09,
342053 3/18/2009 NY 65 65 M 3/18/2009 Like usual after vax, jogged for 3 1/2
342054 3/18/2009 NJ 32 32 F 3/16/2009 3/19/09 T/C to reporter who states p
342055 3/18/2009 CA 4 4 F 3/17/2009 Erythematous induration area at the
342056 3/18/2009 CA 4 4 F 3/18/2009 Local redness and swelling 13 x 10
342057 3/18/2009 LA 40 40 U 6/7/2005 Incidental diagnosis of thrombocyto
342058 3/18/2009 CA 16 16 F 3/18/2009 Dizziness and LOC x 30 sec, about
342059 3/18/2009 PA 0.6 0 0.6 M 3/17/2009 On 5/28/08, Pt was 7mo old and rec
342060 3/18/2009 MA 24 24 F 2/11/2009 Pt had a c/o feeling as though she w
342978 3/18/2009 TX 4 4 F 2/12/2009 A serious, study report of right lowe
342979 3/18/2009 WA 2.8 F 2/19/2009 A non-serious spontaneous report o
342980 3/18/2009 OK 2 2 0.8 F 2/11/2009 A non-serious, spontaneous report
342981 3/18/2009 OH 4 4 M 2/11/2009 A non-serious, spontaneous report
342982 3/18/2009 UT U 2/6/2009 A non-serious spontaneous report o
342983 3/18/2009 TX 4 M 2/5/2009 A non-serious spontaneous report o
342990 3/18/2009 GA F 2/17/2009 A non-serious, spontaneous report
343098 3/18/2009 SC 0.1 0 0.1 M 3/6/2009 Information has been received from
343103 3/18/2009 0 0 0F 3/6/2009 Information had been received from
343106 3/18/2009 SD 0 0 0F 3/6/2009 Information has been received from
343107 3/18/2009 MD 0 0 0F 3/6/2009 Information has been received from
343143 3/18/2009 F 3/6/2009 Information has been received for a
343144 3/18/2009 TX 0 0 0F 3/6/2009 Information has been received from
343146 3/18/2009 PA 0 0 0M 3/6/2009 Information has been received from
343147 3/18/2009 IN 0 0 0F 3/6/2009 Information has been received from
343158 3/18/2009 WI 0.2 0 0.2 F 3/6/2009 Information has been received from
343160 3/18/2009 MN 0 0 0M 3/6/2009 Information has been received from
343170 3/18/2009 IA U 3/6/2009 Information has been received from
343175 3/18/2009 PA 26 F 3/6/2009 Initial and follow up information has
343177 3/18/2009 43 U 3/6/2009 Information has been received from
343190 3/18/2009 U 3/6/2009 Initial information has been received
343194 3/18/2009 TX 0.1 0 0.1 F 3/6/2009 Initial information has been received
343196 3/18/2009 AZ 0 0 0F 3/6/2009 Information has been received from
343198 3/18/2009 0.1 0 0.1 M 3/6/2009 Pediatric medical records were rece
343200 3/18/2009 IN M 3/6/2009 Information has been received from
343202 3/18/2009 20 F 3/6/2009 Initial and follow up information has
343205 3/18/2009 F 3/6/2009 Initial and follow-up information has
343212 3/18/2009 NH U 3/6/2009 Information has been received from
343215 3/18/2009 MD U 3/6/2009 Information has been received from
343219 3/18/2009 OH 30 U 3/6/2009 Information has been received rega
343228 3/18/2009 OH 0 0 0F 3/6/2009 Information has been received from
343231 3/18/2009 UT 1.2 F 3/6/2009 Information has been received from
343232 3/18/2009 NH 0 0 0F 3/6/2009 Information has been received from
343234 3/18/2009 PA 0 0 0F 3/6/2009 Information has been received from
343235 3/18/2009 PA 0 0 0M 3/6/2009 Information has been received from
343281 3/18/2009 CO 0 0 0M 3/6/2009 Information has been received from
343286 3/18/2009 NJ 27 27 M 3/6/2009 Initial and follow up information has
343288 3/18/2009 WA U 3/6/2009 Information has been received from
343290 3/18/2009 TN U 3/6/2009 Information has been received from
343393 3/18/2009 NC 28 28 F 3/4/2009 This case was reported by a healthc
343394 3/18/2009 IL 13 13 F 3/4/2009 This case was reported by a healthc
343395 3/18/2009 OH 1.3 1 0.3 M 3/4/2009 This case was reported by a healthc
343396 3/18/2009 OR M 3/4/2009 This case was reported by a healthc
343397 3/18/2009 CA 3 3 M 3/4/2009 This case was reported by a healthc
343398 3/18/2009 TX 1.2 1 0.2 F 3/4/2009 This case was reported by a physici
343399 3/18/2009 NC 18 18 F 3/4/2009 This case was reported by a consum
343400 3/18/2009 NJ 41 F 3/4/2009 This case was reported by a healthc
343401 3/18/2009 MD 47 47 M 3/4/2009 This case was reported by a healthc
343403 3/18/2009 GA 45 45 F 3/4/2009 This case was reported by a consum
343404 3/18/2009 NJ 29 F 3/4/2009 This case was reported by a physici
343406 3/18/2009 VA 1.2 1 0.2 F 3/4/2009 This case was reported by a healthc
343409 3/18/2009 MI 20 20 F 3/4/2009 This case was reported by a healthc
343420 3/18/2009 CO U 3/4/2009 This case was reported by a healthc
343421 3/18/2009 NV F 3/4/2009 This case was reported by a consum
343428 3/18/2009 M 3/4/2009 This case was reported by a healthc
343429 3/18/2009 NY F 3/4/2009 This case was reported by a healthc
343431 3/18/2009 NY 17 17 F 3/4/2009 This case was reported by a physici
343432 3/18/2009 CO 3 3 F 3/4/2009 This case was reported by a healthc
343433 3/18/2009 MD 66 66 F 3/4/2009 This case was reported by a healthc
343434 3/18/2009 CO U 3/4/2009 This case was reported by a healthc
343437 3/18/2009 KY 25 25 F 3/4/2009 This case was reported by a healthc
343438 3/18/2009 TN 5 5 F 3/4/2009 This case was reported by a healthc
343439 3/18/2009 KY U 3/4/2009 This case was reported by a healthc
343441 3/18/2009 NY 13 14 M 3/4/2009 This case was reported by a physici
343442 3/18/2009 GA 1.6 1 0.6 M 3/4/2009 This case was reported by a healthc
343443 3/18/2009 1 U 3/4/2009 This case was reported by a physici
343444 3/18/2009 WI 1 1 0F 3/4/2009 This case was reported by a healthc
343446 3/18/2009 PA 52 52 F 3/4/2009 This case was reported by a healthc
343447 3/18/2009 MI 0.1 0 0.1 M 3/4/2009 This case was reported by a physici
343448 3/18/2009 CO 34 34 M 3/4/2009 The subject's medical history includ
343449 3/18/2009 SD 6 6 F 3/4/2009 This case was reported by a healthc
343450 3/18/2009 PA 0.8 0 0.8 F 3/4/2009 This case was reported by a consum
343451 3/18/2009 MA 22 22 F 3/4/2009 This case was reported by a physici
343452 3/18/2009 NC 0.6 0 0.6 M 3/4/2009 This case was reported by a healthc
343453 3/18/2009 U 3/4/2009 This case was reported by a consum
342080 3/19/2009 ME 3 U 3/17/2009 A 3-year-old child had received thei
342083 3/19/2009 OH 1.7 1 0.7 M 3/17/2009 Initial report received on 13 March 2
342088 3/19/2009 54 54 M 3/18/2009 Information has been received from
342096 3/19/2009 ND 20 20 F 3/18/2009 Initial information has been received
342102 3/19/2009 NC 5 5 M 3/18/2009 Within 10 min. of vaccines pt. had c
342103 3/19/2009 CA 0.5 0 0.5 M 3/13/2009 On 3/13/09 pt. received 3rd dose of
342104 3/19/2009 CA 35 35 F 3/14/2009 Approx. 24-28 after 12 pt. noted sw
342105 3/19/2009 WI 17 17 F 10/12 - tingling in arms/legs, feeling
342106 3/19/2009 MD 2 2 0.9 M 3/11/2009 Pt received flu vaccine & got INFLU
342108 3/19/2009 TX 18 18 F 3/14/2009 Feb-2-09 at 3:00 pm vaccines were
342109 3/19/2009 WA 72 72 M 3/12/2009 Increased somnolence and headach
342110 3/19/2009 CO 1.1 1 0.1 M 3/16/2009 Diffuse macular papular rash.
342111 3/19/2009 NY 81 81 F 3/6/2009 Pt went to a fast food restaurant afte
342112 3/19/2009 NJ 0.1 0 0.1 F 3/19/2009 3-4 hrs. of non-stop crying.
342113 3/19/2009 NJ 0.3 M 3/19/2009 Jerky movements of head to right
342115 3/19/2009 TX 11 11 F 3/18/2009 Received Varicella and Hepatitis A v
342117 3/19/2009 SC 0 0 0F 3/9/2009 Patient was given HEPATITIS B vac
342118 3/19/2009 MA 65 65 F 3/9/2009 Red swollen, painful (L) upper arm a
342119 3/19/2009 NY 4 4 M 3/13/2009 48 hrs after the vaccine the site bec
342120 3/19/2009 FL 2 2 0M 3/19/2009 Fever 102.7 48 hrs after administrat
342121 3/19/2009 OH 1.4 1 0.4 M 3/19/2009 Starting at 8:00PM on 3/18/09 Temp
342161 3/19/2009 MO 38 38 F 3/19/2009 Began having chills, achy joints, sho
342162 3/19/2009 ND 35 35 F 3/19/2009 DEVELOPED ACHING/ FEVER AB
342163 3/19/2009 TX 0.5 0 0.6 F 3/19/2009 BREAKTHROUGH ROTAVIRUS DI
342164 3/19/2009 IN 14 0 0M 3/19/2009 has temp of 102, hurts to move,bod
342165 3/19/2009 CA 64 64 F 3/19/2009 A red swelling developed that has b
342166 3/19/2009 WA 0.3 0 0.4 F 3/19/2009 Tdap given to patient in error, shoul
342167 3/19/2009 AK 34 34 F 3/19/2009 Flu vaccine administered at 10 a.m.
342168 3/19/2009 MI 4 4 M 3/19/2009 None
342169 3/19/2009 FL 11 11 F 3/19/2009 PATIENT NOTED HIVES ONCE AG
342170 3/19/2009 OH 0 0.2 M 3/19/2009 Pt was fully immunized and pretty m
342171 3/19/2009 CA 0.5 0 0.5 M 3/19/2009 Infant developed hives 22 hours pos
342172 3/19/2009 PA 5 5 M 3/19/2009 Within a few hours after receiving 4
342173 3/19/2009 CA 7 1 0.3 M 3/19/2009 Saw a black dot on patient's left arm
342174 3/19/2009 CA 1 1 0M 3/19/2009 Patient had 5 minute tonic clonic se
342175 3/19/2009 CA 4 5 F 3/19/2009 Noticed black dot on patient's right a
342176 3/19/2009 WA 22 22 M 3/19/2009 Patient complained of tightness and
342177 3/19/2009 NJ 16 16 F 3/19/2009 supraclavicular lymphadenopathy o
342178 3/19/2009 CA 20 20 F 3/19/2009 UTI like symptoms, frequent urinatio
342182 3/19/2009 CA 14 14 F 3/19/2009 HPV #1, 8/18/08; HPV #2, 10/20/08
342183 3/19/2009 KS 0.2 0 0.2 F 3/19/2009 Red, papular, vesicular, asymptoma
342184 3/19/2009 CA 4 4 F 3/18/2009 Left & right thigh swollen, red, pain.
342185 3/19/2009 NY 1.2 1 0.2 F 3/19/2009 Fever started 03/16/09 and develop
342186 3/19/2009 ME 5 5 M 3/19/2009 Patient was given MMR vaccine on
342187 3/19/2009 NM 1.3 1 0.3 M 3/19/2009 Child started with redness to right th
342188 3/19/2009 MA 17 17 M 3/19/2009 "Blacked out" for a few seconds the
342189 3/19/2009 KY 4 4 M 3/19/2009 Redness and warmth to deltoid site
342190 3/19/2009 OR 4 F Immus given 03-16-09. Called by m
342191 3/19/2009 KY 4 4 F 3/19/2009 Patient with local reaction, left uppe
342192 3/19/2009 NC 4 4 F 3/19/2009 Left thigh 8x10cm red oval. mild ede
342193 3/19/2009 CA 66 66 F 3/18/2009 For the past 15 yrs, pt has had sing
342194 3/19/2009 WA 1 1 0F 3/19/2009 Hives developed on entire torso 7 h
342195 3/19/2009 MO 1.6 1 0.6 M 3/19/2009 Head to toe macular papular rash. P
342196 3/19/2009 MA 12 12 M 3/19/2009 2 cm in diameter erythematous lesio
342197 3/19/2009 VA 4 4 F 3/18/2009 Chicken pox 3/18/09 after 2 vaccina
342198 3/19/2009 TX 33 33 M 3/18/2009 3/14/09- Experienced diarrhea, vom
342225 3/20/2009 MN 19 19 F 3/19/2009 Initial information has been received
342228 3/20/2009 FL 22 22 F 3/19/2009 Initial and follow-up information has
342231 3/20/2009 2 2 0.1 F 3/19/2009 Information has been received from
342235 3/20/2009 IN 1.5 M 3/19/2009 Information has been received from
342239 3/20/2009 WI 1 1 0F 3/19/2009 Information has been received from
342254 3/20/2009 MN 23 23 F 3/13/2009 Information has been received form
342256 3/20/2009 11 U 3/20/2009 This case was reported by a pharma
342272 3/20/2009 NY 0.3 0 0.3 M 3/12/2009 12 hours after 4 month vaccines giv
342273 3/20/2009 TX U 3/6/2009 This non serious case was received
342274 3/20/2009 FL 4 4 M 3/20/2009 9 X 9 cm irregular area to left delt.
342275 3/20/2009 ID 1.3 1 0.3 M 3/20/2009 Fever up to 105
342276 3/20/2009 VA 11 11 M 3/20/2009 Onset of fever to 102, hives under b
342277 3/20/2009 CA 1.8 1 0.8 M 3/18/2009 About 1540 pm MA had just finished
342278 3/20/2009 MO 73 73 F 3/16/2009 3" x 6" erythema at injection site no
342279 3/20/2009 WA 0.6 0 0.6 F 3/13/2009 Pt had nonstop crying for 3 + hours
342280 3/20/2009 TX 20 20 F 3/15/2009 Non stated.
342281 3/20/2009 PA 16 16 F 1/30/2009 Reactive Lymphadenopathy, cervica
342282 3/20/2009 WV 18 18 F 3/16/2009 Head to toe rash and headache. Re
342283 3/20/2009 FL 72 71 F 3/16/2009 Received Herpes Zoster Vaccine 5/
342284 3/20/2009 TX 8 8 M 3/16/2009 Initial, hives, abdominal pain ( <5 m
342285 3/20/2009 FL 13 13 M 3/9/2009 Extensive local swelling including en
342286 3/20/2009 IN 11 11 M 3/16/2009 The a.m. after vaccinations pt. notic
342287 3/20/2009 OH 11 11 F 1/26/2009 Mom states that eve after a shower
342288 3/20/2009 ID 0.7 0 0.7 M 3/21/2009 Fever 102-103 degrees F wouldn't c
342289 3/20/2009 LA 0.5 0 0.5 F 3/13/2009 Vomiting, fever to 103 degrees. Fev
342291 3/20/2009 ID 42 42 F 2/19/2009 Client reports that she had a softbal
342292 3/20/2009 ID 8 8 M 3/11/2009 Small pea-sized redness @ site of i
342293 3/20/2009 ID 20 20 F 3/10/2009 Patient reports approximately 40 mi
342294 3/20/2009 TX 46 46 F 3/20/2009 The day after the vaccine was given
342295 3/20/2009 LA 71 71 F 3/20/2009 Pt received shot 12/30/08 - Raised
342296 3/20/2009 MD 4 4 M 3/19/2009 Local inflammatory reaction. 7x7 wa
342297 3/20/2009 MO 40 40 M 3/2/2009 Stated developed raised red "bump
342298 3/20/2009 OH 11 11 M 3/16/2009 Post vaccine VARICELLA.
342299 3/20/2009 KY 1.2 1 0.2 M 3/16/2009 3/14/09 Diagnosis of chickenpox Re
342300 3/20/2009 DE 76 76 M 3/11/2009 Pt received ZOSTER & TD BOOST
342301 3/20/2009 PA 64 64 F 3/17/2009 Pain 24/7. Limited movement of righ
342302 3/20/2009 VA 46 46 F 3/16/2009 03/13/2009 pt. called to report "hive
342303 3/20/2009 WA 1.5 1 0.5 M 3/6/2009 Abscess on Rt thigh hard red lump,
342304 3/20/2009 NY 33 33 M 3/20/2009 Patient presented to the clinic on th
342305 3/20/2009 ME 21 M 3/20/2009 Patient developed pain and redness
342306 3/20/2009 KS 1 0 1M 3/20/2009 Crying nonstop from 1am-8am. Sho
342307 3/20/2009 NJ 10 10 F 3/20/2009 Seen on 3/13/09 for 10 year old wel
342308 3/20/2009 MD 58 F 3/20/2009 After 1 series of Hepatitis B vaccine
342309 3/20/2009 NY 26 26 M 3/20/2009 Member developed erythema swelli
342310 3/20/2009 MD 19 F 3/20/2009 After 1 series of Hep B vaccine (4/2
342311 3/20/2009 MN 12 F 3/20/2009 fever to 103.4, muscle spasm, r thu
342312 3/20/2009 RI 19 19 M 3/20/2009 Pt received adacel vaccine on 3/18/
342313 3/20/2009 PA 25 25 F 3/20/2009 After receiving the second dose of t
342314 3/20/2009 PA 4 4 M 3/20/2009 MMR given at 0930am, developed e
342315 3/20/2009 PA 60 60 F 3/20/2009 Pt noted an ugly looking rash, which
342316 3/20/2009 PA 65 65 F 3/20/2009 Pt noted a faint red rash around the
342317 3/20/2009 FL 20 20 M 3/20/2009 Mother reported to Health Dept. tha
342318 3/20/2009 PA 12 12 F 3/20/2009 12 hours after receivng vaccines pa
342319 3/20/2009 VA 20 20 M 3/20/2009 PT RECIEVED ANTHRAX VACCIN
342320 3/20/2009 MA 1 1 0F 3/20/2009 Hives appeared on 3/19/09 and a ve
342321 3/20/2009 DC 27 27 M 3/20/2009 Localized soreness/tenderness in u
342322 3/20/2009 MI 1 0F 3/20/2009 One inch area of inderation at the s
342333 3/20/2009 CT 60 60 F 3/10/2009 Had cold symptoms in Nov - Dec. F
342334 3/20/2009 MD 13 13 M 3/20/2009 3-4 hours after vaccines (and after d
342335 3/20/2009 OR 60 60 F 3/21/2009 Redness, itching and shortness of b
342336 3/20/2009 AZ 7 7 M 3/20/2009 Fever, left arm swelling, redness an
342337 3/20/2009 CA 12 12 F 3/18/2009 Within 5 minutes of receiving 3 vacc
342338 3/20/2009 IL 19 19 F 3/19/2009 Blurred vision, Nausea. Vomiting 20
342339 3/20/2009 PA 1 1 0M 3/20/2009 Child noted to have Erythema Multif
342340 3/20/2009 OR 41 41 F 3/20/2009 Sensation of swelling in legs, knees
342341 3/20/2009 NC 7 7 M 3/20/2009 L arm swollen around site.
342342 3/20/2009 OH 26 26 F 1/28/2009 TD given instead of TDAP
342343 3/20/2009 OH 20 20 M 1/29/2009 TD given instead of TDAP
342344 3/20/2009 OH 31 31 F 1/28/2009 TD given instead of TDAP
342345 3/20/2009 OH 38 38 M 1/29/2009 TD given instead of TDAP
342346 3/20/2009 OH 51 51 M 1/29/2009 TD given instead of TDAP.
342347 3/20/2009 OH 0 0 0F 1/29/2009 TD given instead of TDAP.
342348 3/20/2009 OH 26 26 F 1/28/2009 TD given instead of TDAP.
342349 3/20/2009 AL 4 4 F 3/20/2009 Urticaria = Legs and arms. No other
342350 3/20/2009 FL 43 43 M 3/20/2009 Swelling @ site of injection. Post 12
342323 3/21/2009 VA 4 4 F 3/21/2009 My daughter had her 4yr old injectio
342324 3/21/2009 SC 16 16 F 3/21/2009 Shortly after first shot, daughter star
342325 3/21/2009 AL 1.3 1 0.3 M 3/21/2009 Sudden onset of fever accompanied
342326 3/21/2009 ID 74 74 F 3/21/2009 TDAP ADMINISTERED (L) DELTOI
342327 3/21/2009 NY 34 34 M 3/21/2009 In 2002 patient started to loose mus
342328 3/21/2009 CT 58 58 F 3/21/2009 Patient received both a pneumovax
342329 3/21/2009 TN 0 0 0M 3/21/2009 We left the clinic and within 1-2 hou
342330 3/22/2009 CA 1.8 1 0.8 M 3/22/2009 This previously healthy 22-month-ol
342331 3/22/2009 CO 1 1 0M 3/22/2009 Complex febrile seizure (15-20 min
342365 3/23/2009 F 3/20/2009 InformationYhas been received from
342366 3/23/2009 47 F 3/20/2009 InformationYhas been received form
342373 3/23/2009 TN U 3/19/2009 Initial report received 09 March 200
342374 3/23/2009 MS 17 17 M 3/19/2009 This case was received from a heal
342375 3/23/2009 0.7 F 3/19/2009 Initial report received on 17 March 2
342385 3/23/2009 FL 1.3 1 0.3 M 3/20/2009 Information has been received from
342393 3/23/2009 NY 10 10 F 3/23/2009 Possible vaccine
Y failure. Child expir
342394 3/23/2009 VT 5 5 M 3/9/2008 7x7 cm local swollen, red , warm on
342395 3/23/2009 PA 12 12 M 3/19/2009 3 inch area of erythema, fever to 10
342396 3/23/2009 ME 63 63 M 2/26/2009 Vaccines given 2/23/09. Patient mo
342397 3/23/2009 CT 14 14 F 3/19/2009 On 3/12/09 Pt presented here with v
342398 3/23/2009 GA 1.1 1 0.1 F 3/16/2009 Red maculopapules x 3 clustered o
342400 3/23/2009 FL 0.6 0 0.6 F 3/16/2009 Febrile seizure seen at Hospital on
342416 3/23/2009 NC 27 27 M 3/10/2009 Pt developed rash approx 10 days p
342417 3/23/2009 TN 4 4 M 3/13/2009 Left thigh red, hot and swollen x 6 d
342418 3/23/2009 CA 51 F 3/1/2009 Induration and tenderness at injectio
342420 3/23/2009 PA 14 14 F 3/23/2009 On 12/17/08 patient presented as a
342421 3/23/2009 MN 14 14 F 3/23/2009 Patient fainted and hit her head, app
342422 3/23/2009 NJ 70 70 F 3/20/2009 Zoster
342423 3/23/2009 10 M 3/20/2009 Local erythema with superficial swe
342424 3/23/2009 MA 62 62 F 3/23/2009 Pt developed papulovesicular lesion
342425 3/23/2009 GA 33 33 F 3/23/2009 C/o fall with knee pain on 11-19-08
342455 3/23/2009 24 24 F 3/23/2009 Unspecified disease of pericardium
342456 3/23/2009 ME 67 67 F 3/23/2009 1 inch red raised area at injection si
342457 3/23/2009 23 23 M 3/23/2009 Non-specific myocarditis
342458 3/23/2009 22 22 M 3/23/2009 Acute pericarditis, unspecified
342459 3/23/2009 26 26 M 3/23/2009 Acute pericarditis, unspecified; Unsp
342460 3/23/2009 NY 30 30 F 3/23/2009 supraventricular tachycardia, dizzine
342461 3/23/2009 OK 5 5 F 3/23/2009 Pediarix given IM to LD and MMR g
342462 3/23/2009 NY 37 37 M 3/23/2009 member presented for follow up afte
342463 3/23/2009 MT 64 64 M 3/23/2009 Patient received the zoster vaccine
342464 3/23/2009 VA 48 48 F 3/23/2009 Rabies vaccine was given on 3-6-09
342465 3/23/2009 IN 75 75 F 3/23/2009 ON 3/20/09 BROKE OUT WITH 3-4
342466 3/23/2009 TX 29 29 F 3/23/2009 RIGHT ARM SWOLLEN FROM SH
342467 3/23/2009 MD 60 60 F 3/23/2009 The patient received the Tdap immu
342468 3/23/2009 TX 46 46 M 1/23/2009 LEFT ARM RED & SWOLLEN FRO
342469 3/23/2009 IL 4 4 F 3/23/2009 On 3/20/09, approximately 24 hours
342470 3/23/2009 26 26 M 3/23/2009 Pt. developed his initial symptoms o
342471 3/23/2009 OK 18 18 F 3/23/2009 Syncope immediately following injec
342472 3/23/2009 PA 1 1 0F 3/23/2009 One day post vaccine patient develo
342473 3/23/2009 NC 61 61 M 3/23/2009 2/12/09 - Shingles Vaccine and Teta
342474 3/23/2009 CA 39 39 F 3/23/2009 Neurologic symptoms started in my
342475 3/23/2009 CT 16 16 F 3/23/2009 Less then 24 hours after Meningoco
342478 3/23/2009 CA 1 1 0M 3/23/2009 Varicella - like exanthem 20 days po
342479 3/23/2009 NM 8 8 F 3/3/2009 Varicella rash 2 weeks after admin o
342480 3/23/2009 CA 15 15 F 3/23/2009 Gave Pt MMR on 2-2-09. Paperwor
342481 3/23/2009 NC 11 11 F 3/23/2009 Left arm swollen, red, hot to touch f
342482 3/23/2009 NV 5 5 M 3/20/2009 Walked out of exam room after vacc
342483 3/23/2009 MT 23 23 F 3/19/2009 Soreness in arm for over a month -
342484 3/23/2009 AZ 4 4 M 3/23/2009 (L) upper arm cellulitis Deltoid area.
342485 3/23/2009 CA 1.3 1 0.3 F 3/23/2009 About 7 days after receiving VARIV
342486 3/23/2009 CA 9 9 F 3/20/2009 Patient developed hives 2 dys after
342487 3/23/2009 NC 0.6 0 0.6 M 3/23/2009 Fever > 100 x 2 days. Rash x3 days
342488 3/23/2009 MN 5 5 M 3/23/2009 10x8cm erythema on L thigh around
342489 3/23/2009 MA 37 37 F 3/23/2009 Date of injection 3/17/09 - 1st 8 hou
342476 3/24/2009 CA 10 M 3/24/2009 The must important efect was today
342477 3/24/2009 CA 0.2 0 0.6 M 3/24/2009 My son's upper left thigh started to s
342502 3/24/2009 NV 57 F 3/23/2009 Information has been received from
342506 3/24/2009 IL 0.3 0 0.3 M 3/24/2009 Two events of intussusception, each
342508 3/24/2009 PA 79 80 F 3/24/2009 Approximately 8 days after administ
342509 3/24/2009 SC 9 9 F 3/24/2009 Pt. was given varivax on 3/5/09. Wit
342510 3/24/2009 NC 11 11 F 3/24/2009 reddened area on right arm with a d
342511 3/24/2009 AL 32 32 F 3/24/2009 Came in clinic on 03/24/2009 c/o se
342512 3/24/2009 VA 5 5 F 3/24/2009 Cellulitis at injection site, redness, s
342514 3/24/2009 MI 0.2 0 0.2 M 3/24/2009 NO ADVERSE REACTIONS
342515 3/24/2009 IN 12 12 F 3/24/2009 child found on the floor due to faintin
342516 3/24/2009 OH 40 40 F 3/24/2009 MMR was given on 3/12/09. She st
342517 3/24/2009 GA 64 64 M 3/24/2009 right shoulder swollen & extremely s
342518 3/24/2009 NJ 6 6 F 3/24/2009 Patient developed left-sided neck pa
342519 3/24/2009 21 21 F 3/24/2009 Patient came to ER for 2nd injection
342520 3/24/2009 NC 14 14 F 3/24/2009 Patient received her first shot 5/24/0
342521 3/24/2009 IL 0.3 0 0.4 F 3/24/2009 Flatulence, vomiting, lack of appetit
342523 3/24/2009 CA 1 1 0M 3/17/2009 4 days after vaccine got vesicular ra
342524 3/24/2009 TX 4 4 M 3/19/2009 Thigh Red, Swollen, hot to touch - A
342525 3/24/2009 CT 5 5 M 3/17/2009 Within 24 hours entire upper arm wa
342526 3/24/2009 PA 1.3 1 0.3 F 3/13/2009 Developed rash 8 days after receivi
342527 3/24/2009 WA 4 4 F 3/19/2009 Erythema multiforme- Itchy red rash
342528 3/24/2009 AL 36 36 M 3/15/2009 C/o minor rash on arms & forehead
342529 3/24/2009 NV 0.3 0 0.3 F 3/16/2009 Non stop crying for 3 Hour for no re
342530 3/24/2009 OR 32 32 F 3/12/2009 Chills, Fatigue, itching, hands hard
342531 3/24/2009 OK 7 7 F 3/18/2009 3x3 induration with 2x2 redness in c
342532 3/24/2009 SC 67 67 F 3/20/2009 Sat. - site of injection was red and s
342533 3/24/2009 PA 4 4 F 3/17/2009 Temperature 104.2 within 12 hours
342536 3/24/2009 4 4 M 3/24/2009 This case was reported via a legal c
342537 3/24/2009 CO 56 56 M 3/18/2009 Tinnitus - continual ringing in left ea
342538 3/24/2009 TX 40 40 M 3/18/2009 I asked pt if he felt ok after I adminis
342539 3/24/2009 IA 4 4 F 3/18/2009 Thigh was red, warm + swollen, pai
342540 3/24/2009 FL 0.2 0 0.2 M 3/20/2009 Vaccine admin. 12/20/83, immediat
342541 3/24/2009 NC 14 14 F 3/16/2009 Mom reports fever started 3/14/09.
342542 3/24/2009 PA 6 6 F 3/24/2009 Seizure 13 days post VARIVAX. Se
342543 3/24/2009 MD 18 18 F 3/24/2009 GARDASIL given 3/17/2009. Patien
342544 3/24/2009 NY 4 4 M 3/24/2009 Right upper arm completely swollen
342545 3/24/2009 WA 1.7 1 0.7 M 3/23/2009 24 hours after shots given, swelling
342546 3/24/2009 MA 17 17 M 3/27/2009 24 hours after second dose of VARI
342547 3/24/2009 KY 39 39 F 2/25/2009 Swelling, redness and induration dis
342548 3/24/2009 CA 53 53 F 3/24/2009 I developed a 103 degrees fever for
342549 3/24/2009 CA 4 4 M 3/24/2009 Slightly edematous + erythematous
342550 3/24/2009 MI 11 11 F 2/24/2009 Patient c/o itchy hives on Left deltoi
342551 3/24/2009 ID 1.5 1 0.5 M 3/10/2009 24 hours post injection patient had l
342552 3/24/2009 PA 0.9 0 0.9 F 3/13/2009 No adverse reaction reported - *Chi
342553 3/24/2009 23 23 F 3/20/2009 My primary care physician informed
342554 3/24/2009 TX 44 44 F 3/16/2009 Broke out in hives on arm where inje
342555 3/24/2009 WA 54 54 F 3/16/2009 Friday 3-13-09 Body aches, fever, le
342556 3/24/2009 U None Stated
342557 3/24/2009 GA M None stated
342558 3/24/2009 NY 47 47 F 3/20/2009 Patient received TDAP & PNEUMO
342559 3/24/2009 AR 1 1 0M 2/24/2009 Patient diagnosed with chicken pox
342560 3/24/2009 PA 9 9 F 3/13/2009 After receiving MENACTRA, in proc
342561 3/24/2009 CA 69 69 F 3/17/2009 Facial and arm rash lasting several
342562 3/24/2009 AZ 15 15 F 3/19/2009 (D:) BP 102/60; P 60 - R-12;- Pt fee
342563 3/24/2009 CA 1.1 1 0.1 M 3/18/2009 3/13/09, fever 104.5, poor appetite,
342564 3/24/2009 1.1 1 0.1 M 3/20/2009 Non stated.
342565 3/24/2009 PA 13 13 F 3/19/2009 Redness, swelling (half dollar sized)
342566 3/24/2009 PA 1.6 1 0.6 M 3/11/2009 Received PENTACEL on 03/10/09.
342567 3/24/2009 NY 4 4 F 3/17/2009 Erythema and induration (L) deltoid
342568 3/24/2009 30 30 M 3/18/2009 None stated.
342569 3/24/2009 NC 13 13 F 3/17/2009 GARDASIL dose #3 1/27/09 2/17/09
342570 3/24/2009 PA 70 70 F 3/15/2009 Patient experienced a headache Tu
342571 3/24/2009 MI 0.4 0 0.4 U 3/17/2009 Varicella given before age 1 no side
342572 3/24/2009 PA 70 70 F 3/17/2009 Patient reported that injection site w
342573 3/24/2009 KS 29 29 M 3/15/2009 3 vaccines were given, the patient w
342574 3/24/2009 FL 0.2 0 0.2 M 3/16/2009 Mild swelling on legs. Slightly raised
342575 3/24/2009 IN 0.5 0 0.5 F 3/16/2009 Patient woke up the day after vaccin
342576 3/24/2009 MN 0.5 0 0.5 M 3/12/2009 Hives one day after vaccination.
342577 3/24/2009 NY 8 8 M 3/17/2009 Immediately after receiving HAV pa
342578 3/24/2009 PA 20 20 F 30 minutes after injection - hive 3x4
342579 3/24/2009 IN 5 5 M 3/17/2009 Pt given HEP A dose 2 in our office
342581 3/24/2009 IL 5 5 M 3/10/2009 Mother called office 2 hrs after vacc
342582 3/24/2009 VA 72 72 F 3/19/2009 Rash appeared on neck 1 week afte
342522 3/25/2009 WA 90 90 M 3/25/2009 Pt broke out in full body rash consis
342580 3/25/2009 TX 67 67 F 3/17/2009 3/17/09 Approx. 11:15am shingles v
342591 3/25/2009 FL 67 67 F 3/23/2009 Initial information was received on 2
342593 3/25/2009 OK 0.3 M 3/24/2009 Information has been received from
342600 3/25/2009 AR 59 59 F 4-20-07 - onset "bruising" dx: ITP. 4
342601 3/25/2009 NY 23 23 F 3/19/2009 Severe Nausea, vomiting, fever + jo
342602 3/25/2009 AR 4 4 M 2/26/2009 Mom noticed around 7:00 AM this m
342603 3/25/2009 AR 11 11 F 2/13/2009 Red-itchy-warm to touch-rash over e
342604 3/25/2009 AR 3 3 F ### Rec'd flu vacc 110708; presented to
342605 3/25/2009 NC 38 38 F 3/17/2009 None Stated
342606 3/25/2009 AL 54 54 F 3/10/2009 pain in (R) arm at inj site. redness, w
342607 3/25/2009 UT 23 23 M 3/16/2009 None stated
342652 3/25/2009 MO 16 16 F 3/19/2009 After vaccination, patient collapsed
342653 3/25/2009 GA 15 15 F 3/25/2009 Pt experienced vasovagal reaction w
342654 3/25/2009 MO 5 5 M 3/25/2009 Mother states client woke up from a
342655 3/25/2009 OH 13 13 F 3/25/2009 Approximately 4:00PM 12/7/08 Sym
342656 3/25/2009 NC 59 59 F 3/25/2009 59 yo BF presented to clinic 3/24/09
342657 3/25/2009 VA 33 33 F 3/25/2009 1. Severe pain/muscle locking appro
342658 3/25/2009 OR 65 65 F 3/25/2009 Hep B vaccine administered in Lt De
342659 3/25/2009 FL 29 29 M 3/25/2009 29 y/o AD male flyer w/ no significan
342660 3/25/2009 IN 5 5 M 3/25/2009 Mother noted a red, hot raised area
342661 3/25/2009 WY 4 4 F 3/25/2009 Reported by Mother of client on 3/2
342662 3/25/2009 TN 82 82 F 3/25/2009 Zostavax administered Jan 27th, 20
342663 3/25/2009 NJ 79 79 F 3/25/2009 Elevated Blood pressure, Face and
342664 3/25/2009 SD 8 8 F ### Left hand red, swelling and itching,
342665 3/25/2009 WA 37 37 M 3/25/2009 Arm redness, tightness in chest. S/s
342666 3/25/2009 CO 0.3 0 0.4 F 3/25/2009 no adverse reactions/symptoms. pa
342667 3/25/2009 CA 13 13 M 3/25/2009 Had 2 swollen lump area. One lump
342668 3/25/2009 MN 37 37 F 3/25/2009 erythematous vessicles at injection
342669 3/25/2009 CO 0.4 0 0.4 F 3/25/2009 Nurse gave first dose of Rotateq aft
342670 3/25/2009 UT 69 69 F 3/25/2009 I am submitting this report per patie
342671 3/25/2009 VA 52 52 F 3/25/2009 Itchy, hot rash broke out the night o
342682 3/25/2009 PA 11 11 F 3/25/2009 Localized erythema, plaque lesion;
342683 3/25/2009 NJ 11 11 M 3/18/2009 DV made by pt to show nurse react
342684 3/25/2009 TX 15 15 F 3/25/2009 L arm red and swollen all around ba
342685 3/25/2009 PA 25 25 F 3/25/2009 Swelling of throat with difficulty swa
342686 3/25/2009 MN 36 36 F 3/25/2009 3-20-09: Tdap left deltoid, 3-22-09:
342687 3/25/2009 CA 17 F 2/27/2009 Pt was waiting in line about 15 minu
342688 3/25/2009 PA 70 70 M 3/25/2009 No reaction reported yet. Misadmin
342689 3/25/2009 NH 6 6 M 3/25/2009 Developed Acute L arm swelling + r
342690 3/25/2009 KS 12 M 3/24/2009 Vomiting Thurs. night Temp 105 Fri
342691 3/25/2009 CT 33 33 U Pt reported a fever 103-104 F on Sa
342692 3/25/2009 FL 11 11 M 3/25/2009 My son right after getting vaccines s
342697 3/26/2009 OH 1 M 3/25/2009 Information has been received from
342715 3/26/2009 GA 8 M 3/24/2009 This case was received via an autho
342730 3/26/2009 NY 18 18 F 3/23/2009 Headache, vomiting approximately 3
342731 3/26/2009 KY 67 67 M 3/13/2009 Severe pain - whole body - muscles
342732 3/26/2009 IL 0.3 0 0.3 M 3/20/2009 Pt administered PENTACEL, PREV
342733 3/26/2009 CA 12 12 M 3/23/2009 MENACTRA given left upper arm 3/
342734 3/26/2009 CA 43 43 F 3/18/2009 Redness and swelling
342735 3/26/2009 IL 40 40 F 3/23/2009 Had some significant pain in arm at
342736 3/26/2009 VA 6 6 F 3/24/2009 rash - scattered papules -> Probabl
342738 3/26/2009 KY 60 60 M 3/12/2009 1) Swollen, red circle about 4" in dia
342739 3/26/2009 MA 11 F 3/23/2009 Given 11 yr old immunizations on 3/
342740 3/26/2009 AZ 65 65 F 3/23/2009 Swelling, Red rash size, 2 " in diam
342741 3/26/2009 TX 40 40 M 3/20/2009 None stated.
342742 3/26/2009 UT 4 4 M 3/18/2009 Polio vaccine given March 12 3:00 p
342743 3/26/2009 TX 1.9 1 0.9 F Urticaria at injection site noted after
342744 3/26/2009 RI 1.5 1 0.5 F 3/20/2009 Febrile seizure-no treatment
342745 3/26/2009 29 29 M 3/23/2009 A 31 year old male subject presente
342746 3/26/2009 10 10 M 3/21/2009 Patient received varicella vaccine at
342747 3/26/2009 IN 2 2 0.5 M 3/22/2009 4 days after vaccine, he ran a fever
342748 3/26/2009 TX 9 9 F 3/20/2009 Chicken pox #2 given on 3/17/09 an
342749 3/26/2009 TX 1.9 1 0.9 F 3/21/2009 Urticaria at injection site noted after
342750 3/26/2009 WI 8 8 F 3/20/2009 Received immunization on 3/12/09.
342751 3/26/2009 VA 4 4 F 3/19/2009 Redness & swelling at injection site.
342752 3/26/2009 23 23 M 3/26/2009 Redness, itching, swelling, fever at
342753 3/26/2009 U Redness, itching, swelling and feve
342758 3/26/2009 MN 19 19 F 3/13/2009 Information has been received throu
342770 3/26/2009 IN 11 11 F 3/26/2009 c/o numbness, tingling, tightness rig
342771 3/26/2009 VA 43 43 M 3/26/2009 Patient received Tdap (Adacel) on 3
342772 3/26/2009 AK 1 0 0.1 M 3/26/2009 HE BEGAN TO HAVE SEIZURES A
342773 3/26/2009 PA 43 43 M 3/26/2009 Patient received vaccine and report
342774 3/26/2009 TX 28 28 F 3/26/2009 Itching began about 2 hours after re
342775 3/26/2009 19 19 F 3/26/2009 She came in for labs and for a Gard
342776 3/26/2009 LA 5 5 F 3/26/2009 SEIZURE LASTING APPROX. 3 MI
342777 3/26/2009 LA 7 7 F 3/26/2009 30 minutes post administration of V
342778 3/26/2009 VA 27 28 M 3/26/2009 Client received second dose of pre-
342779 3/26/2009 MD 46 F 3/26/2009 Arm warm, very edematous, erythm
342780 3/26/2009 DE 0.3 0 0.2 F 3/20/2009 Unconsolable crying for more than 3
342781 3/26/2009 VA 52 52 F 3/25/2009 After receiving vaccine patient beca
342782 3/26/2009 OH 34 34 F 3/26/2009 Received second dose in series of H
342783 3/26/2009 TX 0.5 0 0.6 M 3/26/2009 INTERFERENCE WITH LIMB MOV
342784 3/26/2009 WI 11 11 M 3/26/2009 Outer aspect of left arm at Varicella
342785 3/26/2009 AZ 13 13 M 3/26/2009 Patient received his Tdap vaccine fi
342786 3/26/2009 WA 0.2 0 0.2 F 3/26/2009 Fever to 103, nausea, vomiting app
342787 3/26/2009 NJ 22 23 F 3/26/2009 Immediate weakness, lethargic, mu
342788 3/26/2009 WA 0.2 0 0.2 F 3/26/2009 Pneumovax was ordered and admin
342791 3/26/2009 PA 43 43 F 3/26/2009 This case was reported via medical
342792 3/26/2009 51 51 M 3/26/2009 This case was reported by a lawyer
342795 3/26/2009 MA 66 66 M 3/16/2009 12/2/08 S&S inc. numbness/tingling
342796 3/26/2009 KY 4 4 M 3/26/2009 Pt.'s mother called 2 days after imm
342797 3/26/2009 PA 49 49 F 3/25/2009 Within 10min of getting the shot, pt
342798 3/26/2009 OR 1.6 1 0.6 M 3/17/2009 Mom reports about 14 hours after s
342799 3/26/2009 VT 1 1 0F 3/26/2009 Mom calling today to report that on
342800 3/26/2009 WA 1.9 1 0.9 M 3/26/2009 Fever ; Febrile Seizure
342801 3/26/2009 WA 42 42 M 3/26/2009 Exaggerated local reaction.
342802 3/26/2009 CA 5 5 M 3/27/2009 Redness with swelling to R deltoid.
342803 3/26/2009 CA 15 15 F 3/26/2009 High fever, achy all over body and n
342804 3/26/2009 CA 12 12 M 3/25/2009 Itch. redness. induration pain. Since
342805 3/26/2009 CA 60 60 F 3/26/2009 Rash on chest 3 days after adminis
342806 3/26/2009 PA 5 5 M 3/26/2009 Redness, swelling and warm to touc
342807 3/26/2009 CA 21 21 M 3/26/2009 Pt states felt woozy approx 5pm afte
342808 3/26/2009 NC 45 45 F 3/26/2009 1 day after injection - Pt c/o rash, sw
342809 3/26/2009 AL 25 25 F 3/26/2009 Local Rx, delayed. Redness, warmt
342810 3/26/2009 MI 36 36 F 3/26/2009 Localized swelling and pain after sh
342811 3/26/2009 PA 0.2 0 0.2 M 3/23/2009 ROTARIX was reconstituted with ste
342812 3/26/2009 FL 4 4 F 1/9/2009 Large, red inflammatory reaction, rig
342813 3/26/2009 MI 7 7 M 3/26/2009 Rash on the left upper arm 2cm/3cm
342814 3/26/2009 NE 1.1 1 0.1 M 3/19/2009 Redness + minimal swelling @ site.
342815 3/26/2009 MA 45 45 M 3/25/2009 Pain in upper right arm and neck an
342816 3/26/2009 NY 28 28 F 3/26/2009 Pt received Tdap + Typhoid 3/9/09 f
342817 3/26/2009 OR 1.3 1 0.3 F 3/25/2009 Developed 8x15cm local erythema,
342818 3/26/2009 U Pt showed up to ER 2/27/09 after re
342789 3/27/2009 30 30 M 3/27/2009 Joint pain and fevers.
342790 3/27/2009 CA 24 24 F 3/27/2009 Achy feeling all over started and he
342820 3/27/2009 HI 23 F 3/26/2009 Information has been received from
342824 3/27/2009 4 M 3/26/2009 Information has been received rega
342825 3/27/2009 LA 11 11 M 3/16/2009 Parent stated that right arm was sw
342832 3/27/2009 LA 0.7 0 0.7 F 3/19/2009 Patient was accidentally administere
342833 3/27/2009 PA 1 1 0F 3/24/2009 Mild fever, fussiness and swollen gl
342834 3/27/2009 WA 28 28 F 3/24/2009 Diaphoresis and lightheadedness sh
342835 3/27/2009 NC 12 12 F 3/23/2009 1 wk. after pt. received vaccine she
342836 3/27/2009 WA 25 25 F 3/18/2009 Rash on back, chest, abdomen with
342837 3/27/2009 IA 2 2 0.8 M 3/23/2009 Two days after receiving immunizat
342838 3/27/2009 IA 4 4 F 3/23/2009 Arm swelling & redness at injection
342839 3/27/2009 GA 18 18 M 3/24/2009 Pt was given Tripedia U2397BA ins
342840 3/27/2009 GA 14 14 F 3/24/2009 Pt was given Tripedia U2397BA ins
342841 3/27/2009 GA 13 13 F 3/24/2009 No adverse problem- Pt was given D
342842 3/27/2009 TX 1.3 1 0.3 M 3/23/2009 As per mom left thigh red, hot and s
342843 3/27/2009 TX 7 7 F 3/23/2009 As per mom left upper arm with eryt
342845 3/27/2009 VA 39 39 F 3/27/2009 Developed headache within 2-3 hou
342846 3/27/2009 MN 58 58 M 3/27/2009 DURING LATTER PART OF FEBRU
342847 3/27/2009 AZ 8 8 F 3/27/2009 NOT CLASSIC LESIONS, BUT HAS
342848 3/27/2009 NY 22 22 F 3/27/2009 Headaches and Fatigue increasing
342849 3/27/2009 AK 31 31 F 3/27/2009 Pt came in to have TB test read 3/1
342850 3/27/2009 CA 4 4 F 3/27/2009 VACCINES ADMINISTERED IN AM
342851 3/27/2009 TX 64 64 M 3/27/2009 64HM h/o DM, HTN, HLD, BPH p/w
342852 3/27/2009 AZ 64 64 F 3/27/2009 ITCHING,PAIN LEFT SHOULDER S
342853 3/27/2009 NC 84 84 F 3/27/2009 She received vaccine on Fri. She d
342854 3/27/2009 AL 1 1 0M 3/27/2009 On March 3rd 2009 my son recieved
342855 3/27/2009 MD 30 30 M 3/27/2009 Persisting headache from day after
342856 3/27/2009 MI 1 1 0F 3/27/2009 child presented to er on 3-20-09 wit
342858 3/27/2009 TX 2 2 0M 3/27/2009 2 y/o male. After receiving Hepatitis
342859 3/27/2009 MI 66 66 F 3/27/2009 Left arm and shoulder very sore, sw
342860 3/27/2009 MI 55 55 F 3/27/2009 site became red, inflamed, sore, pa
342861 3/27/2009 TX 4 4 M 3/27/2009 Child was inoculated with 6 separat
342862 3/27/2009 CO 0.3 0 0.3 M 3/27/2009 a rash that started at the site of the
342863 3/27/2009 KY 0.2 0 0.2 F 3/27/2009 Day after shot was given, her legs s
342884 3/27/2009 MO 4 4 M 3/27/2009 Redness & induration on left arm m
342888 3/27/2009 IA 17 17 F 3/25/2009 High fever, injection site pain, redne
342890 3/27/2009 58 F 3/27/2009 We received the following from a co
342891 3/27/2009 AZ F 3/26/2009 Vaccinated with 2 doses of 2 month
342892 3/27/2009 IA 1.3 1 0.3 M 3/27/2009 Lump Rt thigh and red area both siz
342893 3/27/2009 MO 1.1 -1 0.2 M 3/27/2009 Developed raised blister like lesions
342894 3/27/2009 CA 0.2 0 0.2 M 3/27/2009 Fever 103F at 11 PM, following imm
342895 3/27/2009 CA 5 5 F 3/27/2009 Left leg swollen @ injection site with
342896 3/27/2009 ID 4 4 M 3/27/2009 Left upper leg with large warm eryth
342897 3/27/2009 SC 54 54 F 3/27/2009 Left shoulder joint pain with occasio
342898 3/27/2009 CA 58 58 F 3/26/2009 Redness and swelling at injection si
342899 3/27/2009 MT 24 24 F 3/27/2009 Client received IMOVAX IM on 3/26
342900 3/27/2009 CA 5 5 M 3/23/2009 Large area of swelling & redness in
342901 3/27/2009 NE 4 4 F 3/24/2009 Gave patient BOOSTRIX instead of
342902 3/27/2009 CA 12 F 3/27/2009 10 days after GARDASIL (#2) Pt de
342903 3/27/2009 NC 67 67 F 3/27/2009 Dizziness, nausea, sweating - soon
342904 3/27/2009 MT 11 11 F 3/27/2009 Local reaction - redness and indura
342905 3/27/2009 WA 0.3 0 0.3 M 3/28/2009 Seen 3/27/09 for "diffuse maculo - p
342906 3/27/2009 VT 4 4 F 3/25/2009 2 hrs after MMR began screaming,
342907 3/27/2009 CA 4 4 M Parent brought patient in stated tha
342908 3/27/2009 GA 30 30 F Client c/o tingly warm feeling in L fin
342909 3/27/2009 VA 60 60 F 3/27/2009 Swelling at injection site, redness an
342910 3/27/2009 VA 73 73 M 3/27/2009 None
342911 3/27/2009 NJ 0.2 0 0.2 M 3/27/2009 Fever > 102, irritable. S/S started pm
342912 3/27/2009 NH 11 11 F 3/26/2009 Pt received HPV (GARDASIL) #2 in
342913 3/27/2009 CA 1.3 1 0.3 M Rash; Fever.
342914 3/27/2009 VA 67 67 F 3/27/2009 Swelling at injection site, redness an
342915 3/27/2009 MI 1.3 1 0.3 F 3/26/2009 TDAP was given but it was suppose
342916 3/27/2009 TX 15 15 F 3/27/2009 Dizziness, nausea, headache, slurre
342917 3/27/2009 VA 47 47 F 3/25/2009 Reported receipt of FLUSHIELD Lo
342918 3/27/2009 56 56 M 3/26/2009 The patient reported receipt of IM in
342864 3/28/2009 TX 1.6 1 0.7 F 3/28/2009 1 Hour after injections, raised, red a
342865 3/28/2009 MI 15 15 F 3/28/2009 FELT DIZZY AND LIGHTHEADED,
342866 3/28/2009 OH 1 1 0M 3/28/2009 2/24/09REPORTED TO PEDIATRIC
342868 3/28/2009 NY 4 4 M 3/28/2009 Received Flu vaccine on 3/12/09. H
342869 3/28/2009 CA 12 12 F 3/28/2009 Pt got vaccinated with MCV4 (MENA
342870 3/28/2009 NC 67 66 F 3/28/2009 Moderate to severe hives, relieved b
342871 3/28/2009 NC 69 69 M 3/28/2009 Severe hives on ankles and lower le
342872 3/28/2009 OH 18 18 M 3/28/2009 8/08-High fever-102, chills, body ac
342873 3/29/2009 AR 56 56 F 3/29/2009 Hard,painful, hot to the touch, egg s
342874 3/29/2009 KY 0.4 0 0.4 F 3/29/2009 Patient received shots Dec. 29th, se
342875 3/30/2009 WA 1 1 0M 3/30/2009 Fever of 103.5 at 0130 in the AM on
342921 3/30/2009 TN 73 73 F 3/26/2009 Initial report received from a health
342922 3/30/2009 M 3/25/2009 Initial report received on 19 March 2
342924 3/30/2009 F 3/25/2009 Initial report received on 19 March 2
342927 3/30/2009 ID 35 35 F 3/27/2009 Cellulitis R upper arm injection site.
342928 3/30/2009 NC 4 4 F 3/27/2009 Right leg thigh red and swollen over
342929 3/30/2009 TX 1 1 0F 3/26/2009 Vaccinated 3/9/09 - on 3/14/09 moth
342930 3/30/2009 KY 12 12 F 3/24/2009 Mother brought patient to the clinic
342931 3/30/2009 CA 4 4 M 3/5/2009 Redness and swelling LUD. Warm
342932 3/30/2009 CT 11 11 M 3/25/2009 Redness & swelling on arm - right s
342933 3/30/2009 WV 63 63 M 3/26/2009 Fever (102 degrees) multiple muscl
342934 3/30/2009 MO 61 61 F 3/23/2009 Patient called 2 days after vaccine t
342935 3/30/2009 OH 11 11 F 3/4/2009 Site reaction, large area of redness
342936 3/30/2009 MO 14 14 F 3/20/2009 Morning after immunizations, child h
342937 3/30/2009 MN 35 35 F 3/24/2009 Initial information was received from
342938 3/30/2009 TX 0.3 0 0.3 F 3/27/2009 This case was received on 23 Marc
342942 3/30/2009 NJ M 3/27/2009 Information has been received from
342949 3/30/2009 MO 76 76 F 3/20/2009 C/o chest pain radiating from back t
342952 3/30/2009 WA 1.1 1 0.1 M 3/24/2009 Pt given 12mo shots on 3/9/09. Ha
342954 3/30/2009 NC 15 15 F 3/23/2009 Awakened with joint pain, & nausea
342955 3/30/2009 TX 0.2 0 0.2 F Received 1st immunizations 3/13/09
342956 3/30/2009 GA 11 11 F 3/5/2009 Pt's mom reports today that child is
342957 3/30/2009 GA 2 2 0M 3/4/2009 Fever, rash and hair loss.
342958 3/30/2009 GA 60 60 F 2/17/2009 Received ZOSTAVAX 2-2-09, then
342959 3/30/2009 GA 4 4 M ### Broke out with red patches and sma
342960 3/30/2009 GA 1.2 1 0.2 F 3/18/2009 Mother brought child back to Health
342961 3/30/2009 GA 17 17 M 3/17/2009 Vaccines received 3/16/09 5pm, Mo
342962 3/30/2009 GA 70 70 M 2/19/2009 Developed redness, swelling, pain a
342972 3/30/2009 UT 5 5 M 3/30/2009 Urticarial type rash on legs and arm
342973 3/30/2009 NE 66 66 F 03/24/09 Sore + tender - Hurt with m
342974 3/30/2009 CA 4 4 F 3/12/2009 7.5 cm x 11.3 w. with redness, warm
342975 3/30/2009 MI 6 6 F 3/3/2009 Patient was given a second dose of
342976 3/30/2009 AL 60 60 F 3/23/2009 3/9/09, tingling in jaw and lips, very
342977 3/30/2009 MA 24 24 F 3/26/2009 Tingling and numb feeling in legs, it
342993 3/30/2009 MI 18 18 M 3/30/2009 Client was given a Tdap on 03/24/2
342994 3/30/2009 MA 3 3 M 3/30/2009 CHILD WAS GIVEN HIB AND PCV7
342995 3/30/2009 FL 12 12 F 3/30/2009 swelling of injection site, low-grade
342996 3/30/2009 VA 62 62 M 3/30/2009 Comes to clinic as walk-in with c/o n
342997 3/30/2009 AZ 50 50 F 3/30/2009 Soreness and bruising noted at inje
342998 3/30/2009 OK 18 18 F 3/30/2009 Clients mother call to Health Depart
342999 3/30/2009 DC 61 61 F 3/30/2009 THE DAY AFTER RECEIVING THE
343000 3/30/2009 CA 54 54 F 3/30/2009 03/26/09 swelling began left arm. 03
343001 3/30/2009 VA 53 53 F 3/30/2009 Infjection on Thursday, March 26, 2
343002 3/30/2009 MO 60 60 F 3/30/2009 Chills, full and deep bone & body ac
343003 3/30/2009 MA 65 65 F 3/30/2009 First day: Very fatigued, with severe
343005 3/30/2009 VA 62 62 F 3/30/2009 Patient claims "huge" bruise near el
343006 3/30/2009 TX 39 39 F 3/30/2009 With receipt of AVA # 1, TYPHOID,
343007 3/30/2009 NM 4 4 M 3/19/2009 Right thigh with significant swelling,
343008 3/30/2009 UT 4 4 F 3/30/2009 Patient was given MMR and Varicel
343009 3/30/2009 CA 0.1 0 0.1 F Crying for about 3 hours, didn't wan
343010 3/30/2009 WI 60 60 M 3/30/2009 Tdap injection 3/18/09 left deltoid, 3
343011 3/30/2009 PA 41 F 3/30/2009 Urticarial reaction at injection site 4
343012 3/30/2009 IL 1 1 0M 3/10/2009 Patient fell over forward while sitting
343013 3/30/2009 GA 63 63 M 3/30/2009 Vaccine was given Mon 3/23/09 abo
343014 3/30/2009 NM 9 9 F 3/30/2009 Patient had redness, swelling and p
343015 3/30/2009 AR 10 10 F 3/30/2009 Rash outbreak - vaccinated 3/5/09.
343016 3/30/2009 CT 39 39 F 3/18/2009 Vaccine, associated Varicella rash.
343017 3/30/2009 NC 65 65 F 3/30/2009 Injection site reaction. Sore with in 1
343018 3/30/2009 MI 0.7 0 0.7 M 3/30/2009 Rota given at 32 weeks and 10 day
343019 3/30/2009 NC 5 5 F 3/30/2009 Right thigh swollen, red, warm to tou
343020 3/30/2009 CA F 3/26/2009 Patient got shingles around 3 days
343021 3/30/2009 MI 20 20 F 3/30/2009 Adult patient received a pediatric do
343024 3/31/2009 CA 70 70 M 3/30/2009 Information has been received from
343031 3/31/2009 NE 0.5 0 0.5 F 3/30/2009 Information has been received from
343033 3/31/2009 MD 1.6 1 0.6 M 3/30/2009 Information has been received from
343043 3/31/2009 1.4 M 3/27/2009 Initial report received on 17 March 2
343047 3/31/2009 NE M 3/27/2009 This serious case was received on 2
343049 3/31/2009 NJ 3 3 F 3/30/2009 Caretaker states pain, erythema, an
343050 3/31/2009 OK 44 44 M 3/24/2009 Signs of bruising and petechiae in A
343051 3/31/2009 MS 36 36 M 3/27/2009 Developed chest pain, SOB and dia
343052 3/31/2009 CA 11 11 M 3/31/2009 Left deltoid 13 1/2 x 12 cm reddene
343053 3/31/2009 KY 4 4 M 3/31/2009 Localized reaction, red, warm to tou
343054 3/31/2009 AZ 4 4 F 3/30/2009 L arm Swelling With mild erythema.
343055 3/31/2009 WA 26 26 F 3/31/2009 Patient had a hot, red, swollen lump
343056 3/31/2009 ME 1.1 1 0.1 F 3/25/2009 Red ring around injection site. Low
343057 3/31/2009 KS 48 48 F 1/23/2009 Right after injection I got very hot an
343060 3/31/2009 CA 0.3 0 0.3 M 3/26/2009 Developed rash on Both anterior thi
343061 3/31/2009 WA 45 45 F 3/24/2009 Right arm pain, swelling radiating up
343062 3/31/2009 MA 6 6 F 3/25/2009 None as of this date.
343063 3/31/2009 OK 11 11 F 3/25/2009 Approximately 48 hours after admin
343064 3/31/2009 MI 25 25 F 3/27/2009 No adverse event, dose given 3 we
343065 3/31/2009 MI 65 65 F 3/25/2009 Developed low grade fever, arthralg
343066 3/31/2009 AZ 11 11 F 3/23/2009 Redness, swelling and hot touch.
343067 3/31/2009 OH 1 1 0M 3/25/2009 Presented in ED 3/11/09 with possib
343068 3/31/2009 IN 61 61 F 3/25/2009 Local reaction of pain, warmth, + er
343069 3/31/2009 CA 4 4 M 3/19/2009 Whole left arm red and swelling.
343071 3/31/2009 UT 11 11 M 3/26/2009 Red, swollen arm, bump, raised and
343072 3/31/2009 CO 5 5 F 3/27/2009 Redness, swelling of left arm. 48 hrs
343073 3/31/2009 IL 78 78 F 11/24/08 - Office visit - Dr. - Shingle
343074 3/31/2009 MA 63 63 F 3/30/2009 3-18-09 3:40p seen for erythema 3.
343075 3/31/2009 OH 4 4 M 3/30/2009 4 yr old male received DTAP, MMR
343076 3/31/2009 TX 66 66 M 3/31/2009 Redness, hard knot. No fever or chi
343077 3/31/2009 TX 49 49 F 3/31/2009 Cellulitis to left arm. Running tempe
343078 3/31/2009 TN 2 2 0.1 M 3/26/2009 Right leg at injection site was warm
343079 3/31/2009 WA 5 5 F 3/26/2009 Chicken Pox.
343080 3/31/2009 MI 1.9 1 0.9 M 3/26/2009 Phone call from mom got Imms (HIB
343081 3/31/2009 MO 32 32 F 3/25/2009 Approximately 15 minutes after rece
343083 3/31/2009 MO 22 22 F 3/25/2009 HEP B vaccine administration on 3-
343084 3/31/2009 1.6 1 0.6 F 3/23/2009 Patient was given adult dosage of H
343085 3/31/2009 NV 23 23 M 3/24/2009 23 y/o male with generalized mildly
343086 3/31/2009 TX 51 M 3/23/2009 Non stated
343087 3/31/2009 VT 53 53 U Diarrhea for 12 hours
343088 3/31/2009 PA 1.6 1 0.6 M 3/25/2009 Patient returned to office 3-23-09, a
343109 3/31/2009 MN 53 53 M 3/31/2009 Patient received Pneumovax 23 vac
343110 3/31/2009 MA 50 50 F 3/31/2009 Pain, warmth and induraton at vacc
343111 3/31/2009 NJ 1.5 1 0.5 M 3/31/2009 received IPOL on 3/27/09 and deve
343112 3/31/2009 AZ 18 18 F 3/31/2009 After administration of GPV, patiien
343113 3/31/2009 CA 0.8 0 0.8 F 3/31/2009 Pt was noted to have a thigh mass o
343114 3/31/2009 CA 26 26 F 3/31/2009 PATIENT CALL A DAY AFTER AND
343115 3/31/2009 IL 0.2 0 0.2 M 3/31/2009 On 3/27/09 Mom reports to IM clinic
343116 3/31/2009 FL 42 42 F 3/31/2009 Swollen arm after Tdap vaccine give
343117 3/31/2009 NY 0.7 0 0.7 M 3/31/2009 Patient had a tactile fever for 3 days
343118 3/31/2009 CO 13 13 F 3/31/2009 Client developed localized eythema
343119 3/31/2009 OK 1.3 1 0.4 M 3/31/2009 URTICARIA/HIVES- TREATMENT
343120 3/31/2009 CO 38 38 F 3/31/2009 The following was reported by the c
343121 3/31/2009 OR 11 11 F 3/31/2009 Fainted aprox 5 min after vaccinatio
343122 3/31/2009 CT 76 76 M 3/31/2009 - Pt called clinic and later seen on 3
343123 3/31/2009 GU 1.5 1 0.5 M 3/31/2009 High fever for three days (T. Max 10
343124 3/31/2009 SD 0.2 0 0.2 M 3/31/2009 On 1-4-09 patient
Y had Hep B Vaccin
343125 3/31/2009 AZ 46 46 M 3/31/2009 Symptoms began the same evening
343127 3/31/2009 WI 48 48 M 3/31/2009 1. Swelling warmth, redness injectio
343128 3/31/2009 TX 1.1 1 0.1 F 3/31/2009 Scattered erythema rash, primarily t
343129 3/31/2009 MA 1.3 1 0.3 M 3/31/2009 Dry, seal barky cough, hard time bre
343130 3/31/2009 VA 10 10 M 3/24/2009 Vaccine administered on 3-20-09 in
343131 3/31/2009 NY 61 F 3/30/2009 Patient c/o body ache, weakness, p
343132 3/31/2009 CA 1.6 1 0.6 F 3/26/2009 Lumps on thigh: No tx. Telephone a
343133 3/31/2009 MA 46 46 F 3/31/2009 Lump (bigger than a bean) tenderne
343134 3/31/2009 FL 4 4 M 3/31/2009 Err:508
343135 3/31/2009 CA 19 19 F 3/31/2009 Tingling around mouth with swelling
343136 3/31/2009 MN 0.5 0 0.5 F 3/30/2009 Approx 6 hrs after receiving 6mo va
343137 3/31/2009 MN 12 12 F 3/31/2009 1. 2 lesions on labia - lidocaine jelly
343138 3/31/2009 CA 1.1 1 0.1 F 3/31/2009 (1) Reactive nodule. No sign of infe
343139 3/31/2009 CA 12 12 F 3/31/2009 About 6 minutes after administering
343140 3/31/2009 CA 0.6 0 0.6 F Mother brought her daughter in @ 1
343141 3/31/2009 MT 11 11 M 3/31/2009 Large red spot, raised area, Lt uppe
343292 3/31/2009 PA U 3/26/2009 Nonspecific reaction, This case was
343126 4/1/2009 MN 15 15 F 3/31/2009 Upon injection, My daughter immed
343154 4/1/2009 NE 18 18 F 3/31/2009 Information and follow up has been
343181 4/1/2009 NJ 39 39 F Started having severe stabbing ach
343183 4/1/2009 MO 9 9 M 3/26/2009 5.5 X 2.5 Cm red, raised, hot area c
343184 4/1/2009 62 M 3/30/2009 Patient received PNEUMOVAX vac
343185 4/1/2009 MN 0.2 0 0.2 M 3/24/2009 Child developed ROTAVIRUS infec
343186 4/1/2009 UT 62 62 F 3/27/2009 Pt returned to clinic the day after rec
343220 4/1/2009 FL 4 4 M 4/1/2009 MMR was possible mixed with IPV f
343221 4/1/2009 TN 1.7 1 0.7 F 4/1/2009 3-31-09 Mom states light rash on fa
343222 4/1/2009 MT 70 74 M 3/31/2009 Has a red heavily speckled line or b
343237 4/1/2009 NC 14 14 F 4/1/2009 Client became dizzy after vaccinatio
343238 4/1/2009 TX 13 13 F 4/1/2009 several fevers a day, bad headache
343239 4/1/2009 TX 56 56 M 4/1/2009 Patient was given flu shot and pneu
343240 4/1/2009 WI 19 19 M 4/1/2009 Developed one-sided facial palsy w
343241 4/1/2009 NJ 1.6 1 0.6 F 4/1/2009 Child developed fever and had febri
343242 4/1/2009 TN 1.4 1 0.4 M 4/1/2009 Red macular rash over chest, abdom
343243 4/1/2009 NC U 4/1/2009 PATIENT LOST CONSCIOUSNESS
343244 4/1/2009 LA 63 63 F 4/1/2009 @ 24 hrs post-vaccine: egg-shaped
343245 4/1/2009 FL 22 22 M 4/1/2009 Yellow Fever vaccination given on 3
343246 4/1/2009 NC 13 14 F 4/1/2009 CLIENT BECAME DIZZY AFTER R
343247 4/1/2009 CA 13 13 F 4/1/2009 24 hours after varicella vaccine #2 d
343248 4/1/2009 OR 61 61 F 4/1/2009 AFEBRILE - REDDNESS AND ERY
343249 4/1/2009 MI 5 5 M 4/1/2009 Last PM temp up to 103 - today 102
343250 4/1/2009 GA 59 59 F 4/1/2009 Symptoms:Shortness of Breath, Ra
343251 4/1/2009 IL 1.3 1 0.3 M 4/1/2009 Gave Pediarix instead of DTaP. No
343253 4/1/2009 CA 4 4 F 4/1/2009 Returned to clinic one day after rece
343254 4/1/2009 TX 0.8 0 0.8 F 4/1/2009 Large Welts under skin, muscle feel
343255 4/1/2009 NE 0 0 0M 4/1/2009 My son received Influenza vaccine (
343256 4/1/2009 IL 83 83 F 4/1/2009 Patient reported redness for a few d
343257 4/1/2009 TX 16 16 F 4/1/2009 Gardasil shot was given. Pain start
343264 4/1/2009 AZ 2 2 0.3 F 3/19/2009 A serious, spontaneous report of se
343265 4/1/2009 AZ 18 18 F 3/27/2009 Pt was given GARDASIL vaccine w
343266 4/1/2009 NY 0.2 0 0.2 F 4/1/2009 Started to become fussy, crying - ha
343267 4/1/2009 18 F 4/1/2009 Rash.
343268 4/1/2009 IN 5 5 F 4/1/2009 Left thigh red.
343269 4/1/2009 CA 16 16 F 3/29/2009 Hot, red area @ injection site.
343270 4/1/2009 TX 41 F Started getting a rash of small red b
343271 4/1/2009 TX 26 26 F 4/1/2009 Pt reports woke up the morning afte
343272 4/1/2009 ID 66 66 F 4/1/2009 Severe pain, induration warmth at in
343273 4/1/2009 NY 0.2 0 0.2 F 4/1/2009 Pt given vaccines 10:30 am, began
343274 4/1/2009 NY 32 32 M 3/23/2009 2 hrs after immunization patient sha
343275 4/1/2009 WI 4 4 F 48-72 Hrs after VARIVAX develope
343306 4/2/2009 NC 23 M 3/30/2009 This serious case was received on 2
343307 4/2/2009 WV 74 M 4/2/2009 This is a 74yo, Male, came to ER w
343308 4/2/2009 CA 84 84 M Complete loss of control - 9-13-08. H
343309 4/2/2009 NY 0.9 0 0.9 F 4/1/2009 Acute disseminated encephalomyel
343311 4/2/2009 OH 1 1 0F 4/2/2009 generalized rash over trunk, face &
343313 4/2/2009 CA U L Leg 4 cm erythema and induration
343314 4/2/2009 NY 1 0 1M 3/30/2009 Patient developed fever up to 103.2
343315 4/2/2009 NJ 11 11 F 3/30/2009 105 fever 12 hours later. Headache
343316 4/2/2009 VA 41 41 M 2/9/2009 The moment needle was in right de
343317 4/2/2009 NC 17 17 F 3/25/2009 Injection about 15:40. Approximatel
343318 4/2/2009 CA 4 4 F 3/20/2009 Large area of redness and induratio
343319 4/2/2009 IA 0.2 0 0.2 F 3/25/2009 2 doses of PREVNAR were adminis
343320 4/2/2009 KS 18 18 F 3/29/2009 Fever, headache, neck soreness, vo
343321 4/2/2009 SC 12 12 M 4/2/2009 Malaise, poor appetite, nausea/vom
343322 4/2/2009 TX 1 1 0F 3/26/2009 Post vaccine hives for 15 min. Then
343323 4/2/2009 RI 1 1 0F 4/1/2009 fever of 101 degrees, rubbing @ he
343324 4/2/2009 RI 0.6 0 0.6 M 4/1/2009 @ 3 AM on 3/18/2009 pt. awoke wit
343326 4/2/2009 WY 31 31 F 3/27/2009 Received TDAP vaccine 3/19/09. D
343327 4/2/2009 PA 53 53 F 3/30/2009 Patient received Tdap on 3/23/09. C
343328 4/2/2009 MS 0.4 F 3/26/2009 None stated
343329 4/2/2009 TX 25 25 M 3/18/2009 A rash began to develop around the
343330 4/2/2009 TX 12 12 M 3/27/2009 Home visit B/P 106/60 Temp 98.4 P
343331 4/2/2009 PA 5 5 F 3/30/2009 VARIVAX breakthrough. Had 2 dos
343332 4/2/2009 AZ 14 14 F 3/19/2009 Patient turned pale a minute after re
343333 4/2/2009 TN 1.4 1 0.4 F 3/11/2009 Child developed diarrhea evening o
343334 4/2/2009 TN 63 63 F 3/18/2009 Received TdaP 3/16/09 Developed
343335 4/2/2009 TX 25 F 4/2/2009 Experienced tightness in throat 30 m
343336 4/2/2009 WV 70 M 4/1/2009 from pt. States he was in this office
343337 4/2/2009 TX 2 2 0M 4/2/2009 Fever 101-103.8 and diarrhea.
343338 4/2/2009 MO 48 48 M 4/2/2009 Patient states he felt some numbne
343339 4/2/2009 NY 37 M None stated
343340 4/2/2009 NY 23 23 F Facial palsy (R). Pt states a few hou
343341 4/2/2009 CA 4 4 M 4/1/2009 Large local swelling @ site of KINR
343342 4/2/2009 MA 15 15 F 4/2/2009 0.1 cm in diameter nodule, palpable
343343 4/2/2009 MN 31 31 F ### Severe total body itching for 1 1/2 m
343344 4/2/2009 IL 12 12 F 4/1/2009 After 2 h erythematous rash and sm
343346 4/2/2009 DE 4 4 M 4/2/2009 Right upper arm swollen, warm to to
343347 4/2/2009 OR 95 95 F 3/31/2009 Pt had a TETANUS shot a week ag
343348 4/2/2009 NY 16 16 F 4/2/2009 2/22/09 to 2/24/09 Fever by report f
343349 4/2/2009 NC 18 18 F 4/2/2009 CLIENT RECEIVED 7 VACCINES O
343352 4/2/2009 CO 64 64 F 3/9/2009 Soreness and erythema (~4 inches
343353 4/2/2009 CA 0.3 0 0.3 F 4/2/2009 Child was in office for a 6 month ph
343354 4/2/2009 FL 4 4 F 4/2/2009 On the evening of the shots, she de
343355 4/2/2009 MO 66 66 F 4/2/2009 Patient call on 4/2/09 stating that on
343357 4/2/2009 CO 59 59 M 4/2/2009 Had inner gluteal pain starting four d
343358 4/2/2009 WA 0.2 0 0.2 F 4/2/2009 Pt received a vaccination from an e
343359 4/2/2009 CO 59 59 M 4/2/2009 Took first oral typhoid capsule as di
343360 4/2/2009 CA 77 77 M 4/2/2009 Developed full blown Shingles appr
343361 4/2/2009 CA 1.1 1 0.1 F 4/2/2009 Child received subcutaneous injecti
343362 4/2/2009 CA 4 4 F 4/2/2009 GAVE 4TH PEDIARIX
343363 4/2/2009 AZ 4 4 M 4/2/2009 EDEMA AND ERYTHEMA TO RIGH
343364 4/2/2009 NM 65 65 F 4/2/2009 Patient started to notice hives on th
343365 4/2/2009 WA 32 32 M 4/2/2009 Minor local reaction at the left deltoi
343366 4/2/2009 IL 0.5 0 0.5 M 4/2/2009 He vomited about 5 hrs. after being
343367 4/2/2009 WA 0.2 0 0.2 M 4/2/2009 N/A
343368 4/2/2009 NE 11 11 F 4/2/2009 High fever of 106F, wheezing, uppe
343375 4/2/2009 SC 29 29 F 4/2/2009 This case was reported by a pharma
343377 4/2/2009 28 28 M 4/1/2009 While attending graduate school, th
343378 4/2/2009 MN 69 69 F 4/2/2009 Per pt had orange size lump/ swellin
343379 4/2/2009 MN 44 44 M 4/2/2009 None
343380 4/2/2009 MN 6 6 F 3/30/2009 About 2 1/2 inches red area with sw
343381 4/2/2009 TX 2 2 0.6 M 4/2/2009 Swelling red ball under skin @ injec
343382 4/2/2009 AR 11 11 F 4/2/2009 Nausea 15 min after GARDASIL Diz
343383 4/2/2009 NC 3 3 M 3/31/2009 Febrile seizure. Temp. 105. TYLEN
343384 4/2/2009 IN 0.2 0 0.2 M 4/1/2009 12 n Mother gave child TYLENOL 0
343385 4/2/2009 MN 58 58 F 4/2/2009 Soreness in joints, muscles - consta
343386 4/2/2009 KY 3 3 M 4/2/2009 Lg area of bumps at injection site go
343387 4/2/2009 WA 59 59 F 4/2/2009 Redness/ itching at injection site rig
343388 4/2/2009 CA 4 4 F 4/2/2009 Moderate redness and swelling of R
343389 4/2/2009 MA 78 78 F 4/2/2009 Erythema right upper arm below inje
343390 4/2/2009 TX 64 64 F 4/2/2009 3-27-09 1:00 PM - began experienc
343391 4/2/2009 AK 31 31 F 4/2/2009 Pain at injection site, malaise, naus
343412 4/3/2009 CT 72 M 4/2/2009 Information has been received from
343454 4/3/2009 NC 33 33 F 3/31/2009 Respiration problems, dizziness, ne
343455 4/3/2009 HI 38 38 F 3/31/2009 RUE cellulitis, pain, fever, tachycard
343456 4/3/2009 30 30 M 4/3/2009 Pt had SPV on 3/6/09 and AVA on 3
343457 4/3/2009 37 37 M 4/3/2009 Vesicular rash on (L) arm, neck and
343458 4/3/2009 OH 16 16 M 3/27/2009 Fever (103 degrees), headache, bo
343459 4/3/2009 AL 35 F 3/31/2009 After last flu shot experienced head
343460 4/3/2009 OH 29 29 F 4/3/2009 4cm X 4cm pink area around where
343462 4/3/2009 CA 11 11 F 4/3/2009 Patient fainted for a few seconds af
343463 4/3/2009 CA 4 4 M 3/18/2009 Reaction began 1 hr after injection.
343464 4/3/2009 NC 12 12 F 3/31/2009 Hours after the vaccines, patient c/o
343465 4/3/2009 NC 58 58 M None
343466 4/3/2009 HI 48 48 F 3/30/2009 4 days after administration, nickel si
343467 4/3/2009 NM 0.2 0 0.2 M 3/31/2009 Patient came in 3/31/09 stated that
343468 4/3/2009 FL 46 46 F 3/31/2009 Began to feel nauseous, vomited x
343469 4/3/2009 PA 71 71 F 3/28/2009 Severe lightheadedness within 15 m
343470 4/3/2009 MA 12 M 3/25/2009 Baseball sized swelling at site of VA
343471 4/3/2009 LA 13 13 M 3/20/2009 Pt reports broke out in small blisters
343472 4/3/2009 KY 51 51 F 3/31/2009 Swelling + erythema + pruritis of Rt
343473 4/3/2009 NJ 5 5 F 4/2/2009 While at home: (Location) bilateral a
343474 4/3/2009 NY 0.1 0 0.1 M 3/31/2009 Patient received 6 wks immunization
343475 4/3/2009 KY 11 11 M 4/2/2009 Pt presents today 4/1/09 with red ar
343476 4/3/2009 OH 4 4 F 4/3/2009 Large local reaction 9X6 cm local ic
343477 4/3/2009 FL 0.2 0 0.2 F 4/3/2009 Vaccine administered to left thigh bu
343479 4/3/2009 KY 1.3 1 0.3 M 4/3/2009 Swelling of Rt thigh area after vacci
343480 4/3/2009 TX 75 75 M 4/3/2009 Redness, soreness, swelling.
343481 4/3/2009 TX 7 7 F 4/3/2009 Patient developed redness around b
343482 4/3/2009 PA 18 18 F 3/31/2009 3-30-2009 Received Hep A at appro
343483 4/3/2009 MI 0.8 0 0.8 M 3/30/2009 Hep A was given at 9 months.
343484 4/3/2009 IN 0.6 0 0.6 M 4/3/2009 Given DTap/Hib/IPV and HebB/Hib-
343485 4/3/2009 NJ 0.5 0 0.6 F 4/3/2009 NICKEL SIZE DARK PINK RAISED
343486 4/3/2009 PA 75 75 F 4/3/2009 Patient broke out in shingles 6 days
343487 4/3/2009 OH 0.5 0 0.5 M 4/3/2009 High fever, strong crying, for many h
343488 4/3/2009 AL 30 30 F 4/3/2009 Golf ball sized knot on right arm. Re
343489 4/3/2009 MO 14 14 F 3/30/2009 Headache adn hives were around s
343490 4/3/2009 GA 11 11 F 4/3/2009 Cellulitis on left deltoid where Tdap
343491 4/3/2009 TX 11 11 M 4/3/2009 No noted adverse reaction. Patient
343492 4/3/2009 MI 39 39 M 4/3/2009 Developed bilateral kidney area pai
343493 4/3/2009 WI 0.9 0 0.9 M 4/3/2009 4/1/2009 MOTHER PRESENTED T
343494 4/3/2009 IL 14 14 F 4/3/2009 approx two weeks after my daughte
343496 4/3/2009 WA 1 1 0M 4/3/2009 Pt received a vaccination from an e
343497 4/3/2009 WA 0.2 0 0.2 M 4/3/2009 Pt received a vaccination from an e
343498 4/3/2009 RI 1.1 1 0.1 F 4/3/2009 My daughter developed a large red
343499 4/3/2009 OK 16 16 F 4/3/2009 Within 5-10 minutes of patient recei
343515 4/3/2009 CA 1 1 0F 4/3/2009 Varicella disease (rash, fever).
343516 4/3/2009 CA 48 48 F 4/3/2009 Received TDaP and PNEUMOVAX
343517 4/3/2009 MO 68 68 F Pt stopped by Clinic today to report
343518 4/3/2009 OH 73 73 F 4/3/2009 Red blistering rash in groin and hip
343519 4/3/2009 PA 1 1 0M 4/3/2009 Fever, max 100.5; redness, indurati
343520 4/3/2009 MN 5 5 M 4/1/2009 Sore arm -> redness + swelling at th
343521 4/3/2009 AR 1.4 1 0.4 M 4/1/2009 >10 cm area of redness on L thigh i
343522 4/3/2009 AR 5 5 M 4/3/2009 >10 cm area of redness, warmth an
343525 4/3/2009 CA 63 M 4/3/2009 Myalgias / arthralgias / HA (L) shoul
343526 4/3/2009 CA 10 10 M 4/2/2009 Ameliorated varicella rash (Sib with
343527 4/3/2009 CA 8 8 M 4/2/2009 Ameliorated Varicella rash (Sib with
343546 4/3/2009 CT 0.5 0 0.5 M 1/23/2009 Initial report received on 20 January
343547 4/3/2009 PA 0.8 0 0.8 M 3/17/2008 Initial report received on 13 March 2
343548 4/3/2009 CT 3 F 1/26/2009 Initial report received from a manufa
343549 4/3/2009 NM 0.6 0 0.6 F 1/29/2009 Initial report received on 22 January
343550 4/3/2009 IN 0.2 0 0.2 F 9/9/2008 Initial information was received on 1
343551 4/3/2009 IL 2 2 0.9 M 8/19/2008 Initial report received on 08 August
343552 4/3/2009 NJ 1.3 1 0.3 M 8/12/2008 This case was received from a heal
343553 4/3/2009 LA 36 36 U ### This case was received from a heal
343500 4/4/2009 NC 0.2 0 0.2 M 4/4/2009 SCREAMING AFTER WAKING, CR
343507 4/5/2009 GA 11 11 M 4/5/2009 First 20 hrs- He had extremely sore
343508 4/5/2009 IN 57 M 4/5/2009 Pt had receive.5cc pneumo-vac on
343509 4/5/2009 DE 60 60 M 4/5/2009 Moderate Fever ~ 101 F, Malaise, M
343510 4/5/2009 IN 69 69 M 4/5/2009 On 11/28/08, pt was in clinic and C/
343511 4/5/2009 CA 36 36 M 4/5/2009 Patient was given scheduled vaccin
343512 4/5/2009 CA 46 46 F 4/5/2009 On Friday, 4/3/09, I received two va
343523 4/5/2009 NV 40 40 M 4/5/2009 2-3 day after hives around vaccinati
343524 4/5/2009 MO 24 24 F 4/5/2009 Had Hep A and Hep B shots on 4/4
343528 4/6/2009 M 4/3/2009 InformationYhas been received from
343532 4/6/2009 SC 8 8 M 4/2/2009 This non serious case was received
343554 4/6/2009 ME 2 2 0.2 U Developed fever 3/26/09/ER visit fo
343555 4/6/2009 IL 0.5 0 0.5 F 3/26/2009 4 hours after receiving DTAP, PREV
343556 4/6/2009 AL 1.3 1 0.3 F 4/1/2009 Seizure, thought to be febrile seizur
343557 4/6/2009 HI 15 15 F 3/23/2009 Syncope 5 minutes after HPV (GAR
343558 4/6/2009 PR 0.5 0 0.5 F 3/31/2009 Pt developed erythematous rash, ur
343559 4/6/2009 GA 67 67 M 4/2/2009 None. Patient said arm slightly sore
343560 4/6/2009 TX 1.4 1 0.4 M 4/1/2009 Developed hives within 15 minutes
343561 4/6/2009 NY 36 36 M 3/7/2009 Small localized reaction started day
343562 4/6/2009 OH 1.7 1 0.7 F 4/1/2009 1. Erythema around injection site, n
343563 4/6/2009 IL 5 5 F 4/3/2009 Received KINRIX (DTaP/IPV) Rt thi
343564 4/6/2009 IN 8 8 F 3/28/2009 Received VARIVAX 3/26/09 mom n
343565 4/6/2009 CA 55 55 F 4/5/2009 Patient is a USAFR female service m
343566 4/6/2009 IA 8 8 F 3/25/2009 Injection given 3-20-09 AM. Seen in
343568 4/6/2009 MN 65 65 F 3/30/2009 Sore arm very painful every time I m
343570 4/6/2009 TX 11 11 M 4/6/2009 Localized allergic reaction
343571 4/6/2009 FL 39 39 M 4/6/2009 Pt. felt weak, muscle soreness for 3
343572 4/6/2009 WA 0.8 0 0.8 M 4/6/2009 Pt received an expired dose of Hep
343573 4/6/2009 WA 0.2 0 0.2 F 4/6/2009 Pt received an expired dose of Hep
343574 4/6/2009 WA 0.2 0 0.2 M 4/6/2009 Pt received an expired dose of Hep
343575 4/6/2009 WA 0.2 9 F 4/6/2009 Pt received an expired dose of Hep
343576 4/6/2009 WA 0.2 0 0.2 F 4/6/2009 Pt received an expired dose of Hep
343577 4/6/2009 NE 29 29 F 4/6/2009 Pt called clinic, c/o redness and blo
343578 4/6/2009 IN 18 18 F 4/6/2009 Mother called on 4-6-09 stating that
343579 4/6/2009 OH 40 40 F 4/6/2009 pain started out as aching 1 hour af
343580 4/6/2009 KS 39 39 M 4/6/2009 On 3/27/09 the employee went to th
343581 4/6/2009 CT 14 14 F 4/6/2009 swelling pain of both knees. 4/13/09
343582 4/6/2009 MN 19 19 F 4/6/2009 Approximately 24 hours after the va
343583 4/6/2009 GA 60 60 F 4/6/2009 Patient noticed on 4/5/08 at 2:00AM
343584 4/6/2009 AL 5 5 F 4/6/2009 4/3/09 @ 9am- phone call from pare
343585 4/6/2009 MI 6 6 F 4/6/2009 Rash - localized papules. No bullae
343586 4/6/2009 AL 17 17 F 4/6/2009 Varicella given 3/31/09 approx. 10:3
343587 4/6/2009 CO 0.4 0 0.4 M 4/6/2009 Rotateq (rotavirus) vaccine given vin
343588 4/6/2009 IL 4 4 F 4/6/2009 Child received IPV and DTAP in Rig
343589 4/6/2009 MI 28 28 F 4/6/2009 24hrs after shot pt had swollen, pain
343590 4/6/2009 CA 34 34 F 4/6/2009 Pt was given Pneumovax vaccine a
343591 4/6/2009 OK 18 18 F 4/6/2009 Unexplained sudden and severe ha
343592 4/6/2009 IL 19 19 F 4/6/2009 Pt called Clinic on 4-6-09 to report t
343593 4/6/2009 WI 30 30 F 4/6/2009 Hypotonic-Hyporesponsive Episode
343594 4/6/2009 WI 28 27 M 4/6/2009 PT HAD A TDAP SHOT ON FRIDA
343596 4/6/2009 FL 79 79 F 4/6/2009 red, swollen, feverish arm where sh
343597 4/6/2009 CA 14 14 F 4/6/2009 He had some numbness and tinglin
343598 4/6/2009 WA 60 60 F 4/6/2009 This case was reported by a consum
343601 4/6/2009 CA 11 11 F 4/6/2009 On 3/30/09, pt presented w/ about 1
343602 4/6/2009 ID 0.5 0 0.5 M 3/31/2009 The grandmother and mother repor
343603 4/6/2009 IA 15 15 F 4/2/2009 Progressive Diarrhea, Vomiting, Bac
343604 4/6/2009 CA 1.3 1 0.3 F 4/6/2009 She had a reddish purplish area on
343605 4/6/2009 TX 12 12 F 4/6/2009 Erythema at injection site "burning"
343606 4/6/2009 CA 17 17 M 3/11/2009 Headache: onset: 3/10/09-present.
343607 4/6/2009 OR 5 5 M 4/6/2009 Redness and swelling L leg. Started
343608 4/6/2009 MO 14 14 M 4/6/2009 Fri - 4-3-09 - School nurse phoned H
343609 4/6/2009 FL 0.5 0 0.5 M 4/6/2009 Irritability with long periods of crying
343610 4/6/2009 MI 7 7 U 4/6/2009 Both legs red and swollen. Cellulitis
343626 4/7/2009 NY 4 4 M 4/2/2009 Fever one week after vaccinations -
343627 4/7/2009 OH 4 4 M 4/6/2009 Red swollen thigh left - side left day
343628 4/7/2009 CA 4 4 M 3/31/2009 Redness to site with induration x 3-4
343629 4/7/2009 66 66 F 3/29/2009 Received shingle shot. Asked nurse
343630 4/7/2009 69 69 F 4/1/2009 Developed petechial rash on inner t
343631 4/7/2009 30 F 3/29/2009 Laceration so had ADACEL vaccine
343632 4/7/2009 MA 20 20 F 4/2/2009 1st GUARDISIL vaccine administere
343633 4/7/2009 MS 1.3 1 0.3 M Increase swelling & erythema of ent
343634 4/7/2009 NC 0.7 0 0.7 M 4/2/2009 About a 2cm red wheal appeared af
343635 4/7/2009 MN 0.3 0 0.3 F 4/2/2009 Local reaction right thigh with erythe
343636 4/7/2009 CO 83 83 M 4/3/2009 Developed rash L side neck in derm
343637 4/7/2009 CA 2 2 0.1 M 4/2/2009 Vaccine given 3/19/09, fever develo
343638 4/7/2009 PA 12 12 F 4/2/2009 Syncopal event.
343639 4/7/2009 AL 0.5 0 0.5 F 3/10/2009 Pt. received 6 mo. well baby checku
343640 4/7/2009 MO 69 69 F 3/30/2009 3/30 Pt called, c/o erythema (L) upp
343641 4/7/2009 PA 4 4 M 4/1/2009 No adverse events recorded
343642 4/7/2009 PA 1.2 1 0.2 M 4/1/2009 Presented to the office on 3/31/09 w
343644 4/7/2009 NJ 4 4 F 3/26/2009 Received KINRIX 3/24/09 (R) deltoi
343645 4/7/2009 NY 14 14 F 3/31/2009 Protracted headache 5/26/09 Rece
343646 4/7/2009 PA 1 1 0F 4/1/2009 Bright red maculo papular rash to fa
343649 4/7/2009 PA 4 4 F 4/6/2009 patient received KINRIX as part of 4
343650 4/7/2009 CO 60 60 F 4/1/2009 3/30/09 Rec. Yellow Fever Vaccine
343651 4/7/2009 KY 11 11 F 3/31/2009 Immediately following injection pt. b
343652 4/7/2009 NJ 21 21 F 3/25/2009 Complained of itchy throat 40 minut
343653 4/7/2009 MI 17 17 M 4/1/2009 Pain, redness, swelling and firmnes
343654 4/7/2009 TX 1 1 0M 3/31/2009 1-5-09 pm notices red spots on bac
343655 4/7/2009 WA 68 68 F 4/7/2009 Reaction to pneumonia vaccine give
343656 4/7/2009 U 3/25/2009 10 mg of Hep B vaccines were give
343657 4/7/2009 70 M 4/1/2009 Frompt. States he was in his office y
343658 4/7/2009 OH 0.5 0 0.5 M Immunization given on 3/27/09 3 ho
343659 4/7/2009 ME 10 10 F 4/1/2009 Developed redness around upper a
343660 4/7/2009 FL 1.5 1 0.5 M 3/30/2009 Fever began two days after shot wa
343661 4/7/2009 OK 4 4 F 4/2/2009 Immunization site reaction with mild
343662 4/7/2009 DE 1.5 1 0.5 F 4/2/2009 Vomiting X 24 hr, injection site rash
343663 4/7/2009 TN 39 39 F 4/2/2009 Redness, heat, swelling left deltoid
343664 4/7/2009 MA 10 10 F 3/30/2009 Acute RAD with throat itching within
343665 4/7/2009 AK 0.4 0 0.4 M 3/26/2009 5 month old with spots on body, sta
343666 4/7/2009 WI 13 13 F 4/1/2009 Left arm pain, left sided facial flushi
343667 4/7/2009 TN 9 9 M 4/2/2009 Erythema and swelling to left upper
343668 4/7/2009 OK 14 14 F 3/27/2009 Next day noticed itching at site of va
343669 4/7/2009 CO 15 15 F 4/2/2009 Redness 5 cm X 5 cm; Swelling + P
343670 4/7/2009 OH 34 34 F 4/7/2009 Fever, rash
343671 4/7/2009 IN 5 5 F 4/7/2009 felt sick to stomach,head hurt, feet f
343672 4/7/2009 20 20 F 4/7/2009 Vaccinated with ACAM2000 during
343673 4/7/2009 KY 12 12 F 4/7/2009 Received 3rd dose of Gardasil on 3
343675 4/7/2009 MN 5 5 M 4/7/2009 patient was given Adacel instead of
343676 4/7/2009 OH 2 2 0.7 F 4/7/2009 Child missed appt for Well Child Clin
343677 4/7/2009 NC 54 54 F 4/7/2009 11/4/08 Optic Neuropathy leading t
343678 4/7/2009 CA 12 12 M 4/7/2009 DIZZY,FAINTED.ASSESSED MY M
343679 4/7/2009 MI 69 69 F 4/7/2009 2 days following vaccination, pt. dev
343680 4/7/2009 29 29 M 4/7/2009 Non-specific myocarditis. This case
343682 4/7/2009 36 36 M 4/7/2009 Subendocardial infarction (410.7), u
343683 4/7/2009 CT 5 5 F 4/7/2009 MMR and Kinrix innoculations given
343684 4/7/2009 FL 4 4 F 4/7/2009 Mother brought child in today for as
343685 4/7/2009 PA 81 81 F 4/7/2009 Two weeks after her vaccine was gi
343686 4/7/2009 TX 18 18 F 4/7/2009 Vaccinated with ACAM2000 during
343688 4/7/2009 PA 56 56 M 4/7/2009 Patient states he got his second inje
343693 4/7/2009 NV 1.4 1 0.4 M 4/6/2009 Rash head to toe. Not sleeping or e
343694 4/7/2009 AZ 74 74 F 4/7/2009 Shingles (rash with blisters) on lowe
343695 4/7/2009 MO 1.5 1 0.5 F 4/7/2009 None reported
343696 4/7/2009 IA 0.1 0 0.1 F 4/6/2009 Onset of erythema L thigh day after
343697 4/7/2009 70 70 M 4/1/2009 Mar 26, 2009@09-43 from pt. State
343700 4/8/2009 F 4/7/2009 Information has been received via a
343702 4/8/2009 20 20 M 3/31/2009 Developed focal deficits temporally
343707 4/8/2009 MO 51 51 F 4/3/2009 Client reports pain & burning sensa
343708 4/8/2009 CA 5 M 4/1/2009 Right deltoid (arm) red and swollen,
343710 4/8/2009 NE 49 49 F ### Angloedema & swelling of uvula.
343711 4/8/2009 KY 4 4 F 4/3/2009 Rt arm red swollen warm to touch.
343712 4/8/2009 66 66 F 3/29/2009 Received shingle shot. Asked nurse
343713 4/8/2009 GA 9 9 M 4/3/2009 Pt. had slightly raised, warm to touc
343714 4/8/2009 NC 9 9 F 4/4/2009 15x10cm area of blanching erythem
343717 4/8/2009 NE 12 12 M 8/20/2008 Red spot on arm. Not sure if it was
343719 4/8/2009 NE 46 46 F 9/22/2008 Patient had syncopal episode, short
343726 4/8/2009 CA U 4/3/2009 This case was received from a heal
343736 4/8/2009 HI 75 75 F 2/16/2009 See attached copy.
343737 4/8/2009 NY 8 8 F 3/19/2009 Whelps developed. Got in waiting a
343739 4/8/2009 CA 23 23 F 4/8/2009 1st GARDASIL 1-30-09 - At 2nd app
343740 4/8/2009 NC 2 2 1M 4/8/2009 Erythema induration at left thigh ele
343741 4/8/2009 41 41 M 4/8/2009 Persitant redness, itching and swell
343742 4/8/2009 MD 71 72 F 4/8/2009 Rash at injection site.
343743 4/8/2009 IN 4 4 M 4/8/2009 Mother called stating that left arm is
343744 4/8/2009 MD 9 9 F 4/8/2009 Pt arm Turned red and slightly raise
343746 4/8/2009 SC 32 32 F 4/8/2009 Edema of the tongue and throat. No
343747 4/8/2009 IL 2 2 0.4 F 4/8/2009 CLT SCREAMED ALL DAY RIGHT
343748 4/8/2009 NY 47 47 F 4/8/2009 The patient received Tdap vaccine (
343749 4/8/2009 CA 4 4 M 4/8/2009 HEP A GIVEN X3
343750 4/8/2009 NY 44 44 F 4/8/2009 The patient received Tdap and expe
343751 4/8/2009 CA 0 0 0M 4/8/2009 Patient has a Methicillin Sensitive S
343752 4/8/2009 AL 0.3 0 0.3 M 4/8/2009 Injection site blanched and cool to
343754 4/8/2009 NY 58 17 F 4/8/2009 The patient received the Tdap vacc
343756 4/8/2009 TX 22 22 F 4/8/2009 I had the HPV vaccine Gardisil on M
343757 4/8/2009 MO 5 5 M 4/6/2009 Received Hep B shot 3-31-09 VLL.
343758 4/8/2009 MO 11 10 F 4/1/2009 Administered DTAP instead of Tdap
343759 4/8/2009 TN 77 77 M 4/8/2009 03/14/2009@ 11:05AM, Injection sit
343760 4/8/2009 TN 4 4 F 4/8/2009 Approximately 48 hours after immun
343761 4/8/2009 DC 62 62 F 4/8/2009 Patient is a 62 year old African Ame
343762 4/8/2009 CA 5 5 M 4/8/2009 Vaccinations were received on 04/0
343763 4/8/2009 MN 20 19 F 4/8/2009 On 4/7/09 had a rash on neck and c
343764 4/8/2009 OR 12 12 F 4/8/2009 At time and the months up to March
343765 4/8/2009 WA 31 31 F 4/8/2009 WITHIN 48HRS DEVELOPED LOC
343766 4/8/2009 CA 0.4 0 0.4 M 4/8/2009 Within 10 minutes of receiving the v
343767 4/8/2009 AZ 14 14 F (Per mother), child went to ER 2-13
343768 4/8/2009 CA 20 20 M 4/8/2009 Pt received immunizations (FLUMIS
343769 4/8/2009 WI 1.3 1 0.3 M 4/8/2009 Local (L) thigh-redness, 14x17 cm s
343770 4/8/2009 TN 52 52 M 4/8/2009 Pt states today that he had a reactio
343771 4/8/2009 MA 1.1 1 0.1 F 4/9/2009 Developed rash around belly button
343772 4/8/2009 CA 88 88 F 4/8/2009 Swelling, redness, 12 cmx8cm. Not
343773 4/8/2009 HI 60 60 F 4/3/2009 Headache began about 3 days after
343774 4/8/2009 HI 64 64 F 4/8/2009 Patient noticed red welt on site of in
343775 4/8/2009 PA 62 62 F 4/8/2009 Silver sized red itchy mark ant injec
343776 4/8/2009 CA 22 22 F 4/8/2009 Pt had syncopal episode after GAR
343889 4/8/2009 ID F 3/27/2009 Information has been received from
343893 4/8/2009 MS 65 65 M 3/27/2009 Information has been received from
343897 4/8/2009 TX 73 73 M 3/27/2009 Information has been received from
343901 4/8/2009 AL 79 M 3/27/2009 Information has been received from
343902 4/8/2009 KY 3 U 3/27/2009 Information has been received from
343906 4/8/2009 ME F 3/27/2009 Information has been received from
343911 4/8/2009 CO 62 62 M 3/27/2009 Information has been received from
343980 4/8/2009 M 3/27/2009 Information has been received form
343983 4/8/2009 AR 60 60 M 3/27/2009 Information has been received from
343984 4/8/2009 IL 80 M 3/27/2009 Information was received from a 80
343985 4/8/2009 SC 74 F 3/27/2009 Information has been received from
343988 4/8/2009 F 3/27/2009 Information has been received form
343989 4/8/2009 OK 60 M 3/27/2009 Information has been received from
344075 4/8/2009 KS 1 M 3/27/2009 Information has been received from
344078 4/8/2009 LA 76 M 3/27/2009 Information has been received from
344717 4/8/2009 2 2 0.3 M 4/7/2009 Information has been received from
344729 4/8/2009 FL 67 M 3/27/2009 Information has been received from
344731 4/8/2009 KY 76 M 3/27/2009 Information has been received from
344755 4/8/2009 MI 1.2 1 0.2 M 3/27/2009 Information has been received from
344756 4/8/2009 CA M 3/27/2009 Information has been received from
344777 4/8/2009 SD 72 72 F 3/27/2009 Information has been received from
344784 4/8/2009 NY 61 61 M 3/27/2009 Information has been received from
344823 4/8/2009 WV 62 F 3/27/2009 Information has been received from
344826 4/8/2009 AZ U 3/27/2009 Information has been received from
344861 4/8/2009 NC 65 U 3/27/2009 Information has been received from
344862 4/8/2009 RI M 3/27/2009 Information has been received from
344877 4/8/2009 IN 61 61 M 3/27/2009 Information has been received from
344879 4/8/2009 NV 81 81 F 3/27/2009 Information has been provided from
344890 4/8/2009 AR U 3/27/2009 Information has been received from
345495 4/8/2009 77 77 M 3/27/2009 Initial information has been received
345499 4/8/2009 IA 68 F 3/27/2009 Information has been received from
345502 4/8/2009 AR 74 74 F 3/27/2009 Information has been received from
345508 4/8/2009 OH M 3/27/2009 Information has been received from
345512 4/8/2009 FL U 3/27/2009 Information has been received from
345620 4/8/2009 FL 59 59 F 3/27/2009 Initial information has been received
345623 4/8/2009 TX 71 M 3/27/2009 Information has been received from
345627 4/8/2009 66 66 U 3/27/2009 Information has been received from
345632 4/8/2009 MO 73 M 3/27/2009 Information has been received from
345637 4/8/2009 OK 62 62 F 3/27/2009 Information has been received from
345648 4/8/2009 MI 62 62 F 3/27/2009 Initial and follow-up information has
345654 4/8/2009 SC 61 61 M 3/27/2009 Information has been received from
345655 4/8/2009 IL 1.1 1 0.1 F 3/27/2009 Information has been received from
345656 4/8/2009 ID 74 F 3/27/2009 Information has been received from
345664 4/8/2009 CT 1 U 3/27/2009 Information has been received from
345668 4/8/2009 OR F 3/27/2009 Information has been received from
345674 4/8/2009 WI 74 74 M 3/27/2009 Information has been received from
345773 4/8/2009 75 75 M 3/27/2009 Initial and follow-up information has
345776 4/8/2009 MD 70 70 M 3/27/2009 Information has been received from
343777 4/9/2009 VA 11 U 4/8/2009 InformationYhas been received from
343790 4/9/2009 MO 49 49 F When the rib cracked went to docto
343791 4/9/2009 NE 16 16 F 4/6/2009 Patient is a 16-year-old female who
343792 4/9/2009 IN 27 27 F 4/3/2009 Received vaccines on 3-16-09. The
343793 4/9/2009 KY 4 4 F 4/3/2009 Right thigh swollen, red with blisters
343794 4/9/2009 PA 14 14 F 4/2/2009 24 hours dizziness, vomiting low gra
343795 4/9/2009 NH 15 15 F Developed bilateral pulmonary emb
343796 4/9/2009 CO 13 13 M 4/4/2009 Redness, pain and swelling in arm.
343797 4/9/2009 VA 15 15 F 4/2/2009 During the course on the vaccines,
343798 4/9/2009 MA 13 13 F 3/27/2009 Fever 103 at 10:45 am 3/26/09, sha
343799 4/9/2009 NY 5 5 M 4/6/2009 410PM LPE complete immunization
343800 4/9/2009 CA 4 4 F 4/2/2009 Local reaction lasting 4 days.
343801 4/9/2009 FL 0.3 0 0.3 M 4/3/2009 Pt received PREVNAR vaccine @ t
343802 4/9/2009 GA 4 4 M 4/3/2009 Positive redness and swelling of left
343803 4/9/2009 64 M 3/23/2009 Patient received the Zoster vaccine
343804 4/9/2009 66 66 M 4/7/2009 I had an injection of ZOSTAVAX on
343805 4/9/2009 CA 1.1 1 0.1 M 4/8/2009 Pt. developed rash after vaccines w
343806 4/9/2009 MI 4 4 F 4/9/2009 Patient came to pick up a sticker an
343807 4/9/2009 PA 1.7 1 0.7 M 4/7/2009 Rash, several scattered vesicles. S
343808 4/9/2009 NY 1.3 1 0.3 F 4/9/2009 Urticaria broke out on left thigh as s
343809 4/9/2009 MS 40 40 M Large are of redness to the right de
343810 4/9/2009 CA 28 28 F 4/9/2009 Patient called 4/9/09 AM to notify us
343811 4/9/2009 WA 14 14 M 4/9/2009 VARICELLA vaccine (along with TD
343812 4/9/2009 IN 31 31 M 4/6/2009 None stated.
343813 4/9/2009 MO 21 21 M 3/31/2009 Gave pediatric/adolescent dose of H
343814 4/9/2009 GA 15 15 F 4/6/2009 Patient was inadvertently given DTa
343815 4/9/2009 CA 52 52 M 4/3/2009 L arm swelling - Pt reported fever to
343816 4/9/2009 51 U Rash and fever.
343817 4/9/2009 64 M 4/2/2009 Urticaria Pruritus
343819 4/9/2009 CA 1.3 1 0.3 F 4/9/2009 16 month old female presents with f
343820 4/9/2009 NC 40 40 U 4/9/2009 Pt called the dept and left message
343821 4/9/2009 MA 38 47 F 4/9/2009 Patient immunized with Varivax vac
343822 4/9/2009 AL 76 U 4/9/2009 Subject in pneumococcal
Y vaccine tr
343823 4/9/2009 KS 43 43 F 4/9/2009 Silver dollar sized redness and warm
343824 4/9/2009 FL 44 44 F 4/9/2009 Reports felt "woozy,dizzy" when got
343825 4/9/2009 IN 1.2 1 0.2 F 4/9/2009 developed fever
Y and rash approx. 1
343826 4/9/2009 KY 12 12 F 3/30/2009 Appointment at 10:15am, pt. called
343827 4/9/2009 IA 1.3 1 0.3 F 4/9/2009 developed Herpes Zoster (C5 distrib
343828 4/9/2009 MI 61 61 M 4/9/2009 Patient has a softball sized area at t
343829 4/9/2009 TX 1 1 0F 4/9/2009 Started fever 6 hours after injection.
343830 4/9/2009 MI 11 11 F 4/9/2009 Patient received #2 VZV, #1 HPV, a
343831 4/9/2009 FL 0.2 0 0.2 M 4/9/2009 Patient brought
Y in the clinic in the af
343832 4/9/2009 CA 19 19 M 4/9/2009 During 5 week field exercise, patien
343833 4/9/2009 KY 1.5 1 0.5 F 3/17/2009 Child recieved shots at health depa
343834 4/9/2009 FL 0.2 M 4/9/2009 Patient bacame cranky cried her de
343835 4/9/2009 MI 8 8 F 4/9/2009 About 24 hours after TD was given
343836 4/9/2009 MO 4 4 M 4/9/2009 Patient received Kinrix (DTaP,IPV, M
343837 4/9/2009 CA 1.9 1 0.9 F 4/9/2009 Fever up to 102.5, rhinorrhea, and e
343839 4/9/2009 IN 81 81 M 4/7/2009 Started w/chest
Y congestion/shortne
343849 4/9/2009 IA 16 16 F 4/9/2009 Pt developed acute abdominal pain
343850 4/9/2009 CA 16 16 F 3/20/2009 Oval hyperemic swelling on Rt uppe
343851 4/9/2009 VA 22 22 F 4/9/2009 On 3/25/09 at 1030 the pt received
343852 4/9/2009 OH 1 1 0M 4/9/2009 Swelling and rash reaction with ang
343853 4/9/2009 WI 13 13 M 4/9/2009 Within a few minutes client turned p
343854 4/9/2009 TX 14 14 M Paleness, weakness BP prior to eve
343855 4/9/2009 NY 18 18 M 4/8/2009 15 minutes after receiving vaccine s
343856 4/9/2009 GA 16 16 F 4/2/2009 Patient was in office to have mening
343857 4/9/2009 VA 33 33 U 4/9/2009 Received vaccination on 3/31/09: T
343858 4/9/2009 AZ 34 34 F 4/8/2009 Patient states she started having co
343859 4/9/2009 AZ 34 34 M 4/8/2009 Approximately 2 weeks after immun
343860 4/9/2009 IL 14 U Patient complaining of intermittent s
343861 4/9/2009 CO 15 15 F 4/9/2009 48 hrs after vaccine administered ha
343862 4/9/2009 TX 12 12 M 4/9/2009 Patient came to our clinic on 4/9/09
345781 4/9/2009 TX U 1/27/2009 Initial information was received on 2
345782 4/9/2009 NY 0.2 0 0.2 F ### Initial report was received on 08 De
343878 4/10/2009 MN M 4/9/2009 Information has been received from
343881 4/10/2009 IL F 4/7/2009 Initial report was received from anot
343915 4/10/2009 NY 25 25 F 4/10/2009 Employee reporting disturbed sleep
343916 4/10/2009 MO 4 4 M 4/3/2009 Reddness about 4-6 cm left deltoid.
343917 4/10/2009 NC 68 68 F 4/10/2009 Patient had rash. She went to the d
343918 4/10/2009 NV 31 31 F 4/10/2009 I had rash on all my neck for two da
343919 4/10/2009 MI 71 71 F 4/10/2009 Two days after receiving the shingle
343920 4/10/2009 KY 4 4 F 4/2/2009 03/31/09 Dtap given, 04/01/09 Pt. h
343921 4/10/2009 KY 4 4 M 4/1/2009 Local reaction to Dtap (given on 03/
343922 4/10/2009 IL 18 18 F 4/10/2009 within 20 mins of injections, pain, st
343923 4/10/2009 KY 0.3 0 0.3 M 2/10/2009 seizures X2 4/29/09 Received Hos
343924 4/10/2009 KY 51 51 F 8/21/2008 Reddened area, size of half-dollar, l
343925 4/10/2009 KY 11 M 6/13/2008 Pt. had painful red swollen 4 X 3 1/2
343926 4/10/2009 MD 10 10 F 4/10/2009 40mmx28mm red raised area at site
343927 4/10/2009 KY 1 1 0M ### low appetite, fever, seizure
343928 4/10/2009 KY 11 11 M ### urticaria- abdomen/chest/lumbar
343929 4/10/2009 KY 36 36 M 12/7/2007 Intermittent shooting pains in right a
343931 4/10/2009 KY 12 12 F 8/20/2007 Administered Tdap and Gardisil, pt.
343932 4/10/2009 KY 11 11 M 8/6/2007 left arm 2" redness, warm to touch,
343933 4/10/2009 KY 2 0 0.2 M 8/2/2007 high fever and high pitched screami
343934 4/10/2009 SC 16 16 F 4/10/2009 After administration of all 4 vaccines
343937 4/10/2009 CA 1.5 1 0.5 F 4/10/2009 5 days after MMR vaccination our d
343965 4/10/2009 NV 12 12 M 4/9/2009 Protracted vomiting, dehydration an
343966 4/10/2009 69 69 F Pt. came in 02-25-09. States she ha
343967 4/10/2009 KY 1 1 0M 4/10/2009 Pt developed a rash on right arm sh
343968 4/10/2009 OR 4 4 M 4/10/2009 Swelling, redness, very hot, doubled
343969 4/10/2009 WA 3 3 M 4/11/2009 8X6 cm area of induration over R de
343971 4/10/2009 AK 77 77 F 4/10/2009 On March 20, 2009 - developed sev
343972 4/10/2009 CA 4 4 F 4/10/2009 L thigh with large erythematous ede
343973 4/10/2009 MN 9 9 M 4/10/2009 Eye twitching, blinking, facial grimac
343974 4/10/2009 MA 4 4 F 4/8/2009 Bilat parotitis day 13 after MMR.
343975 4/10/2009 CT 4 4 M 4/10/2009 Erythematous discoloration with slig
343976 4/10/2009 MI 4 4 M 4/10/2009 Positive erythema 15x16cm left thig
343977 4/10/2009 CA 15 15 F 4/9/2009 pass out after the shots, became pa
343939 4/11/2009 PR 40 40 M 4/11/2009 Joints ache and pain in all of them,
343940 4/11/2009 TX 44 44 M 4/11/2009 Weakness and dizziness especially
343970 4/11/2009 IN 33 33 F Patient given vaccine IV push instea
343941 4/12/2009 TN 7 7 M 4/12/2009 Patient was extremely exciteable wh
343942 4/12/2009 FL 64 64 M 4/12/2009 Right arm is red, no swelling noted,
343943 4/12/2009 FL 88 88 M 4/12/2009 ulcerated left upper arm
343944 4/12/2009 NC 66 66 F 4/12/2009 Feaver, caugh,weak, breathing prob
343993 4/13/2009 CA -1 0.5 U 4/8/2009 This serious case was received on 0
343994 4/13/2009 M 4/8/2009 Initial report received 01 April 2009
343995 4/13/2009 FL 0.4 0 0.4 M 4/9/2009 This serious case was received on 0
344011 4/13/2009 CO 24 24 F 4/3/2009 Seizure - Full clonic/tonic 1 hr 45 mi
344012 4/13/2009 CA 1.3 1 0.3 F Fever 2 days after vaccine. Hospita
344013 4/13/2009 CA 1 1 0M 3/25/2009 Erythema multiforme major possible
344014 4/13/2009 MN 0.5 0 0.5 F 4/1/2009 Infantile spasms started on the 3rd
344015 4/13/2009 IN 64 64 F 4/6/2009 T=99.7 swelling, induration + erythe
344016 4/13/2009 OR 18 18 F 3/27/2009 3/20/2009 swelling, redness and pa
344017 4/13/2009 OR 64 64 F 3/31/2009 Within 2 hrs of vaccination, Pt deve
344018 4/13/2009 OR 14 14 M 3/31/2009 Called 3-27-09 with c/o dizziness, p
344019 4/13/2009 UT 45 45 F 3/30/2009 Pt came into clinic after shots for im
344020 4/13/2009 VA 4 4 F 4/9/2009 She had a swelling and rash at site
344021 4/13/2009 AL 23 23 F 3/17/09 Received PC from Pt states
344022 4/13/2009 KS 48 48 U Local Rxn w/ redness & warmth x 4
344023 4/13/2009 MD 34 34 F Afternoon after receiving vaccine fe
344024 4/13/2009 MS 1.5 1 0.5 F 4/3/2009 Mom stated child had a tem up to 1
344025 4/13/2009 DE 26 26 F 4/7/2009 Pt. notes truncal pruritis (primarily B
344026 4/13/2009 TX 4 4 F 3/18/2009 Injection site - swollen, red, sorenes
344027 4/13/2009 SC 21 21 F 4/8/2009 Patient received ANTRAX and Typh
344028 4/13/2009 CA 4 4 M 4/7/2009 Diagnosed with shingles along L4 -
344029 4/13/2009 VA 11 11 M 4/7/2009 (lt) arm - reddened, "hst to touch", s
344030 4/13/2009 33 F 4/8/2009 Non stated.
344032 4/13/2009 MA 42 42 M 3/27/2009 Fatigue; night sweats 3/12/09 + 3/13
344033 4/13/2009 GA 5 5 M 3/30/2009 Right thigh was red & swollen with s
344034 4/13/2009 PA 69 69 F 4/2/2009 5cm area erythema, swelling, heat,
344035 4/13/2009 HI 0.5 0 0.5 F 4/4/2009 Morning of 04-1-09 : "Restussness"
344036 4/13/2009 NY 55 55 F 3/23/2009 Pt received injection and by next mo
344037 4/13/2009 TX 4 4 F 4/6/2009 Patient inadvertently received BOO
344038 4/13/2009 NC 15 15 F 4/6/2009 Approximately 5 minutes post inject
344039 4/13/2009 WV 5 5 F 4/10/2009 Large, red, hard area with streaking
344040 4/13/2009 FL 5 5 M 4/13/2009 Patient right shoulder and right delto
344041 4/13/2009 MA 14 14 F 4/10/2009 Cellulitis 4X6 inch area of redness 2
344042 4/13/2009 VA 4 4 F 4/8/2009 Pt developed hives at the IPV site.
344043 4/13/2009 DE 54 54 M 4/8/2009 Patient developed erythema & purit
344044 4/13/2009 U Arthus reaction left shoulder - Swell
344045 4/13/2009 IL 1.4 1 0.4 F 4/8/2009 Reddened, warm to touch, swollen
344046 4/13/2009 CA 32 32 F 4/7/2009 On 3/9/09 Pt received Td & Hep B o
344047 4/13/2009 KY 1.2 1 0.2 F 4/1/2009 3 X 3 cm erythema R upper arm wit
344048 4/13/2009 CA 4 F 4/5/2009 Left thigh red w swelling. Ice packs
344049 4/13/2009 NJ 13 13 F 4/3/2009 Significant itch, redness + swelling a
344050 4/13/2009 AR 31 31 F 3/20/2009 3/19/09 Started with rash neck + ch
344051 4/13/2009 CA 48 48 F 4/8/2009 Fever, total body aches, nausea, fa
344052 4/13/2009 MI 61 61 F 4/13/2009 2 hours after rec vaccine, welts dev
344053 4/13/2009 CT 7 7 F 4/13/2009 12x14 cms- erythema on right right
344054 4/13/2009 OR 21 21 F 4/6/2009 Pt states rash on face day following
344055 4/13/2009 VA 1 1 0F 4/8/2009 VARIVAX eruptions treated with BE
344056 4/13/2009 IN 0.3 0 0.3 F 4/8/2009 This case was reported by a healthc
344057 4/13/2009 FL 0.3 M 4/8/2009 This case was reported by a physici
344058 4/13/2009 KY 1.3 1 0.3 M 4/9/2009 Seen 4/9/09 with small induration an
344059 4/13/2009 AZ 4 4 F 4/9/2009 Right thigh with erythema and swell
344060 4/13/2009 MA 12 12 F 4/10/2009 Pt developed 8cm X 4.5 cm warm, e
344061 4/13/2009 LA 25 25 M 3/26/2009 Patient reports a rash - itching - dev
344062 4/13/2009 MS 0.2 0 0.2 F 4/13/2009 4/3/09 Hx acting different, restless,
344065 4/13/2009 MN 58 58 F 4/12/2009 Report 1999019267-1 describes join
344080 4/13/2009 NJ 1.7 1 0.7 M 4/13/2009 fever, irritability 8 days after vaccina
344081 4/13/2009 PA 24 24 M 4/13/2009 Vaccinated 12 days ago with MMR.
344082 4/13/2009 WI 1 1 0F 4/13/2009 Nine days after receiving the 1st MM
344084 4/13/2009 TX 81 81 M 4/13/2009 PATIENT CALLED COMPLAINING
344085 4/13/2009 CA 10 10 M 4/13/2009 Pt mom reported that son's develop
344086 4/13/2009 VA 10 10 F 4/13/2009 Mildly swollen area 1" to 2" wide pe
344087 4/13/2009 PA 83 83 F 4/13/2009 Pt noted an oval shaped, bright red
344088 4/13/2009 OH 5 5 F 4/13/2009 Parent reported child was not acting
344089 4/13/2009 IN 21 21 F 4/13/2009 Severe suicidal ideation, ever since
344090 4/13/2009 OH 29 29 F 4/13/2009 HIVES OVER FACE AND NECK AP
344091 4/13/2009 WY 4 4 M 4/13/2009 Immunized 4/8/09, The following da
344092 4/13/2009 OK 42 42 F 4/13/2009 numbness in fingers/hands/feet app
344093 4/13/2009 MA 1.3 1 0.4 F 4/13/2009 Immunization given on 3/31/2009. C
344094 4/13/2009 FL 13 13 F 4/13/2009 Client recieved four vaccines on 4/2
344095 4/13/2009 OK 66 66 M 4/13/2009 PT STATES HE REC'D PNEUMOV
344096 4/13/2009 GA 0.5 0 0.5 M 4/13/2009 6 month old child received Hepatitis
344097 4/13/2009 AZ 4 4 M 4/13/2009 mother noticed Saturday night 4/11/
344098 4/13/2009 38 38 F See History & Physical. This patient
344099 4/13/2009 TX 4 4 F 4/9/2009 Approximately 2" induration and red
344100 4/13/2009 NC 61 61 F 4/10/2009 Red spot on arm at shot site. It's the
344101 4/13/2009 NY 11 11 F 4/8/2009 11 y/o experienced a short, 5 secon
344102 4/13/2009 IA 72 72 F 4/13/2009 Patient received vaccination on 4-8-
344103 4/13/2009 FL 4 4 M 4/13/2009 Blister on the site of injection; next d
344104 4/13/2009 IL 14 F 4/15/2009 VARIVAX given L arm on 4/9/09, Pt
344105 4/13/2009 39 40 F 4/13/2009 Severe pain and edema localized a
344106 4/14/2009 TX 38 38 F 4/14/2009 April 7,2009 employee came in to c
344107 4/14/2009 OH 45 45 F 4/14/2009 Pt developed erythrematous local s
344108 4/14/2009 CT 20 20 M 4/14/2009 Non-viral Pustulosis.
344109 4/14/2009 MI 20 20 F 4/14/2009 Nausea, fatigue for one week after v
344110 4/14/2009 KY 11 10 F 4/14/2009 Local redness, swelling around injec
344111 4/14/2009 KS 2 1 0.4 M 4/14/2009 Febrile seizure
344112 4/14/2009 KY 0.2 0 0.2 M 3/19/2007 Apnea episodes on day after receiv
344113 4/14/2009 KY 0.3 0 0.3 M 3/8/2007 Rotateq started after 12 weeks.
344114 4/14/2009 KY 5 5 F 3/28/2007 03/28/07 Pt. developed red rash all
344115 4/14/2009 KY 1.3 1 0.3 U Redness and hives at injection site
344116 4/14/2009 LA 8 8 M 4/14/2009 On 04/07/09 pt. presented to the off
344117 4/14/2009 AR 64 64 F 4/14/2009 lightheaded, dizzy, especially when
344118 4/14/2009 MI 20 20 F 4/14/2009 Onset of signs/symptoms approxima
344119 4/14/2009 CA 40 40 F 4/14/2009 REQUIRED MD VISIT.2 DAYS S/P
344120 4/14/2009 FL 4 4 U 4/14/2009 Received call from mom @ 1:29 sta
344121 4/14/2009 MI 6 6 M 4/14/2009 Area where varicella (RA-SQ) becam
344122 4/14/2009 RI 12 12 F 4/14/2009 Syncopal episode about 5-10 minut
344123 4/14/2009 PR 0.2 0 0.2 M 4/14/2009 RASH ALL OVER THE BODY 2 HO
344124 4/14/2009 MD 18 18 F 4/14/2009 UNPLANNED PREGNANCY
344125 4/14/2009 PR 0.7 0 0.7 M 4/14/2009 SYSTEMIC URTICARIAL RASH A F
344126 4/14/2009 FL 72 F 4/14/2009 Red and indurated area on left delto
344127 4/14/2009 PR 31 31 F 4/14/2009 PATIENT REFERS HAVING A RAS
344128 4/14/2009 PA 27 27 F 4/14/2009 Administration site reaction. 2 inch
344129 4/14/2009 ND 63 63 M 4/14/2009 Developed nausea and vomiting aft
344130 4/14/2009 WI 0.2 0 0.2 M 4/14/2009 Unconsolable crying for several hou
344131 4/14/2009 CA 67 67 F 4/14/2009 Patient developed Guillan Bare syn
344132 4/14/2009 CO 0.3 0 0.4 F 4/14/2009 Patient experienced 5-6 bouts of dia
344133 4/14/2009 FL 39 39 M 4/2/2009 A serious clinical trial report of allerg
344140 4/14/2009 FL 71 71 F 4/14/2009 Local redness and swelling at the in
344141 4/14/2009 TX 39 39 M 4/10/2009 None. WNL.
344142 4/14/2009 PA 11 11 M 3/6/2009 Vaccine given in Left deltoid. Redn
344143 4/14/2009 KY 0.2 0 0.2 M 4/10/2009 Left thigh redness/swelling/tender 4
344145 4/14/2009 ND 70 70 M 4/13/2009 Pt. called @ 11:10 A on 4-13-09 an
344146 4/14/2009 CA 4 4 M 4/14/2009 Pt with hot, tender, swollen area rig
344147 4/14/2009 TX 4 4 F 4/14/2009 Shingles, recurrent area on face,
344148 4/14/2009 CA 2 2 0.4 F 4/13/2009 Had IZ on 4-9-09 04-11-09 2/3 of up
344149 4/14/2009 MA 28 28 F 4/14/2009 Peri-oral rash and slight numbness,
344150 4/14/2009 AL 4 4 M 4/14/2009 9X9 cm red reaction on L thigh with
344151 4/14/2009 CA 68 68 F 4/14/2009 Rash at injection site (large lumps) i
344152 4/14/2009 AZ 9 9 M 4/14/2009 L arm has rash & VARICELLA appe
344153 4/14/2009 CA 0.2 0 0.2 F 4/14/2009 Small rash after receiving Rotavirus
344154 4/14/2009 NM 1 0 1M 4/14/2009 Mother called 8 days after DTap wa
344155 4/14/2009 F 4/9/2009 My daughter is 13 yrs old and has r
344156 4/14/2009 20 20 F 4/10/2009 After first dose, there was a very sh
344157 4/14/2009 18 F 4/11/2009 After injection at 2:33 pm on the dat
344158 4/15/2009 PA 3 U 4/14/2009 It was reported
Y in a newspaper artic
344159 4/15/2009 U 4/14/2009 It was reported
Y in a newspaper artic
344160 4/15/2009 GA 11 11 F 4/14/2009 InformationYhas been received from
344180 4/15/2009 OH 10 10 F 4/10/2009 None Stated
344181 4/15/2009 NH 18 18 F 4/9/2009 Patient left office after getting 4 vac
344182 4/15/2009 CO 2 M 4/10/2009 (red, swollen, warm, painful; he had
344183 4/15/2009 OH 82 82 F 4/10/2009 2" oval area of redness & induration
344184 4/15/2009 NJ 1 1 0M 4/2/2009 Cough, fever- Sat morning (3/28/09
344185 4/15/2009 NY 0.9 0 0.9 F 4/10/2009 Urticaria
344186 4/15/2009 AL 1 1 0M 4/7/2009 Rash - BENADRYL Rash X 24 hour
344187 4/15/2009 CA 13 13 F 4/8/2009 Patient came in for MD visit 4/8/200
344188 4/15/2009 MN 28 28 F 4/6/2009 Employee reports fever ranging from
344189 4/15/2009 CA 4 4 M 4/8/2009 Developed fever, high 103 degrees
344190 4/15/2009 NJ 57 57 F Pain, redness & edema left deltoid w
344191 4/15/2009 NM 4 4 M 4/9/2009 Warm to touch and little swelling LD
344192 4/15/2009 26 26 F 4/8/2009 Headache same day lasted 3 days.
344193 4/15/2009 FL 27 27 M 4/9/2009 Flu Shot
344194 4/15/2009 AZ 65 65 M 4/10/2009 On 4/3 observed rash arms, hands,
344195 4/15/2009 MN 14 14 F 4/9/2009 Pt received shingles vaccine @ app
344196 4/15/2009 TX 21 21 M 4/8/2009 Nodular rash red indurated 1 1/2 inc
344197 4/15/2009 OK 4 4 F 4/8/2009 41/2"x 51/2" duration, warm to touch
344198 4/15/2009 PA 1.3 1 0.3 M 4/8/2009 As per mom, he was drinking juice,
344199 4/15/2009 NY 43 43 M 4/10/2009 Severe left arm pain, fever, chills an
344200 4/15/2009 TX 9 9 F 4/2/2009 Redness & slight swelling posterior
344201 4/15/2009 CO 4 4 U She got a fever the evening of the im
344202 4/15/2009 IL 13 13 F 4/3/2009 Child became very pale, lightheade
344203 4/15/2009 PA 1 0 1M Erythema multiform - treatment 5 da
344204 4/15/2009 MI 1.4 1 0.4 M 4/15/2009 Zoster Vaccine administered to child
344206 4/15/2009 IN 4 4 F 4/15/2009 Mother noted Left upper arm was sw
344207 4/15/2009 NE 41 41 F 4/15/2009 At 1800, noted dime size erythemia
344208 4/15/2009 IN 1 1 0M 4/15/2009 Patient presented to the emergency
344209 4/15/2009 CA 45 45 M 4/15/2009 Chills, fever, joint aches Right shoul
344210 4/15/2009 TN 0.5 0 0.5 M 4/15/2009 within half-hour of Pentacel injection
344211 4/15/2009 PA 1.1 1 0.2 F 4/15/2009 On 4/14/09 mother reported child ha
344212 4/15/2009 SC 12 12 F 4/15/2009 Patient called our office to inform us
344213 4/15/2009 NJ 12 12 M 4/15/2009 High body temperature 103.2 F
344214 4/15/2009 IA 11 11 M 4/15/2009 1.5 CM AREA DIRECTLY OVER LE
344215 4/15/2009 FL 15 15 F 4/15/2009 AMENORHEA SINCE DECEMBER
344216 4/15/2009 MI 55 M 4/15/2009 Was given a shot of PPV Pneumoco
344217 4/15/2009 WI 4 4 F 4/15/2009 Woke up with severe pain yesterday
344218 4/15/2009 MI 55 55 M 4/15/2009 PPV vacine shot on 4/13, 99.4 feve
344219 4/15/2009 CA 18 18 F 4/15/2009 States 2-3 days after recieving 1st G
344220 4/15/2009 CO 38 38 F 4/15/2009 One day post-vaccination with JE-V
344229 4/15/2009 DC 62 62 M 4/15/2009 This case was reported by a healthc
344232 4/15/2009 HI 1.2 1 0.2 M 4/15/2009 Petechial rash + bruising + oral blee
344233 4/15/2009 VA 9 9 F 4/14/2009 Fever to 101-102. (R) arm erythema
344234 4/15/2009 VA 2 2 0.5 M 4/14/2009 L septic hip requiring prolonged IV a
344235 4/15/2009 NY 0.2 0 0.2 F 4/15/2009 Pt. received vaccine 3/31/09. Prese
344236 4/15/2009 WI 1.5 1 0.5 M 3/19/2009 On 10.14.04 - Patient received FLU
344237 4/15/2009 NY 0.5 0 0.5 F 3/31/2009 Patient admitted to hospital for a bo
344238 4/15/2009 MO 19 19 M 4/15/2009 Red slightly raised sand paper type
344239 4/15/2009 MO 45 45 M 4/15/2009 Scattered red raised itching welts pe
344240 4/15/2009 VA 6 6 F 4/14/2009 L upper arm cellulitis at injection site
344241 4/15/2009 VA 6 6 M 4/14/2009 R upper arm cellulitis at injection sit
344242 4/15/2009 IL 49 49 F 4/15/2009 Hives around neck, hairline and bila
344243 4/15/2009 AL 1.1 1 0.1 F 4/15/2009 Erythematous rash, swelling of hand
344244 4/15/2009 NH 0.2 0 0.2 M 4/9/2009 Having runny yellow diarrhea stools
344245 4/15/2009 NC 21 21 M 4/13/2009 Fainted - had not eaten.
344246 4/15/2009 IA 52 52 F 4/13/2009 3/25/09 received vaccination. 3/30/0
344247 4/15/2009 MO 0.2 0 0.2 M 4/13/2009 Patients mother called office approx
344248 4/15/2009 CA 62 62 F 4/15/2009 Pt noticed there was a 4" circle at in
344249 4/15/2009 CA 41 41 F 3/18/2009 Onset of mild - mod fever, nausea,
344250 4/15/2009 CA 14 14 F 4/15/2009 Redness with swelling to R deltoid.
344251 4/15/2009 CA 0.5 0 0.5 F 4/15/2009 Seizure with fever T 103.8.
344252 4/15/2009 WA 11 11 M 4/15/2009 See attached chart note dated 4-15
344304 4/15/2009 MA 23 23 M 4/10/2009 Headache, fever muscle weakness.
344305 4/15/2009 1.2 1 0.2 F 4/11/2009 Blisters on back and on face.
344221 4/16/2009 CA 0.3 0 0.3 F 4/15/2009 ABOUT H+4 HOURS AFTER WE N
344255 4/16/2009 WI 19 F 4/15/2009 Information has been received from
344260 4/16/2009 CA 36 36 F 4/13/2009 This serious case was received on 0
344262 4/16/2009 CA 0.6 0 0.6 F 4/13/2009 Initial SAE report received on 04 Ap
344264 4/16/2009 PA 42 42 F 4/16/2009 Pain, redness, swelling, fever(101),
344265 4/16/2009 NJ 1.6 1 0.6 M 4/16/2009 LARGE RED LUMP WITH BLISTER
344266 4/16/2009 VA 0.2 0 0.2 F 4/13/2009 Parents reported blank stare and un
344268 4/16/2009 NM 31 31 F 4/16/2009 I had local pain, irritation, swelling, a
344269 4/16/2009 FL 0.2 0 0.2 M 4/16/2009 Polyarticular arthritis within 3days o
344270 4/16/2009 NC 54 54 F 4/16/2009 Client c/o pain from Lt shoulder eigh
344271 4/16/2009 CT 0.2 0 0.2 M 4/16/2009 He received his vaccination on Mon
344272 4/16/2009 OR 58 58 F 4/16/2009 Client reports that 3 weeks after rec
344273 4/16/2009 NY 68 68 M 4/16/2009 Right upper arm swelling, edema an
344274 4/16/2009 SD 18 18 M 4/3/2009 Severe H/A, Stiff Neck Temp 100
344275 4/16/2009 NY 5 5 M 4/16/2009 Less than 1 minute after administer
344277 4/16/2009 TX 1 1 0F 4/16/2009 seizures, Anemia, low red and white
344278 4/16/2009 AK 62 62 F 4/16/2009 5 hours after vaccination, became o
344279 4/16/2009 CA 0.5 0 0.5 F 4/16/2009 GAVE ROTARIX AT 6 MONTHS OF
344280 4/16/2009 MD 4 4 F 4/16/2009 PATIENT HAD A REACTION ON LE
344281 4/16/2009 SC 1.3 1 0.3 M 4/16/2009 vaccine given in left thigh, brought b
344282 4/16/2009 CA 48 47 F 4/16/2009 LOCALIZED REACTION ON (R)UP
344283 4/16/2009 CA 0.5 0 0.6 F 4/16/2009 A black dot appeared on infant's rig
344284 4/16/2009 CO 62 62 F 4/16/2009 EDEMA, ERYTHEMA, PRURITIS, S
344285 4/16/2009 WA 17 17 F 4/16/2009 3 days post vaccination, patient had
344291 4/16/2009 NC 5 5 F "Red, hot swollen size of dollar bill"
344292 4/16/2009 NC 15.7 15 F 7 x 7 cm raised erythematous plaqu
344293 4/16/2009 PA 13 13 M 4/15/2009 Fever 101, headache, malaise durin
344294 4/16/2009 0.6 M 4/9/2009 PEDIARIX given R thigh 4-1-09 per
344295 4/16/2009 CA 16 16 F 4/16/2009 Patient was given the GARDASIL #
344296 4/16/2009 PA 4 4 F 4/16/2009 Mom called office 4/16/09 0900 to r
344297 4/16/2009 NY 35 35 F 4/13/2009 Pt presented to PCP 1 wk after she
344298 4/16/2009 UT 21 21 F 4/13/2009 Fever, runny nose, itching started e
344299 4/16/2009 MI F 4/14/2009 Administration of ZOSTAVAX 4-7-0
344300 4/16/2009 FL 28 28 F 4/10/2009 Received FLUZONE vaccine on 9/1
344301 4/16/2009 PR 43 43 M 4/1/2009 1 hr after vaccine: Headache, neck
344302 4/16/2009 NC 1 1 0F 4/2/2009 3-4 cm area of redness - right thigh
344303 4/16/2009 PA 1.5 1 0.5 F 4/15/2009 Below vaccines were given at abou
344306 4/16/2009 MA 65 65 F 4/16/2009 Developed rash on forearms 7 days
344307 4/16/2009 FL 14.4 14 F 4/16/2009 After receiving shot in AM of 4-7-09
344308 4/16/2009 IA 76 76 F 4/16/2009 Received ZOSTAVAX 1500 on 4/8/
344309 4/16/2009 UT 4 7 M 4/16/2009 Rec'd vaccines 4/15 - 4/16 awoke w
344310 4/16/2009 CA 0.2 0 0.2 M 4/16/2009 Cried non-stop for at least an hour.
344311 4/16/2009 NC 11 11 M 4/16/2009 Swelling, erythema, warmth & indur
344312 4/16/2009 MS 3 3 F 4/16/2009 Right thigh hot, swollen and red at i
344313 4/16/2009 KY 14 14 F 4/16/2009 Chest pain, slight shortness of brea
344326 4/17/2009 NH 10 U 5 cm indurated local reaction.
344327 4/17/2009 NH 13 13 M 4/16/2009 Large local reaction 10-12 cm, with
344328 4/17/2009 MS 0.5 0 0.5 F Fever morning after vaccine T max
344329 4/17/2009 CA 4 4 F 4/10/2009 Child had a DTAP on 4/09/09. Bene
344330 4/17/2009 PA 19 19 F 3/26/2009 3/20/09 had GARDASIL #2 at appro
344332 4/17/2009 OR 14 14 F 4/8/2009 Pt. had acute onset of severe vomit
344333 4/17/2009 GA 6 6 F 4/14/2009 Chicken Pox with HX of one dose o
344334 4/17/2009 IA U None Stated
344335 4/17/2009 NY 56 56 F 4/13/2009 Same evening arm soreness + swe
344336 4/17/2009 NY 13 13 F 4/10/2009 Headache, bodyache, some nausea
344337 4/17/2009 WA 0.2 0 0.2 F 3/24/2009 Patient's leg starting swelling right a
344338 4/17/2009 OH 22 22 F 4/10/2009 Rash on stomach, chest, genitals
344339 4/17/2009 MI 9 9 M 4/14/2009 Right arm swollen, red, and hot to th
344340 4/17/2009 KS 0.2 0 0.2 M 4/9/2009 [As reported to me by ER physician
344341 4/17/2009 PA 1 1 0M 4/11/2009 04/09/09 vomit, diarrhea, stomach p
344343 4/17/2009 MI 73 73 M 4/17/2009 Patient developed chills overnight a
344344 4/17/2009 AL 4 4 M 4/17/2009 Phone call from parent on 4/15/09 @
344345 4/17/2009 OH 17 17 F 4/17/2009 Initial fatigue, headaches, muscle cr
344346 4/17/2009 CO 66 66 M 4/17/2009 ON 04/12/2009, PT BROKE OUT O
344347 4/17/2009 KS 80 F 4/17/2009 The patient received the Zostavax v
344348 4/17/2009 KS 80 80 F 4/17/2009 The patient received the Zostavax v
344349 4/17/2009 MN 69 U 4/17/2009 Subject in pneumococcal vaccine tr
344350 4/17/2009 VA 3 3 F 4/17/2009 Parent noted redness and swelling
344351 4/17/2009 WI 10 10 M 4/17/2009 Pt received immunizations and abou
344352 4/17/2009 MS 2 2 0.6 M 4/17/2009 moderate sized erythema to left thig
344353 4/17/2009 MT 12 12 M 4/17/2009 Patient developed red "Rash" accor
344354 4/17/2009 WA 41 41 F 4/17/2009 Received Tdap vaccination on 4/13
344355 4/17/2009 MO 37 37 F 4/17/2009 I developed I large area around the
344356 4/17/2009 OH 34 34 F 4/17/2009 Redness and swelling at injection si
344357 4/17/2009 TX 13 13 F 4/17/2009 fatigue,headache ,feels warm ,no fe
344358 4/17/2009 PA 79 78 F 4/17/2009 Patient had some redness appear a
344359 4/17/2009 OR 4 4 M 4/17/2009 Tolerated immunizations fine Given
344360 4/17/2009 MN 5 5 F 4/17/2009 PT LEFT ARM SWOLLEN AND WA
344361 4/17/2009 FL 0.2 0 0.2 F 4/17/2009 Intussusception 4/29/09 Received h
344362 4/17/2009 MD 9 0 0.2 M 4/17/2009 right arm red and swollen and vomit
344363 4/17/2009 LA 15 15 F 4/17/2009 During summer of 2008, patient had
344364 4/17/2009 NY 74 74 F 4/17/2009 Vaccinated with Pneumovax on 3/3
344365 4/17/2009 TX 14 14 F 4/17/2009 Palm size hot swelling at injection s
344366 4/17/2009 CA 5 5 M 4/17/2009 PT REPORTS LOCALIZED (R) UPP
344367 4/17/2009 PA 63 62 F 4/17/2009 Red rash on left arm (arm of injectio
344368 4/17/2009 CA 53 53 F 4/17/2009 Warm, redness and tenderness 6x1
344369 4/17/2009 CA 53 53 M 4/17/2009 6x8 cm area around injection site te
344370 4/17/2009 CA 51 48 F 4/17/2009 Left deltoid = 4x5 cm area of erythe
344371 4/17/2009 PA 0.4 0 0.4 F 4/17/2009 Paleness, vomiting, lethargic, breath
344376 4/17/2009 IN 0.5 0 0.5 M 4/17/2009 Erythematous, warm 7X7 cm. indura
344377 4/17/2009 PA 4 4 M 4/17/2009 Local erythema + induration 3X2 cm
344378 4/17/2009 WY 20 20 F 4/11/2009 After immunization was given pt we
344379 4/17/2009 NJ 4 4 M 4/17/2009 Localized reaction right upper arm +
344380 4/17/2009 NM 1.6 1 0.6 M 4/18/2009 None
344381 4/17/2009 UT 4 7 M 4/16/2009 Rec'd vaccines 4/15 - 4/16 awoke w
344382 4/17/2009 FL 1.2 M 4/17/2009 Pt had fever followed by generalized
344383 4/17/2009 WA 1.3 1 0.3 M 4/16/2009 Pts mom called on 4/16/09 & said 4
344384 4/17/2009 IL 10 10 F 4/13/2009 Patient started on GARDASIL serie
344726 4/17/2009 CA 18 18 F 4/14/2009 Information has been received throu
344730 4/17/2009 PA 14 14 F 4/14/2009 Information has been received via th
344732 4/17/2009 VA 23 23 F 4/14/2009 Information and follow up informatio
344739 4/17/2009 14 F 4/14/2009 Initial and follow-up information has
344741 4/17/2009 TN 15 15 F 4/14/2009 Initial and follow-up information has
344742 4/17/2009 DC 17 17 F 4/14/2009 Information has been received from
345229 4/17/2009 MI 15 15 F 4/14/2009 Information has been received for th
345237 4/17/2009 OK F 4/14/2009 Information hs been received from a
345242 4/17/2009 NE F 4/14/2009 Information has been received from
345276 4/17/2009 MD F 4/14/2009 Information has been received from
345284 4/17/2009 GA F 4/14/2009 Information has been received from
345290 4/17/2009 WI F 4/14/2009 Information has been received from
344372 4/18/2009 TX 79 79 F 4/18/2009 Red oval (3/8" x l-l/8") around inject
344373 4/18/2009 NY 20 20 F 4/18/2009 Patient inadverently given expired d
344374 4/18/2009 NJ 25 25 F 4/18/2009 Extreme fatigue (20 hours of sleep f
344375 4/19/2009 CA 4 4 M 4/19/2009 Left deltoid area induration 10- to 15
344385 4/20/2009 CA 16 F 4/17/2009 InformationYhas been received from
344386 4/20/2009 U 4/17/2009 Information was received from an in
344399 4/20/2009 64 M 4/20/2009 A 64-year-old
Y male patient was adm
344414 4/20/2009 MS 78 78 M 4/3/2009 Drooling, very slurred speech, loss o
344415 4/20/2009 NY 68 68 F 4/17/2009 Papular rash, left groin area, about
344416 4/20/2009 ID 5 5 M 4/1/2009 Pt woke up this am with redness to
344417 4/20/2009 ID 4 4 F 4/10/2009 Pt noticed itching to right arm 2d aft
344418 4/20/2009 ID 5 5 M 3/23/2009 Pt here in clinic today with chicken p
344419 4/20/2009 ID 4 4 F 4/1/2009 Pt's mom states that pt c/o pain with
344420 4/20/2009 VI 13 13 F 4/20/2009 Client state "notice bumps on body
344421 4/20/2009 NY 64 64 F 4/3/2009 PNEUMOVAX given on 4/1/09 - had
344422 4/20/2009 TX 1 1 0M 4/16/2009 As per mom Pt swollen to Lt thigh.
344423 4/20/2009 TX 40 40 F 4/15/2009 Patient developed pain/tenderness
344424 4/20/2009 MI 1.1 1 0.1 M 4/14/2009 Pt with rash that developed 10 days
344425 4/20/2009 OH 5 5 M 4/15/2009 At site of DTaP noticed red welt on
344426 4/20/2009 IN 2 2 0M 4/16/2009 4-14-09 Mother brought pt to office
344427 4/20/2009 23 23 M 4/20/2009 I received 5 doses of the Anthrax va
344428 4/20/2009 FL 11 11 F 4/20/2009 Hives and swelling of face and eyes
344429 4/20/2009 CA 5 5 M 4/20/2009 Three days after being immunized,
344430 4/20/2009 LA 18 18 M 4/20/2009 Severe joint stiffness-difficulty in get
344431 4/20/2009 NY 3 3 F 4/20/2009 Patient was given Chicken Pox (Var
344432 4/20/2009 NC 4 4 M 4/20/2009 localized rash on left thigh, red patc
344433 4/20/2009 IL 1.5 1 0.5 F 4/20/2009 Mother of child reported that child h
344434 4/20/2009 CA 0.3 0 0.3 M 4/20/2009 Got a fever after 48 hours of receivi
344435 4/20/2009 OH 1 1 0F 4/20/2009 vaccines admin 01/08/09, pt started
344436 4/20/2009 OH 0.2 0 0.2 F 4/20/2009 fussy and lowgrade fever day of imm
344437 4/20/2009 MD 12 12 F 4/20/2009 Pt stated that twice since administra
344438 4/20/2009 SD 15 15 F 4/15/2009 Fever 1 day after vaccinations, Face
344439 4/20/2009 LA 49 49 F 4/20/2009 Was aware of soreness in arm 4/18
344440 4/20/2009 WI 12 12 F 4/20/2009 After recieving vaccine, Mariah start
344442 4/20/2009 VA 12 12 F 4/20/2009 Localized swelling at injection site. R
344443 4/20/2009 OK 18 18 F 4/20/2009 No complaints-screened Jan 13, 20
344444 4/20/2009 OR 22 22 F 4/20/2009 Left sided facial redness, itching an
344445 4/20/2009 GA 0.2 0 0.2 M 4/20/2009 Apparant SIDS/Post
Y Mortem Exam
344446 4/20/2009 FL 79 79 F 4/20/2009 I had the shingles vaccine on April 1
344447 4/20/2009 FL 14 14 F 4/20/2009 fever, vomiting,malise, headache co
344448 4/20/2009 UT 26 26 M 4/15/2009 Fever (102 degrees F) lasting 36 ho
344449 4/20/2009 OR 16 16 M 4/11/2009 Local reaction at injection site, left d
344450 4/20/2009 MN 13 13 M 4/13/2009 Redness and swelling at injection si
344451 4/20/2009 NY 1 F 4/14/2009 Child started with erythematous ma
344452 4/20/2009 19 19 M Vasovagal episode Records recieve
344453 4/20/2009 OH 1.2 1 0.2 M 4/14/2009 Swelling at sight of injection.
344454 4/20/2009 NH 21 21 U Pt complained of severe pain at site
344455 4/20/2009 CA 4 4 M 4/16/2009 Left leg swollen to the knee. No pa
344456 4/20/2009 CA 1.8 1 0.8 M 4/2/2009 Family took patient to walk-in vaccin
344457 4/20/2009 CA 1.3 1 0.3 F 4/13/2009 Swelling, pain, high fever due to mis
344458 4/20/2009 CA 3 3 M 4/9/2009 Pain, fever and swelling due to mist
344459 4/20/2009 OH 11 11 M 4/15/2009 BOOSTRIX given in (L) deltoid on 4
344460 4/20/2009 NY 4 4 M 4/10/2009 Bullae at injection site within 24 h (a
344461 4/20/2009 RI 76 76 M 4/20/2009 This case was reported via medical
344463 4/20/2009 MD 0.4 0 0.4 F 4/15/2009 2 - PREVNAR administered on 4/13
344464 4/20/2009 NY 4 4 M 4/13/2009 10 minutes after shot: body aches-
344466 4/20/2009 MN 30 30 M 4/14/2009 Pt had the TDAP vaccine 10-29-08.
344467 4/20/2009 LA 53 53 F 4/6/2009 4/4/09 Sat. noon sudden onset with
344468 4/20/2009 NY 31 31 M 4/20/2009 Swelling of arm at injection site, diar
344469 4/20/2009 TX 28 M 4/13/2009 None stated.
344470 4/20/2009 MN F 4/13/2009 Extremely swelling to the site. Moth
344471 4/20/2009 NE 0.6 0 0.6 M 4/20/2009 6 mos had 3 seizures following 6 mo
344472 4/20/2009 CA 76 76 F 4/18/2009 2 days after vaccination, patient had
344473 4/20/2009 CA 72 72 F 4/20/2009 Rash, itch, rhinorrhea started the fo
344477 4/20/2009 IL 0.7 0 0.7 F 4/17/2009 03/21/2009 started with cold & coug
344478 4/20/2009 PA 1.4 1 0.4 M Vesicles and ulcers over scrotum, tr
344479 4/20/2009 CA 0.1 0 0.1 F 4/20/2009 Hives, swollen feet + hands
344480 4/20/2009 MN 1.4 1 0.4 M 4/15/2009 Within 48 hours, he had an 11 cm s
344481 4/20/2009 MI 64 64 F 4/20/2009 Cellulitis (R) upper arm. Started on
344482 4/20/2009 1 1 0M 4/20/2009 Chicken pox. Patient had vaccine o
344483 4/20/2009 KY 4 4 F 4/17/2009 Local reaction 4x5cm, induration an
344484 4/20/2009 PA 1 0 1F 4/20/2009 Patient experienced a seizure appro
344485 4/20/2009 TX 12 12 F 4/20/2009 As per patient on off dizziness since
344486 4/20/2009 RI 13 13 F 4/17/2009 Syncope post GARDASIL and MEN
344487 4/20/2009 CT 34 34 M 4/20/2009 Developed fever approximately 8 ho
344488 4/20/2009 NV 19 19 M 4/17/2009 Student had fever 100.1 and chills.
344489 4/20/2009 CO 55 F 4/16/2009 Headache, nausea after 1st shot, re
344490 4/20/2009 15 15 M 4/15/2009 Patient given VARICELLA & MENA
344491 4/20/2009 CT 5 5 M 4/17/2009 Sneezing, congestion, swallowing fr
344492 4/20/2009 NY 1.4 1 0.4 M 4/20/2009 04/16/2009 Mother called and spok
344493 4/20/2009 MN 28 28 U 4/20/2009 Pt received SPV left arm on 4/4/09.
344494 4/20/2009 CA 2 2 0.1 M 4/20/2009 Urticaria started 48-72 hours after H
344495 4/20/2009 VA 2 2 0.3 M 4/20/2009 Oval upper thigh induration 10x9cm
344496 4/20/2009 VA 5 5 F 4/20/2009 Within minutes of the DTAP, pt had
344497 4/20/2009 SC 76 76 F 4/17/2009 Patient developed shingles 4/15/09.
344498 4/20/2009 CA 15 15 F 4/15/2009 Per mother of Pt; Pt arms became t
344897 4/20/2009 MD 4 4 F 3/12/2009 A non-serious, spontaneous report
344898 4/20/2009 MD 1.3 1 0.3 F 3/12/2009 A non-serious, spontaneous report
344499 4/21/2009 WI 11 11 F 4/9/2009 Received MENACTRA 4/8/09 at 4:1
344500 4/21/2009 CT 9 9 F 4/14/2009 5 minutes post vaccine -> felt dizzy,
344501 4/21/2009 AZ 4 4 M 4/15/2009 Pt presented with Sx of allergic Rxn
344502 4/21/2009 FL 32 32 F 4/15/2009 Rash Tightness of chest next day.
344503 4/21/2009 CA 16 16 F 4/16/2009 After Gardasil #3 woke up with shou
344504 4/21/2009 NC 14 14 F 4/15/2009 Hives on face and trunk extremities.
344505 4/21/2009 OH 1 1 0F 4/16/2009 Pt seen with vesicular rash on trunk
344506 4/21/2009 MA 1 1 0M 4/16/2009 3/30/09 physical with immunization
344508 4/21/2009 U 4/20/2009 Via agency concerning a patient wh
344518 4/21/2009 TX M 4/17/2009 Initial report received 07 April 2009
344521 4/21/2009 0.4 0 0.4 M 4/20/2009 Initial report received 09 April 2009
344524 4/21/2009 WI 1.5 1 0.5 F 4/14/2009 Syncopal episode, fever - 102.7, pa
344525 4/21/2009 MS 5 5 M 4/3/2009 Mom stated child c/o pain, redness
344526 4/21/2009 VA 0.3 0 0.3 M 4/16/2009 Approximately 15-20 minutes after v
344527 4/21/2009 CA 13 13 F 4/15/2009 About 5-10 min after vaccination giv
344528 4/21/2009 NY 0.8 0 0.8 M 4/16/2009 Fever to 102 degrees and diffuse ur
344529 4/21/2009 IL 11 11 M 4/10/2009 Seen on 4/10/09 left deltoid noted to
344530 4/21/2009 NC 1.5 1 0.5 F 4/8/2009 Child received vaccination on 3-27-2
344531 4/21/2009 MA 35 35 F 4/16/2009 Pt reported swelling and hardness a
344532 4/21/2009 VA 1 1 0F 4/16/2009 Blue blotches over body, especially
344533 4/21/2009 CA 0.2 0 0.2 M 4/13/2009 2 mo old male received vaccines 4/1
344534 4/21/2009 TX 40 40 F 4/15/2009 Rec'd varicella 4/7/09. At 3:30am on
344535 4/21/2009 IL 13 13 M 4/16/2009 Patient had swelling and pain of inje
344536 4/21/2009 TX 66 66 F 4/21/2009 Patient came down with shingles wi
344537 4/21/2009 TX 73 73 F 4/21/2009 Patient developed painful rash with
344538 4/21/2009 IL 68 68 F 4/21/2009 Shingles vaccine administered 04/1
344539 4/21/2009 NY 6 M 4/21/2009 Child received PPD and Flu vaccine
344540 4/21/2009 LA 1 1 0M 4/21/2009 15 minutes following injection of var
344541 4/21/2009 VA 0.2 0 0.2 F 4/21/2009 On 4/15 and 4/16 baby was cranky
344542 4/21/2009 CA 58 58 F 4/21/2009 Increase itching and rash on arm wh
344543 4/21/2009 NC 14 14 M 4/21/2009 red, swollen, hot area where vaccin
344544 4/21/2009 FL 1 M 4/21/2009 About 12 days after getting Proquad
344545 4/21/2009 22 22 M 4/21/2009 Unspecified disease of the pericard
344546 4/21/2009 NC 12 12 M 4/21/2009 red, swollen, hot area around where
344547 4/21/2009 WI 21 21 F 4/21/2009 On day of administration, had flu-lik
344548 4/21/2009 MO 8 0 0F 4/21/2009 NO ADVERSE EVENT-MD ORDER
344549 4/21/2009 CT 12 12 F 4/21/2009 Syncopal episode fainted
344550 4/21/2009 PA 11 11 M 4/21/2009 Pt recieved tdap and varicella and p
344551 4/21/2009 MI 13 13 M 4/21/2009 Patient received a Tdap and 1st He
344552 4/21/2009 CO 51 51 M 4/21/2009 Two days following Twinrix vaccine
344553 4/21/2009 AL 1.1 1 0.1 F 4/21/2009 2 day h/o rash starting on face and
344554 4/21/2009 CO 35 35 M 4/21/2009 fever body aches HA vomitng for 3
344555 4/21/2009 CA 18 F 4/21/2009 Given HPV injection approx. 8:20 a.
344556 4/21/2009 NY 14 14 F 4/21/2009 Previous diagnosis to vaccine-Hypo
344564 4/21/2009 M 4/21/2009 This case was reported via medical
344566 4/21/2009 ME 21 21 M 4/20/2009 Received vaccines 4/2, on 4/9 deve
344567 4/21/2009 NC 0.6 0 0.6 F 4/21/2009 Child ran a fever up to 104 with last
344568 4/21/2009 MA 1.7 1 0.7 M 3/26/2009 Patient received DTap and VARIVA
344569 4/21/2009 MA 1.3 1 0.3 F 3/26/2009 Patient received DTap vaccine in le
344570 4/21/2009 KS 12 12 M 4/20/2009 Sore throat, difficulty swallowing, ho
344571 4/21/2009 NE 5 5 M 4/21/2009 Large target lesion (7cm x 5 cm) wit
344572 4/21/2009 CA 53 53 F 4/15/2009 Pt c/o mild pain at left upper arm at
344573 4/21/2009 IL 20 20 M 4/21/2009 Fever and cold sweats and chills 4-2
344574 4/21/2009 AZ 1 1 0M 4/21/2009 Erythema on L thigh with chicken po
344575 4/21/2009 OH 12 12 F 4/21/2009 Erythematous papular and plaque li
344576 4/21/2009 NC 20 20 F 4/13/2009 Received smallpox 31 Mar 09 Lt up
344577 4/21/2009 41 41 U 7/28/2008 This is a follow-up to a previously su
344578 4/21/2009 MN 5 5 F Nausea, vomiting and diarrhea, sub
344579 4/21/2009 TN 0.5 0 0.5 F 4/20/2009 Knot upper (R) leg.
344580 4/21/2009 KS 1.3 1 0.3 M 4/17/2009 Fever, decreased appetite, rash, sh
344581 4/21/2009 CA 11 11 F 4/10/2009 After vaccines were given the patien
344582 4/21/2009 FL 1 1 0F 4/21/2009 Sudden (<15min) onset of facial sw
344583 4/22/2009 MN 15 15 F Immediately after vaccination, eyes
344584 4/22/2009 NY 14 14 F 4/20/2009 Since 8/5/08, 2 wks after her 2nd G
344585 4/22/2009 RI 0.3 F 4/10/2009 On 4/15/09 Patient brought by pare
344586 4/22/2009 NJ 1.5 1 0.5 M 4/17/2009 Choking during swallowing; Febrile
344587 4/22/2009 UT 44 44 F 4/17/2009 Fatigue after immunization. Woke u
344588 4/22/2009 WA 12 12 F 4/17/2009 Immediately after receiving 2nd GAR
344589 4/22/2009 MI 58 58 M 4/9/2009 Customer is having tingling sensatio
344590 4/22/2009 TX 12 12 F 4/17/2009 Patient was given Hep A 1st, then H
344591 4/22/2009 KY 12 M 4/17/2009 area of redness where injection give
344592 4/22/2009 21 21 M 4/19/2009 10 days after vaccine with smallpox
344593 4/22/2009 87 87 M 4/17/2009 @ 18 hrs after injection erythematou
344594 4/22/2009 NC 0.2 0 0.2 F 4/17/2009 Hematochezia, twice - Fussiness - C
344595 4/22/2009 GA 0.2 0 0.2 M 4/21/2009 InformationYhas been received from
344596 4/22/2009 MT 5 5 F 4/16/2009 3" area of erythema, induration at Iz
344597 4/22/2009 NH 0.6 0 0.6 F 4/6/2009 HIB vaccine was mixed with sterile w
344609 4/22/2009 AZ 13 13 F 4/21/2009 Initial and additional information has
344616 4/22/2009 MO 15 15 F 4/22/2009 Mother reports child woke up "Sund
344617 4/22/2009 WI 1 1 0F 4/22/2009 Patient developed a skin infection a
344618 4/22/2009 DC 16 16 F 4/22/2009 PT RECEIVED DTAP INSTEAD OF
344619 4/22/2009 AR 4 4 M 4/22/2009 Left upper arm from just above elbo
344620 4/22/2009 NC 32 32 F 4/22/2009 Patient had loss of consciousness a
344621 4/22/2009 MA 0.2 0 0.2 F 4/22/2009 Child received 2 month vaccines as
344622 4/22/2009 IN 18 18 F 4/22/2009 Patient received vaccinations and a
344623 4/22/2009 DC 7 7 M 4/22/2009 THIRD VARICELLA VACCINE REC
344624 4/22/2009 IA 17 17 F 4/22/2009 Patient turned pale and diphoretic a
344625 4/22/2009 IA 4 4 F 4/22/2009 Red and inderated at injection site.
344626 4/22/2009 MN 5 5 M 4/22/2009 Large local reaction from left elbow
344627 4/22/2009 NC 0.3 0 0.3 M 4/22/2009 3 days after receiving his 4 month b
344628 4/22/2009 CA 4 4 M 4/22/2009 WITHIN 24 HR OF VACCINES, PT
344629 4/22/2009 CA 4 4 M 4/22/2009 LT DELTOID MACULAR RASH,MIL
344630 4/22/2009 CA 14 14 M 4/22/2009 developed large local reaction at sit
344631 4/22/2009 CT 63 63 F 4/22/2009 This case was reported by a lawyer
344634 4/22/2009 TX 11 11 M 4/21/2009 Patient became dizzy, pale, clammy
344635 4/22/2009 NY 39 39 F 4/22/2009 Received telephone call from patien
344636 4/22/2009 NC 36 36 M 4/21/2009 34 y/o ADSM referred from aid stati
344637 4/22/2009 IN 22 F 4/21/2009 Non stated.
344638 4/22/2009 MI 60 60 U Pt given injection 02/13/2009 @ 4:0
344639 4/22/2009 TX 53 53 F 4/23/2009 MMR given on 4/8/2009. Pt noted s
344640 4/22/2009 CA 21 21 M 4/22/2009 Patient vaccinated with Hepatitis A
344641 4/22/2009 VA 4 4 F 4/22/2009 Left thigh large area redness/heat d
344642 4/22/2009 SC 0.2 F After leaving office, parents report b
344643 4/22/2009 NC 67 67 F Vax given on 4/17 - Sore, red and it
344644 4/22/2009 MN 4 4 F 4/21/2009 Swollen left thigh around on a or inj
344646 4/22/2009 NC 17 17 F 4/21/2009 Patient had hives 3 days after gettin
345005 4/22/2009 NE 18 F 4/7/2009 Information has been received from
344648 4/23/2009 ID 6 6 M 4/12/2009 Redness, swelling ANT LT Thigh, d
344650 4/23/2009 NC 3 3 M 4/18/2009 10 X 12 cm red patch on L thigh 2 d
344652 4/23/2009 5 M 4/22/2009 This case was considered medically
344653 4/23/2009 CA 0.7 0 0.7 F 4/20/2009 Rash appeared over mid back and b
344655 4/23/2009 IL 69 69 F 4/20/2009 Call from immunization clerical staff
344657 4/23/2009 WA 0.4 0 0.4 M 4/19/2009 Mother called Pt. crying, unable to c
344660 4/23/2009 MI 5 5 F 4/17/2009 After receiving a HEP A injection pt
344662 4/23/2009 NM 12 12 F 4/16/2009 Acute erythema and edema extend
344665 4/23/2009 OH 4 4 M 4/21/2009 3-12-09. Mom called re: 4 bumps to
344667 4/23/2009 IN 38 38 M 4/23/2009 Pt. c/o H/A (intense when moves he
344668 4/23/2009 MI 0.7 0 0.7 M 4/23/2009 Mother states that a few hours after
344669 4/23/2009 PA 15 15 F 4/23/2009 SCHOOL NURSE PHONED TO SA
344670 4/23/2009 WI 4 4 M 4/23/2009 On evening of 4/22/09, the day afte
344671 4/23/2009 NH 0.2 0 0.2 F 4/23/2009 WCC done on 4/15/09 at which time
344672 4/23/2009 AL 52 52 M 4/23/2009 Extreme muscle pain in the deltoid a
344673 4/23/2009 UT 18 18 M 4/23/2009 Took 1st dose of oral typhoid in the
344674 4/23/2009 CA 4 4 F 4/23/2009 After administration of a subcutaneo
344675 4/23/2009 SD 21 21 F 4/23/2009 Diarrhea nausea w/o emesis and Cr
344676 4/23/2009 CA 4 4 F 4/23/2009 After a subcutaneous injection of th
344677 4/23/2009 ND 50 F 4/23/2009 RECEIVED T-DAP 4/1/09 AT BEGI
344678 4/23/2009 PA 61 61 F 4/23/2009 developed severe pain at injection s
344679 4/23/2009 MI 21 21 F 4/23/2009 Within 2-3 minutes after second vac
344681 4/23/2009 NC 38 38 F 4/23/2009 On 4/21/2009, arm was sore and re
344682 4/23/2009 WI 51 51 F 4/23/2009 L upper arm redness, swelling, feve
344683 4/23/2009 NC U 4/23/2009 Site where shingles vaccine adminis
344684 4/23/2009 PA 61 61 M 4/23/2009 This case was reported by a lawyer
344690 4/23/2009 ID 45 45 F 4/23/2009 This case was reported by a consum
344691 4/23/2009 VT 16 16 F 4/23/2009 After leaving office Pt had a delayed
344692 4/23/2009 OR 65 65 F 4/22/2009 4 hours after injection - pain at site -
344693 4/23/2009 CO 8 8 M 4/1/2009 Temperature starting within 24 hour
344694 4/23/2009 MO 4 4 F 4/23/2009 Left arm is red, swollen, itchy
344695 4/23/2009 NY 1.3 1 0.3 F 4/23/2009 Fever 101 degrees (rectal) on 4/23/
344696 4/23/2009 PA 11 11 F 4/16/2009 Pt noticed red area on LA last night
344697 4/23/2009 IL 4 4 F 4/17/2009 5-10 min after vaccines given mom
344698 4/23/2009 WA 54 54 F 4/17/2009 Pt reported redness, swelling, pain
344699 4/23/2009 TN 5 5 M 4/22/2009 On 4/17/09, he was given MMR in r
344700 4/23/2009 KS 5 5 F 4/23/2009 10cm X 8cm redness & swelling aro
344701 4/23/2009 AK 1.4 1 0.4 F 4/23/2009 Mild rash appeared on arm in vicinit
344703 4/23/2009 CA 4 4 M 4/23/2009 4 y. o received varicella vaccine on
344704 4/23/2009 IN 5 5 M 4/23/2009 Red, warm to touch, inflammation in
344705 4/23/2009 AZ 5 5 M Pt L upper arm is red, hot to the tou
344707 4/23/2009 WA 31 31 M 4/23/2009 Raised irregular shaped welts - No t
344708 4/23/2009 GA 0.3 0 0.3 F 4/23/2009 fever fussiness symptomatic tx
344709 4/23/2009 NY 55 55 F 4/21/2009 pain, swelling, redness at site of inje
344710 4/23/2009 NC 70 70 F 4/22/2009 Soreness, swelling, heat (L) upper
344711 4/23/2009 TX 45 45 F 4/23/2009 Swelling, itching - burning - tired - a
344712 4/23/2009 IA 18 18 F 4/23/2009 Half hour post pt left boyfriend calle
344713 4/23/2009 NC 4 4 M 4/22/2009 Within 20 min child had cough, whe
344714 4/23/2009 WI 1 1 0M 4/17/2009 Red hard spot at injection site.
344715 4/23/2009 MA 1 1 0M 4/23/2009 presented 4/22/09 with rash.
344716 4/23/2009 CA 0.5 0 0.5 M 4/21/2009 Tactile. Fever and erythematous, bl
344702 4/24/2009 CA 0.4 0 0.4 M 4/23/2009 Parents report that after shots on 2-
344764 4/24/2009 LA 0.5 0 0.5 U 4/23/2009 Information has been received from
344766 4/24/2009 LA 0.5 0 0.5 U 4/23/2009 Information has been received from
344767 4/24/2009 WA 15 15 F 4/23/2009 Initial information has been received
344775 4/24/2009 NY 11 11 M 4/22/2009 Initial report was received 17 April 2
344786 4/24/2009 NY 30 30 F 4/24/2009 The evening of the vaccine swelling
344787 4/24/2009 IN 1.3 1 0.3 M 4/24/2009 The patient had a seizure on the Fri
344788 4/24/2009 IL 60 60 M 4/24/2009 This patient received travel vaccines
344789 4/24/2009 PA 85 85 F 4/24/2009 Recieved pneumonia vaccine 4/20/0
344790 4/24/2009 MD 61 61 F 4/24/2009 Right arm had slight swelling about
344791 4/24/2009 CA 16 16 M 4/24/2009 GAVE 2ND MCV
344792 4/24/2009 TX 0.4 0 0.4 F 4/24/2009 Patient received her 4 month vaccin
344793 4/24/2009 NV 14 14 F 4/24/2009 Symptoms started exactly 2 months
344794 4/24/2009 MA 62 64 F 4/24/2009 Patient was vaccinated 4/14. Prese
344795 4/24/2009 CA 52 52 F 4/24/2009 I had severe muscle pain in lower le
344796 4/24/2009 NY 0.4 0 0.4 M 4/24/2009 about 12 hoursY after receiving his va
344797 4/24/2009 CA 4 4 M 4/24/2009 Developed shortness of breath, whe
344798 4/24/2009 IN 15 15 M 4/24/2009 Patient experienced two episodes o
344799 4/24/2009 MI 18 19 F 4/24/2009 Within 10 minutes of receiving her fi
344800 4/24/2009 WY 18 18 F 4/9/2009 Within 24 hrs after receiving the imm
344801 4/24/2009 MO 43 43 F 4/24/2009 client called this facility and stated t
344802 4/24/2009 MN 5 5 M 4/24/2009 10 minutes after receiving MMR vac
344803 4/24/2009 FL 4 4 M 4/24/2009 After the vaccination on April 16th 2
344812 4/24/2009 F 4/24/2009 This case was reported by a lawyer
344816 4/24/2009 AR 0.2 0 0.2 M 4/21/2009 None stated. Y 6/22/09 Autopsy repo
344817 4/24/2009 NE 0.5 0 0.5 F 4/24/2009 Intussusception, Bilious vomiting, Irr
344818 4/24/2009 IL 4 4 F 4/16/2009 1545 vaccines emesis about 10 min
344819 4/24/2009 NC 0.5 0 0.5 M Intussusception, s/p surgical reduct
344820 4/24/2009 NJ 11 11 F 4/22/2009 My daughter received her second G
344822 4/24/2009 CA 91 91 F 4/25/2009 4/23/09 - reviewed PROTCOL ques
344824 4/24/2009 WA 40 40 F 4/24/2009 -migraine headache, - flu-like sympt
344825 4/24/2009 TX 1.5 1 0.5 F 4/23/2009 After receiving IM DTaP and IM PRE
344827 4/24/2009 NC 27 27 F 4/24/2009 4-20-09 pt was given a DTaP immu
344828 4/24/2009 AR 12 12 F 4/24/2009 Localized swelling, redness, and wa
344829 4/24/2009 AZ 35 35 F 4/24/2009 Body aches, shortness of breath, ve
344832 4/24/2009 NC 5 5 F 4/16/2009 The day of the she c/o itching at the
344833 4/24/2009 IN 5 5 F 4/24/2009 Known Cerebral Palsy, 1 seizure pe
344835 4/24/2009 FL 11 11 M 4/3/2009 R shoulder to elbow swollen twice th
344836 4/24/2009 GA 11 11 F 4/20/2009 Child received 2 chicken pox vaccin
344838 4/24/2009 RI 0.2 0 0.2 F 4/16/2009 Developed hives within 10 minutes
344841 4/24/2009 NY 25 24 M 4/20/2009 None stated.
344843 4/24/2009 CO 12 12 F 4/20/2009 About 2:30PM Hep A #1 given LA. A
344845 4/24/2009 CA 8 8 F 4/15/2009 Err:508
344846 4/24/2009 IL 9 9 M 4/17/2009 Received vaccines - approx 30 mins
344848 4/24/2009 WA 16 15 F 4/20/2009 Received GARDASIL shot. Approx
344850 4/24/2009 WV 4 4 M 4/17/2009 As related by parent, Pt.'s R arm an
344852 4/24/2009 TN 4.8 4 F 4/20/2009 Large red warm area without indura
344853 4/24/2009 NC 0.2 0 0.2 M 4/20/2009 Administered ROTATEQ orally befo
344854 4/24/2009 CT 58 58 F 4/16/2009 Patient is here for evaluation of dizz
344855 4/24/2009 LA 6 6 M 4/6/2009 Upper right arm within about 4" from
344870 4/24/2009 WV 3.8 3 M 4/14/2009 Patient was brought back to office 2
344872 4/24/2009 VA 1 1 0F 4/24/2009 Rash at injection site 2" x 1" rednes
344873 4/24/2009 CO 65 65 F 4/24/2009 Pt. c/o pain in Rt. deltoid about 2-3
344878 4/24/2009 MD 65 65 F I am almost 66, have always had a
345009 4/24/2009 1 1 0M 4/10/2009 This case was considered medically
345011 4/24/2009 1.5 1 0.5 F 4/10/2009 This case was considered medically
345012 4/24/2009 F 4/10/2009 This case was considered medically
345013 4/24/2009 1.6 M 4/10/2009 Information regarding PREVENAR w
345014 4/24/2009 1.4 1 0.4 M 4/10/2009 This case was considered medically
345015 4/24/2009 0.2 0 0.2 M 4/10/2009 Follow-up provided Quality Assuran
345016 4/24/2009 1.3 1 0M 4/10/2009 Follow-up received provided additio
345017 4/24/2009 0.5 0 0.5 M 4/10/2009 Information regarding PREVNAR wa
345022 4/24/2009 1 M 4/10/2009 Information regarding PREVNAR wa
345024 4/24/2009 0.5 F 4/10/2009 Information regarding PREVNAR wa
345030 4/24/2009 0.5 0 0.5 M 4/10/2009 Follow-up information provided patie
345125 4/24/2009 U 4/10/2009 Information regarding PREVNAR wa
345126 4/24/2009 0.4 0 0.4 F 4/10/2009 Information regarding PREVNAR wa
345128 4/24/2009 0.5 0 0.5 F 4/10/2009 Follow up information was received
345130 4/24/2009 0.5 0 0.5 F 4/10/2009 New information was received in do
345131 4/24/2009 0.2 0 0.2 U 4/10/2009 Information regarding PREVNAR wa
345133 4/24/2009 4 4 F 4/10/2009 Additional Information provided test
345135 4/24/2009 M 4/10/2009 Information regarding PREVENAR w
345251 4/24/2009 0.3 M 4/10/2009 Information regarding PREVNAR wa
345263 4/24/2009 0.8 U 4/10/2009 Information regarding PREVNAR wa
345265 4/24/2009 0.3 M 4/10/2009 Information regarding PREVNAR wa
345390 4/24/2009 0.6 0 0.6 M 4/10/2009 Additional information was received
345398 4/24/2009 0.3 U 4/10/2009 Information was received from a ped
345401 4/24/2009 1 U 4/10/2009 Information regarding PREVNAR wa
345402 4/24/2009 1.1 1 0.1 M 4/10/2009 Information was received from a hea
344804 4/25/2009 OR 11 11 F 4/25/2009 Pt developed a sore throat and feve
344805 4/25/2009 MT 65 65 F 4/25/2009 Localized injection site reaction. So
344806 4/25/2009 OR 1 1 0F 4/25/2009 Parents told me today at a sibling's
344807 4/25/2009 FL 40 40 F 4/25/2009 Warmth, redness, swelling, induratio
344808 4/25/2009 MD 39 39 F 4/25/2009 Intense sweating, chills, fainting, pa
344809 4/25/2009 WA 64 64 F 4/25/2009 Several hours after the vaccine my
344810 4/26/2009 TX 1 1 0F 4/26/2009 fever, diarrhea, crying (insolable), st
344811 4/26/2009 FL 76 75 M 4/26/2009 After shot(pneumococcal polysacch
344921 4/27/2009 WI 42 42 M 4/27/2009 reaction to small pox lot number VV
344922 4/27/2009 MS 20 20 M 4/27/2009 PT PRESENTS WIH SKIN IRRITAT
344923 4/27/2009 NY 41 40 M 4/27/2009 Pt received TD vaccination 18 April
344924 4/27/2009 CO 12 12 M 4/27/2009 Mom states son ran high fever (102
344925 4/27/2009 LA 58 58 M 4/27/2009 Local reaction at injection site. Red
344926 4/27/2009 TX 10 10 M 4/27/2009 SWELLING RIGHT ARM FROM DE
344927 4/27/2009 NC 13 12 F 4/27/2009 CLIENT GIVEN TDAP AND MENAC
344928 4/27/2009 IL 40 40 F 4/27/2009 Headache and fever reported on 4/3
344929 4/27/2009 IL 17 17 M 4/27/2009 Per mother, child started with fever
344930 4/27/2009 CA 50 50 F 4/27/2009 Diagnosed with severe arthus allerg
344931 4/27/2009 KS 1 1 0M 4/27/2009 Patient's father reports elevated tem
344932 4/27/2009 CA 40 40 M 4/27/2009 After I received the flu shot I develo
344933 4/27/2009 PA 1 0 0.1 M 4/21/2009 Fever of 104, not responding to infa
344934 4/27/2009 LA 6 6 F 4/27/2009 Immediately after receiving her seco
344935 4/27/2009 CO 64 64 M 4/27/2009 Started wuth pain on right leg and it
344936 4/27/2009 MN 17 17 F 4/27/2009 Soreness at site starting at 4/23 inc
344937 4/27/2009 AK 48 48 F 4/27/2009 Patient had increased pain that eve
344938 4/27/2009 MI 22 22 F 4/27/2009 autoimmune disease fibromyalgia, r
344941 4/27/2009 M 4/23/2009 Initial report was received on 21 Ap
344942 4/27/2009 WA M 4/23/2009 Initial report received on 21 April 20
344947 4/27/2009 MO 57 57 M 4/20/2009 Flu like symptoms for two to three w
344948 4/27/2009 AK 9 9 F 4/20/2009 On 4/20/09 pt came to my office - h
344950 4/27/2009 AZ 4 4 F 4/27/2009 Redness & swelling after inj. given &
344951 4/27/2009 AZ 1 1 0M On 3-25-09 pt presented with classi
344952 4/27/2009 CA 57 57 F 4/24/2009 Given tetanus shot in clinic on 4/21/
344953 4/27/2009 OH 29 29 F 3/26/2009 Approx. 1/2 hr after immunization gi
344954 4/27/2009 MA 4 4 F 4/20/2009 L deltoid area with redness, warmth
344955 4/27/2009 NY 18 18 F 4/16/2009 Pt's mom called doctors office 4/16/
344956 4/27/2009 CA 65 F 4/23/2009 Approx. 4-09-09 I started getting a '
344957 4/27/2009 CA 50 50 M 4/22/2009 Received Flu and PNEUMOVAX 3/2
344958 4/27/2009 IA 1.4 1 0.4 F 4/21/2009 1/7/09 Parent called, red puffy (R) le
344959 4/27/2009 TX 16 16 F 4/22/2009 Day after injection erythema and pru
344960 4/27/2009 CA 5 5 M 4/21/2009 Redness, swollen arm, hot tender
344961 4/27/2009 CA 4 4 M 4/21/2009 Redness, swelling of arm; Hot.
344962 4/27/2009 MN 12 12 M 4/17/2009 Blotchy rash, few hives occurring af
344963 4/27/2009 VT 21 21 F 4/20/2009 Pt received first GARDASIL injection
344964 4/27/2009 PA 36 36 M 4/20/2009 Rash on ankles, elbows, arms, and
344965 4/27/2009 CA 1.3 1 0.3 F 4/20/2009 Vomiting, loose stools, fever Tyleno
344966 4/27/2009 AL 44 44 F 4/20/2009 LP Rash, itching, Skin Inflammation
344967 4/27/2009 MI 17 17 F 4/21/2009 HPV# 2 4 1/2 hours after patient g
344972 4/27/2009 NY 5 5 F 4/27/2009 5 - 10 minutes after Pt received 2nd
344974 4/27/2009 VA 1 1 0M 4/26/2009 Local Varicella at VARIAX shot site
344975 4/27/2009 CA 71 71 F 4/24/2009 On 4-16-09 around 11:30 A.M. had
344977 4/27/2009 GA 15 15 F 4/22/2009 Member complained of itching at inj
344978 4/27/2009 OH 0.8 0 0.8 M 4/21/2009 Received vaccine 041409 fever low
344980 4/27/2009 WI 12 12 M 4/22/2009 Welts developed on back, abd, arm
344981 4/27/2009 CO 63 63 F 4/22/2009 Zoster out break along 2 T-11. Derm
344982 4/27/2009 AK 1.4 1 0.4 M 4/17/2009 Mom reported "dime" size swelling-
344984 4/27/2009 NY 18 18 F 4/13/2009 24 hours after vaccine administratio
344985 4/27/2009 CO 12 12 F 4/23/2009 Received vaccine on 4-21-2009. Wh
344986 4/27/2009 CT 1.2 1 0.2 M 4/21/2009 Limping (unable to bear weight on le
344987 4/27/2009 CO 4 4 M 4/23/2009 4-21-09 - 7:50 PM Mother called to
344989 4/27/2009 NJ 4 F 4/17/2009 L lateral upper arm: L red, warm, ind
344990 4/27/2009 MD 13 13 F 4/23/2009 Syncope following vaccinations, the
344992 4/27/2009 AZ 66 F 4/16/2009 Welt - 4 X 4 cm allergic skin reaction
344994 4/27/2009 FL 79 79 M 4/27/2009 Pt given ZOSTAVAX vaccine 4/14/0
344995 4/27/2009 TX 35 35 F 4/22/2009 Red around the area itchy, raised a
344997 4/27/2009 WA 61 61 F 4/22/2009 Adenopathy. Knee pain. Fever. Ras
344999 4/27/2009 NC 17 17 F 4/22/2009 1) first few hours - splotches noted o
345000 4/27/2009 TX 32 32 M 4/20/2009 Call received 4/20/09 - Pt states itch
345002 4/27/2009 OK 73 73 F 2/3/2009 Redness, tenderness & increased w
345021 4/28/2009 SC M 4/27/2009 Information has been received from
345038 4/28/2009 NY 42 42 F 4/24/2009 Initial report received on 15 April 20
345040 4/28/2009 KS M 4/24/2009 This serious case was received on 2
345041 4/28/2009 MI 69 69 M 4/28/2009 No adverse effects. Received the T
345042 4/28/2009 MD 1 1 0M 4/28/2009 DEVELOPED FEVER ON 4/23/09.
345043 4/28/2009 IN 0.3 0 0.3 M 4/28/2009 On 4/22/08 Client received both Pen
345044 4/28/2009 NJ 2 2 0M 4/28/2009 Patient was very irritable and "not h
345045 4/28/2009 NC 21 21 M 4/28/2009 None. Patient recieved four doses
345046 4/28/2009 MA 48 48 M 4/28/2009 COULD NOT SLEEP AT ALL, JOIN
345047 4/28/2009 TX 5 5 F 4/28/2009 collapse, profuse sweating, disorien
345048 4/28/2009 LA 11 11 F 4/28/2009 Within 4 hours of Tdap and Varivax
345049 4/28/2009 OH 1 1 0M 4/28/2009 About 10 minutes after IPV,Prevnar
345050 4/28/2009 IN 16 16 F 4/28/2009 seizure activity taken by ambulance
345051 4/28/2009 CA 37 37 F 4/28/2009 PATIENT HAD VACCINE ON 4/21/2
345052 4/28/2009 MN 12 12 F 4/28/2009 Patient seated on a chair in exam ro
345053 4/28/2009 TX 68 68 M 4/28/2009 Patient (68 Y year old male) received
345054 4/28/2009 NM 12 12 M 4/28/2009 Symptoms: hives, vasculitis, joint pa
345055 4/28/2009 SC 7 7 F 4/28/2009 Pt developed an egg shaped redden
345056 4/28/2009 IL 57 57 F 4/28/2009 TDAP GIVEN 4/22/09 IN AFTERNO
345057 4/28/2009 AZ 21 21 F 4/28/2009 Patient broke out in hives all over he
345058 4/28/2009 CA 9 9 M 4/28/2009 he developed hives after injection a
345059 4/28/2009 TX 60 60 F 4/28/2009 Client received the influenza, pneum
345060 4/28/2009 WY 41 41 F 4/28/2009 Pt received Tdap on 4-22-2009, IM
345061 4/28/2009 VA 15 15 F 4/28/2009 Mother states arrived home @ abou
345062 4/28/2009 CA 15 15 M 4/28/2009 PATIENT C/O PAIN STARTING 8 H
345063 4/28/2009 MT 0.9 0 0.9 F 4/28/2009 Child received a 4th DTaP and IPV
345064 4/28/2009 GA 17 17 M 4/28/2009 Approximately 1 minute after receiv
345065 4/28/2009 MI 0.2 0 0.2 M 4/28/2009 Initially patient was quite irritable an
345066 4/28/2009 CA 0.2 0 0.2 M 4/28/2009 Notable change in feeding pattern a
345067 4/28/2009 FL 1 1 0M 4/28/2009 Child developed bilateral buccal mu
345069 4/28/2009 M 4/28/2009 This case was reported by a lawyer
345071 4/28/2009 FL M 4/28/2009 This case was reported by a lawyer
345072 4/28/2009 OH 0.3 0 0.3 F 4/28/2009 Intussusception reduced 5/04/09 R
345073 4/28/2009 MS 72 72 M 4/23/2009 Received Yellow fever immunization
345074 4/28/2009 HI 19 19 F 4/23/2009 Extensor surfaces rash on elbows, k
345075 4/28/2009 CA 0.2 0 0.2 F 4/23/2009 High Pitch screams for 3 days and f
345076 4/28/2009 CA 51 51 F 4/25/2009 Received Flu Vaccine on Oct. 10, 2
345077 4/28/2009 MS 14 M 4/28/2009 Gave pt varicella #2 9/26/9 (1st dos
345078 4/28/2009 MA 11 M 4/27/2009 R upper arm swelling red, tender, itc
345079 4/28/2009 NH 64 64 F 4/27/2009 Herpes zoster type rash developing
345080 4/28/2009 PA 4 4 M 4/28/2009 Started with pain at the injection site
345081 4/28/2009 VA 0.5 0 0.5 M 4/24/2009 "3 cm circle of erythema on right sid
345082 4/28/2009 FL 18 18 F 4/28/2009 Shortness of breath, tingling, sweat
345083 4/28/2009 ND 53 53 M 4/27/2009 Body aches, high fever. At night ch
345084 4/28/2009 TX 41 41 M 4/28/2009 None stated
345085 4/28/2009 VA M 4/28/2009 Pt came into office + reported vacci
345086 4/28/2009 KY 10 10 F 4/28/2009 About 2hrs after getting vaccine, arm
345087 4/28/2009 NJ 5 5 M Presented to hospital 4/23/09 with r
345088 4/28/2009 NC 27 27 F 4/16/2009 Pt c/o pain at injection site beginnin
345089 4/28/2009 FL 4 4 M 4/22/2009 Small area of petechiea under right
345090 4/28/2009 NC 12 12 F 4/9/2009 Fever 102 shakes chills abdominal p
345091 4/28/2009 NC 41 40 F 4/13/2009 Client reports rash to inner arms ap
345092 4/28/2009 VA 0.2 0 0.2 M 4/28/2009 Bloody stools, crying spells, abdomi
345093 4/28/2009 IL 1 1 0M 4/23/2009 4/18 developed rash behind ears, b
345094 4/28/2009 MI 0.2 0 0.2 M 4/23/2009 Pt came back into office. Per mothe
345095 4/28/2009 MI 5 5 F 4/23/2009 Pt administered VARIVAX and DAP
345096 4/28/2009 TX 1.3 1 0.3 F 4/21/2009 Urticaria generalized 2 days after im
345097 4/28/2009 NC 16 16 F 9/18/2008 DTAP given instead of TDAP.
345098 4/28/2009 CA 4 4 U -Swelling of LA, tender, hot, itchy - 2
345099 4/28/2009 MI 0.3 0 0.3 F 4/22/2009 3 days after vaccine developed diar
345100 4/28/2009 WI 5 5 M 4/22/2009 Large redness, itching & induration
345101 4/28/2009 IL 31 31 F 4/23/2009 None stated.
345102 4/28/2009 FL 81 81 F 4/28/2009 2 days later had bad stiffness on ba
345103 4/28/2009 MS 23 23 F 4/28/2009 On 4/27 at 8:45am patient was vacc
345104 4/28/2009 TX 44 44 M None Stated
345105 4/28/2009 14 14 F 4/26/2009 Excessive rapid hair loss a month a
345106 4/28/2009 NV 53 53 F 4/28/2009 Rash developed 2 days after shot -
345107 4/28/2009 OH 2 2 0M 4/27/2009 Rash after HEP A with in 24 hr ATA
345108 4/28/2009 AR 27 27 F 4/28/2009 1600 Pt bad at clinic c/o having reac
345109 4/28/2009 CA 15 15 M 4/28/2009 Pt with redness, edema 3 d after va
345110 4/28/2009 SC 10 10 M 4/17/2009 3-31-09 Mom reports that client "wa
345111 4/28/2009 VA 4 4 M 4/17/2009 Redness, swelling and pain at injec
345112 4/28/2009 MN 23 23 M 4/21/2009 Received vaccine on 4/13/09- symp
345113 4/28/2009 NY 0.7 0 0.7 F 4/23/2009 Local reaction at injection site right
345114 4/28/2009 NY 42 42 F 4/24/2009 Patient presented to clinic on 4/24/0
345115 4/28/2009 0.5 0 0.5 F 4/22/2009 She was hoarse and hives - She los
345116 4/28/2009 ID 27 27 M 4/21/2009 Rash to trunk and back that started
345117 4/28/2009 PA 70 70 F 4/23/2009 PNEUMOVAX administered right de
345118 4/28/2009 MI 0.3 0 0.3 M 4/22/2009 Pt developed hives right after vaccin
345119 4/28/2009 AL 18 18 F 4/24/2009 Within 24 hours, developed fever - 1
345120 4/28/2009 PA 0.3 0 0.3 M 4/23/2009 2 days later, with bulging fontanelle
345121 4/28/2009 36 36 F 4/23/2009 Red raised rash appox. 1 1/2 " X 1
345122 4/28/2009 IN 13 M 4/24/2009 Erythematous area surrounding inje
345123 4/28/2009 TN 27 27 F 4/22/2009 Pt. became pale after the vaccinatio
345137 4/29/2009 MI 53 53 M 4/28/2009 Subject received BIOTHRAX in 200
345146 4/29/2009 FL 1 0 1M 4/28/2009 Information has been received from
345157 4/29/2009 18 18 M 4/28/2009 This report was received from a hea
345159 4/29/2009 VA 59 59 F 4/27/2009 Initial report was received 28 Janua
345163 4/29/2009 OH 3 3 F 4/29/2009 hives covering entire body, swelling
345164 4/29/2009 MA 3 3 M 4/29/2009 Within 5 min. post injection patient h
345165 4/29/2009 NC 14 14 F 4/29/2009 Client received Tdap without any sy
345166 4/29/2009 ID 62 62 F 4/29/2009 Reaction to Tdap, muscle aches, he
345167 4/29/2009 CO 65 65 F 4/29/2009 Read area around the Shingles vac
345168 4/29/2009 MA 25 25 F 4/29/2009 Member reports beginning to feel na
345169 4/29/2009 NC 1.3 1 0.3 M 4/29/2009 HIGH FEVER WITH NORMAL CBC
345170 4/29/2009 AZ 1.2 1 0.2 M 4/29/2009 Pt received MMR and Varicella vacc
345171 4/29/2009 CA 11 11 M 4/29/2009 Right deltoid- 2 days sfter vaccine a
345172 4/29/2009 KS 9 9 M 4/29/2009 Herpes Zoster C34 dermatoma G
345173 4/29/2009 KS 34 34 M 4/29/2009 The first signs begin with a pain in m
345174 4/29/2009 AZ 1 1 0.1 M 4/29/2009 SCALEY RASH THATS GETTING W
345175 4/29/2009 WA 63 63 M 4/29/2009 Pt given injection in deltoid. develop
345176 4/29/2009 CA 17 17 M 4/29/2009 27cm from injection site a 15x15cm
345177 4/29/2009 OR 12 12 F 4/29/2009 headache, facial swelling- in pts tem
345178 4/29/2009 PA 0.2 0 0.2 M 4/25/2009 4-23-09 ChildY had respiratory arrest
345182 4/29/2009 0.6 0 0.6 F 4/29/2009 This female subject was enrolled in
345190 4/29/2009 NC 20 20 M 4/28/2009 VHC inpatient consult has been req
345191 4/29/2009 PA 0.1 0 0.1 M 4/22/2009 Temp 101. Baby presented the day
345192 4/29/2009 CA 0.2 0 0.2 F 4/29/2009 04-27-09 patient came for a well ch
345193 4/29/2009 CA 20 20 F 4/28/2009 Fever, nausea, HA, sore throat, rhin
345194 4/29/2009 13 13 M 4/29/2009 Local reaction on R upper arm (injec
345195 4/29/2009 TX 45 45 F 4/27/2009 Pt stated arm was sore for 3 days. T
345196 4/29/2009 NH 9 9 F 4/29/2009 Vaccine administered on 4/23/09. Im
345197 4/29/2009 AZ 11 11 F 4/29/2009 950am student in nurses office or im
345198 4/29/2009 CO 61 61 F 4/29/2009 Hives
345199 4/29/2009 AZ 1 0 1F 4/29/2009 Local Pox 3-4 lesions with cellulitic a
345200 4/29/2009 CA 0.3 0 0.3 M 4/29/2009 Faint erythematous rash under the s
345201 4/29/2009 PA 65 65 F 4/28/2009 (R) arm swollen and red about 10 cm
345202 4/29/2009 DC 42 42 F 4/24/2009 Received ADACEL on 4/16/09 and
345203 4/29/2009 NH 1.3 1 0.3 M 4/23/2009 Pt broke out in hives face to legs 1 1
345204 4/29/2009 NC 10 10 M 4/22/2009 Vaccine given 10:15 A and by 12:00
345205 4/29/2009 NC 5 5 F 4/25/2009 .5 cm diameter redness, and warm
345206 4/29/2009 80 80 F 4/17/2009 PL received the Zostavax vaccine o
345207 4/29/2009 F 4/27/2009 Our infant received the roto vaccine
345208 4/29/2009 PA 5 5 M 4/29/2009 2 days after DTAP, arm red & swolle
345249 4/30/2009 MO 71 71 M 4/29/2009 Information has been received from
345252 4/30/2009 CA 0.2 0 0.2 F 4/29/2009 Information regarding PREVNAR wa
345254 4/30/2009 MI 46 46 F 4/28/2009 This case was received from a heal
345260 4/30/2009 IA 3 M 4/29/2009 Information has been received from
345299 4/30/2009 MA 35 35 M 4/30/2009 Td administered to patient. Less tha
345301 4/30/2009 AR 15 15 F 4/30/2009 Nursing student mistook Menactra a
345302 4/30/2009 MA 1 1 0M 4/30/2009 Patient developed maculopapular ra
345303 4/30/2009 SD 28 28 M 4/30/2009 Fever, Chills, Bodyaches, Nausea, V
345304 4/30/2009 WI 25 25 M 4/30/2009 ON 4-3-09 PATIENT WAS ADMINIS
345305 4/30/2009 TX 28 28 M 4/30/2009 Circumferential swelling and rednes
345306 4/30/2009 28 28 M 4/30/2009 Soldier presented to the ER with R
345307 4/30/2009 IL 17 17 F 4/30/2009 Immediate severe pain in left arm, 'a
345308 4/30/2009 FL 16 16 F 4/30/2009 PATIENT WAS GIVEN ALL THREE
345309 4/30/2009 UT 50 50 M 4/30/2009 left arm warm to the touch and red
345310 4/30/2009 MI 3 F 4/30/2009 Typical Varicella rash began 04/28/
345311 4/30/2009 HI 63 F 4/30/2009 Patient called me the day after the a
345312 4/30/2009 55 55 M 4/30/2009 Fever 100.3F and chills and Severe
345313 4/30/2009 CA 30 30 F 4/30/2009 Client called today, stating she had
345314 4/30/2009 CA 16 16 M 4/30/2009 Patient was seen by this physician t
345315 4/30/2009 IN 1.2 1 0.1 M 4/30/2009 Night wakening, fussiness, constan
345318 4/30/2009 PA 0.1 0 0.1 F 4/28/2009 None. 10/5/09
Y Autopsy received. Ca
345319 4/30/2009 MA 0.5 0 0.5 M 4/27/2009 Came down with Evans Syndrome 3
345320 4/30/2009 46 46 M 4/30/2009 Developed neck right arm pain imm
345321 4/30/2009 CA 1 1 0F 4/26/2009 Patient developed severe systemic
345322 4/30/2009 OH 15 15 F 4/26/2009 Began with stomach pains, rash on
345323 4/30/2009 AK 1.8 1 0.8 M 4/30/2009 Redness + swelling, heat @ site of
345324 4/30/2009 MD 1.1 1 0.1 F 4/30/2009 Child received above listed vaccines
345325 4/30/2009 NM 23 23 F 4/30/2009 Patient complained of headache, rin
345326 4/30/2009 MS 7 7 F 4/30/2009 Redness, warmth to injection site - 4
345327 4/30/2009 MT 13 13 M 4/28/2009 Mother reports patient complaining
345328 4/30/2009 IN 1 1 0F 4/21/2009 Pt received 12 month vaccinations o
345329 4/30/2009 CT 26 26 F 4/30/2009 Within 2 Hrs of vaccine, pt noted ex
345330 4/30/2009 PA 17 17 M 4/23/2009 Pt waited x 15 min & c/o HR. No se
345331 4/30/2009 VA 4 4 F 4/30/2009 Left deltoid swollen with erythema o
345332 4/30/2009 TN 11 11 F 4/30/2009 Right upper arm with redness, swell
345333 4/30/2009 ND 12 12 M 4/24/2009 Left arm swollen, hot, reddened (siz
345334 4/30/2009 FL 1.1 1 0.1 M 4/27/2009 Bumps on face and back.
345335 4/30/2009 NY 1 1 0F 4/27/2009 Left thigh erythema & swelling exten
345336 4/30/2009 OH 20 20 F 4/21/2009 Pt. became slightly lightheaded imm
345337 4/30/2009 KY 1 1 0M 4/24/2009 Child developed chicken pox diseas
345338 4/30/2009 MI 16 16 F 4/24/2009 24 hrs after injection: lip swelling, na
345339 4/30/2009 KY 1.2 1 0.2 F 4/13/2009 Mom states 2 days after vaccines p
345340 4/30/2009 CO U Severe vomiting + diarrhea 48 hour
345341 4/30/2009 KY 28 28 F 4/21/2009 Unable to use my arm/shoulder, ext
345342 4/30/2009 OH 18 18 F 4/24/2009 Pharyngitis, odynophalgia, nausea,
345343 4/30/2009 CT 4 4 M 4/24/2009 Right arm immunization site reaction
345344 4/30/2009 SC 49 49 F 4/27/2009 C/o chest pain, local reaction seen i
346035 4/30/2009 CA U 4/15/2009 This case was reported by a pharma
346036 4/30/2009 SD 19 19 M 4/15/2009 This case was reported by a healthc
346037 4/30/2009 SD 19 19 M 4/15/2009 This case was reported by a healthc
346038 4/30/2009 58 58 M 4/15/2009 This case was reported by a consum
346039 4/30/2009 ID U 4/15/2009 This case reported by a healthcare
346040 4/30/2009 FL 75 75 M 4/15/2009 This case was reported by a consum
345403 5/1/2009 CA 42 42 M 5/1/2009 4/17/2009: SM contacted VHC repo
345404 5/1/2009 NY 13 13 F 5/1/2009 My daughter was given all three dos
345405 5/1/2009 NC 32 32 M 5/1/2009 A GOLF BALL SIZE NODE IN ARM
345406 5/1/2009 VA 24 25 F 5/1/2009 fever of 100.7F, body aches, HA, so
345407 5/1/2009 ID 11 11 F 5/1/2009 Vomiting, indegestion, lack of appet
345408 5/1/2009 WI 33 33 M 5/1/2009 Localized erythema Left shoulder an
345409 5/1/2009 WI 42 42 M 5/1/2009 Rash over chest, back, and arms.
345410 5/1/2009 MO 1 2 0F 5/1/2009 Mother reports client with elevated t
345411 5/1/2009 WI 20 20 M 5/1/2009 Painful Hardened red area mid clav
345412 5/1/2009 SC 5 5 M 5/1/2009 Patient's mom stated symptoms of r
345413 5/1/2009 TX 47 47 F 5/1/2009 Vaccine administered on 04/28/200
345414 5/1/2009 SC 3 3 F 5/1/2009 Pt's mom stated sylmptoms of redne
345415 5/1/2009 GA 1.3 1 0.2 M 5/1/2009 About 5-6 hrs after DTaP pt had fev
345416 5/1/2009 WI 23 23 M 5/1/2009 Rednes and Pain at injection site, in
345417 5/1/2009 CA 1.6 1 0.6 M 5/1/2009 FEBRILE SEIZURE ON 28APRIL20
345418 5/1/2009 WI 39 39 M 5/1/2009 Extensive Erythema Multiforme on b
345419 5/1/2009 MA 0.5 0 0.5 M 5/1/2009 Indurated area at site of each inject
345420 5/1/2009 GA 14 14 F 5/1/2009 APPROXIMATELY 3-5 MINUTES A
345421 5/1/2009 NC 43 43 F 5/1/2009 Six days after administration of MMR
345422 5/1/2009 UT 5 5 F 5/1/2009 Right and Left legs had cellulitis, red
345435 5/1/2009 21 F 4/30/2009 InformationYhas been received via th
345439 5/1/2009 NY 2 2 0.6 M 5/1/2009 On 4/29 (the day after receiving the
345440 5/1/2009 NM 17 17 F 5/1/2009 On 4/24/09, Pt came in for #2 GARD
345441 5/1/2009 WA 2 2 0F 5/1/2009 Within 12 hours after admin of vacc
345442 5/1/2009 VA 11 11 M 5/1/2009 4x6cm area on right deltoid of eryth
345443 5/1/2009 MI 17 17 F Swollen like a size of a baseball hot
345444 5/1/2009 NC 46 46 F 5/1/2009 C/o lightheaded with tunnel vision (c
345445 5/1/2009 TX 13 13 M 5/1/2009 L arm SQ area red and swollen abo
345446 5/1/2009 NJ 70 70 M 5/1/2009 TC from son (MD): Pt had dried like
345452 5/1/2009 KY 0.3 0 0.3 F 4/27/2009 Prev. healthy 4 mo. old admitted to
345453 5/1/2009 OH 12 12 M 4/27/2009 Approx 3" area right upper arm warm
345454 5/1/2009 SD 3 3 M 5/1/2009 16 X 16 cm Erythemic warm rash on
345455 5/1/2009 U Felts like open cut. used rubbing al
345456 5/1/2009 MS 57 57 M 4/1/2009 Extreme swelling and redness of wh
345457 5/1/2009 WY 71 71 F 5/1/2009 Swelling (L) arm
345458 5/1/2009 MA 5 5 M 5/1/2009 Cellulitis
345459 5/1/2009 WA 42 42 F 4/27/2009 Patient reported severe injection sit
345460 5/1/2009 AZ 13 13 M 4/24/2009 R upper arm redness with swelling s
345461 5/1/2009 ND 1.1 1 0.1 F 4/27/2009 Patient was given Pediarix vac. but
345462 5/1/2009 NY 14 14 M 4/24/2009 Left deltoid region w/ 7x7 cm round,
345463 5/1/2009 ND 14 14 F 4/28/2009 Broke out in a rash that evening. Ra
345464 5/1/2009 IL 27 27 F 4/24/2009 2 d Hx generalized weakness + mal
345465 5/1/2009 VA 0.4 0 0.4 F 5/1/2009 Rotavirus vaccine was administered
345466 5/1/2009 WA 32 32 F 4/20/2009 Left arm localized redness + swellin
345467 5/1/2009 WA 7 7 M 4/29/2009 Allergic reaction - hives - severe wh
345468 5/1/2009 IL 2 2 0.2 U Patient was given HEP & DTAP vac
345469 5/1/2009 MN 12 12 M 4/27/2009 Patient given MMR vaccine instead
345470 5/1/2009 CA 5 5 F 4/30/2009 HEP A, HEP B & MMR given in (L)
345471 5/1/2009 SC 1.1 1 0.1 M 3/23/2009 When pt was given MMR & VAR pt
345472 5/1/2009 NC 1.4 1 0.4 M 4/27/2009 Erythema multiforme - minor.
345473 5/1/2009 IL 1 1 0F 4/28/2009 2 wks after VARICELLA was given o
345474 5/1/2009 NC 2 2 0.8 F 4/28/2009 (B) eyelids swollen, puffy and red w
345475 5/1/2009 PA 5 5 F 4/27/2009 Vesicular lesion trunk with scabbing
345476 5/1/2009 NY 4 4 F 4/30/2009 Pt developed a local rxn one day af
345477 5/1/2009 NC 27 27 F 4/30/2009 At 24-36 hours, pain, swelling at inje
345478 5/1/2009 CA 3 3 F 5/1/2009 Caregiver called stating child compl
345479 5/1/2009 NC 33 33 F 4/30/2009 At 48 hours, ipsilateral axillary pain,
346027 5/1/2009 CT 5 5 M 4/29/2009 This case was reported by a consum
346030 5/1/2009 PA 4 4 M 4/29/2009 This case was reported by a healthc
346031 5/1/2009 TX 4 F 4/29/2009 This case was reported by a physici
345423 5/2/2009 NC 33 33 M 5/2/2009 Received vaccination 10/30/07; retu
345424 5/2/2009 KS 17 17 F 5/2/2009 Fever, ache, lethartic onset 48 hour
345425 5/2/2009 CA 59 59 M 5/2/2009 a week later, very tired and rash (sk
345426 5/2/2009 CA 4 4 F 5/2/2009 Measle-like rash all over legs and a
345427 5/2/2009 WA 24 24 M 5/2/2009 Arm goes numb for approximately 3
345428 5/2/2009 CA 2 2 0.7 F 5/2/2009 Ataxic symptoms, shaking, "bobbleh
345429 5/2/2009 FL 12 12 F 5/2/2009 WITHIN A LITTLE OVER 24 HOUR
345430 5/2/2009 FL 1 1 0M 5/2/2009 swelling iside of cheeks.
345438 5/2/2009 AZ 14 14 M 5/2/2009 Mom returned to office - stated "my
345431 5/3/2009 NH 44 44 F 5/3/2009 I needed a tetanus shot for an infec
345432 5/3/2009 CO 36 36 F 5/3/2009 R deltoid injection 5/1/09 yellow fev
345433 5/3/2009 CA 22 22 M 5/3/2009 Papulo-pustular rash extending from
345434 5/4/2009 PR 44 44 M 5/4/2009 Diabetis,Vision,Blood restal,soryasis
345541 5/4/2009 IL 29 29 F 4/30/2009 This serious case was received on 2
345542 5/4/2009 AR 35 35 F 4/30/2009 Initial report received on 24 April 20
345543 5/4/2009 TN F 5/1/2009 This serious case was received on 2
345545 5/4/2009 AR 1 1 0F 4/24/2009 Pt vaccinated at approx. 0830 4/22/
345546 5/4/2009 AZ 11 11 M 4/29/2009 Pt was given SQ left arm of VARICE
345547 5/4/2009 MA 19 19 M 4/28/2009 8 hours after shot, fever, headaches
345548 5/4/2009 AR 0.2 0 0.2 M 4/24/2009 See ER sheet - mom reports infant
345549 5/4/2009 PA 0.6 0 0.6 M 4/21/2009 Patient was given initial dose of RO
345550 5/4/2009 MA 54 54 F Suprasternal chest tightness withou
345551 5/4/2009 VA 54 54 F 4/29/2009 There is a darkened raised area on
345552 5/4/2009 IL 14 14 F 4/22/2009 Child received 2 vaccines, MENACT
345553 5/4/2009 PA 5 5 F 4/29/2009 5 days after vaccine was administer
345555 5/4/2009 OR 37 37 M 48 hrs - following vaccine, swelling d
345556 5/4/2009 MA 1.3 1 0.3 M 4/24/2009 Typical post vaccine rash "mini mea
345558 5/4/2009 MA 0.4 0 0.4 M 4/28/2009 Fever >103, start at 9pm & vomited
345561 5/4/2009 VA 0.2 0 0.2 F 4/29/2009 Prolonged screaming/crying.
345573 5/4/2009 MA 18 18 F 5/4/2009 Within 10 hours of shot fever,palene
345574 5/4/2009 NY 32 32 F 5/4/2009 redness and swelling, painful at site
345575 5/4/2009 NY 28 28 F 5/4/2009 redness, pain and swelling at injecti
345576 5/4/2009 MO 53 53 F 5/4/2009 Patient reports extreme pain at site
345577 5/4/2009 PA 31 31 F 5/4/2009 2 days after receiving the for about
345578 5/4/2009 NY 54 54 F 5/4/2009 redness and pain at site of injection
345579 5/4/2009 TX 74 74 F 5/4/2009 Patient received Zostavax Vaccine
345580 5/4/2009 MN 0.2 0 0.2 F 5/4/2009 I received the MMR vaccine on 4-20
345581 5/4/2009 CA 26 26 F 5/4/2009 Administered yellow fever vaccinatio
345582 5/4/2009 FL 36 36 F 5/4/2009 WITHIN 12 HOURS: SEVERE DRO
345583 5/4/2009 DC 1.3 1 0.3 M 5/4/2009 mother noted thigh swelling at injec
345584 5/4/2009 FL 1.5 1 0.5 F 5/4/2009 Fever, irritablity and rash about 9 da
345585 5/4/2009 MI 1.6 1 0.6 F 5/4/2009 Within 15 minutes post injection pat
345586 5/4/2009 11 11 M 5/4/2009 Vaccination was received on 4/28/2
345587 5/4/2009 FL 0.5 0 0.5 M 5/4/2009 high fever, projectile vomiting, letha
345588 5/4/2009 KS 24 24 F 5/4/2009 Adverse reaction to right deltoid afte
345589 5/4/2009 VT 33 33 F 5/4/2009 Temp of 100-102 within 24 hours. M
345590 5/4/2009 OK 61 61 F 5/4/2009 Patient described onset of large 'ora
345591 5/4/2009 UT 0.4 0 0.5 F 5/4/2009 Pt recieved regular vaccines at two
345592 5/4/2009 VA 26 26 F 5/4/2009 10/11/09 awoke with severe pain an
345593 5/4/2009 OH 12 12 M 5/4/2009 Right arm cellulitis developed at imm
345594 5/4/2009 FL 1.3 1 0.3 F 5/4/2009 On 4/26/09 patient started to develo
345595 5/4/2009 MI 0.2 0 0.2 F 5/4/2009 Blue streaking across the leg from t
345596 5/4/2009 CA 4 4 M 5/4/2009 24 hours after injection - mom noted
345597 5/4/2009 GA 52 52 M 5/4/2009 NONE
345598 5/4/2009 LA 1 1 0.1 M 5/4/2009 Had measle like red, raised bumps
345599 5/4/2009 MI 1 1 0.1 M 5/4/2009 NO ADVERSE EVENTS, SYMPTOM
345600 5/4/2009 IL 4 4 F 5/4/2009 CELLULITIS LEFT LEG DIAGNOSE
345601 5/4/2009 CA 0.8 0 0.8 F 5/4/2009 2 days after administration of rotate
345602 5/4/2009 AZ 14 14 M 5/4/2009 Mother, phoned clinic and left a mes
345607 5/4/2009 CA 16 16 F 5/9/2009 Tremors in R hand started 12-24 ho
345608 5/4/2009 MI 1 1 0F 5/4/2009 Pt broke out with 9 blisters on 5-3-0
345609 5/4/2009 IA 59 59 M 5/4/2009 Pt was given 2nd dose of Hep B ser
345610 5/4/2009 VA 6 6 M Localized cellulitis at administration
345611 5/4/2009 WI 11.2 F 5/3/2009 Teen had syncopal episode after ta
345612 5/4/2009 ID 65 65 F 5/4/2009 Pt developed shingles 7 days after Z
345613 5/4/2009 PA 0.2 0 0.2 M 5/4/2009 TC received from stating pt seems t
345615 5/4/2009 MD 28 27 F 5/4/2009 Pt. presented to GARDASIL clinic 7
345616 5/4/2009 NM 53 53 F 4/30/2009 Swelling & Lg redness at injection s
345617 5/4/2009 MN 4 4 F 5/1/2009 (L) thigh swollen from upper thigh to
345628 5/4/2009 OH 11 11 M 5/4/2009 Fainted - lasting 15 seconds - return
345630 5/4/2009 NM 1 F 5/4/2009 Uticaria to R upper chest welt 3 cm
345631 5/4/2009 TX 52 52 F 5/4/2009 Swollen red left upper arm approx s
345633 5/4/2009 NY 23 23 M 5/4/2009 Hepatitis B #3 vaccine given on 4-2
345634 5/4/2009 WV 0.1 0 0.1 F 5/4/2009 1 month old given Hep A vaccine in
345636 5/4/2009 ME 32 32 F 4/28/2009 L shoulder vaccine site (deltoid) was
345638 5/4/2009 NY 4 4 F 5/11/2009 About 5-10 min after vaccinations (H
345639 5/4/2009 CT 11 11 M 4/23/2009 Mom reports eyes red, puffy & warm
345640 5/4/2009 IL 0.6 0 0.6 M 5/1/2009 Inf received 6 mon vaccinations at 2
345641 5/4/2009 OH 1 1 0F 4/14/2009 Fever and rash trunk after 8 hrs. Te
345643 5/4/2009 OH 11 11 M 4/28/2009 Shot RA- 4/26 - Rt arm swollen, hot
345644 5/4/2009 KY 31 31 F 4/30/2009 Pt describes reddened area around
345645 5/4/2009 PA 6 6 M 4/29/2009 Parent of patient returned to clinic 2
345646 5/4/2009 CA 13.3 13 F 4/21/2009 Fever on 4-17-09, 7 PM. On 4-18-0
345647 5/4/2009 KY 11 11 F 4/28/2009 6 cm red rash with pain and swelling
346062 5/4/2009 PA 54 54 M 6/17/2008 Initial report was received 05 June 2
346063 5/4/2009 MI 62 62 F 8/27/2008 A cluster of four cases of injection s
346064 5/4/2009 AZ 63 63 F 10/4/2008 Initial report received from a consum
346065 5/4/2009 FL U 3/25/2009 Initial report received form a health
346066 5/4/2009 FL 39 39 M 12/9/2008 A 39 year old male patient with a his
346067 5/4/2009 IN 49 49 F 2/9/2009 A 49-year-old female patient, who h
346068 5/4/2009 IN 62 62 M 2/10/2009 A 62-year-old male patient, who had
346069 5/4/2009 NY 31 F 3/6/2009 Initial report received 27 February 2
346127 5/4/2009 VA 21 21 M 7/16/2008 Initial report received from a health
346128 5/4/2009 WA 26 26 F 8/18/2008 Initial report was received 15 May 2
346129 5/4/2009 PA M Initial report was received 20 May 2
345676 5/5/2009 CA 28 28 F 4/27/2009 Pt reports 1 mo after receiving vacc
345677 5/5/2009 NY 46 46 F 4/27/2009 Pt received Immunization on 4/22/0
345678 5/5/2009 MI 5 5 M 4/27/2009 Gave adult dose of HEP A instead o
345679 5/5/2009 MI 7 F 4/27/2009 Gave adult dose of Hep A instead o
345680 5/5/2009 MN 11 11 F 4/30/2009 4cm localized inflammation to left up
345681 5/5/2009 LA 0.4 0 0.4 M 5/1/2009 4mo shots. High pitched crying x1 h
345682 5/5/2009 IN 15 15 F 4/29/2009 Pt given vaccine 4/16/09 - Mother c
345683 5/5/2009 IL 4 4 F 4/30/2009 (1) leg/injection site swollen and pai
345684 5/5/2009 OH 5 5 M 4/29/2009 Red, warm and itchy area over TRIP
345685 5/5/2009 NY 5 5 M 4/28/2009 10 mm diameter area of erythema o
345686 5/5/2009 MI 14 14 F 4/30/2009 Patient fainted, difficult to arouse (1
345687 5/5/2009 OH 6 6 M 4/28/2009 Child received Kinrix injection in R t
345688 5/5/2009 18 18 M Non Stated
345689 5/5/2009 TX 62 62 F 4/29/2009 Pt. called today 4/29/09 at 12:10 PM
345690 5/5/2009 TX 61 61 F 4/29/2009 Pt received vaccine on 4/24/09. Sh
345692 5/5/2009 TN 1.9 1 0.9 M 5/4/2009 Information has been received from
345698 5/5/2009 17 17 F 5/4/2009 Initial information and follow up has
345700 5/5/2009 35 35 M 4/28/2009 Smallpox site still itches. Recently b
345701 5/5/2009 PA 1 1 0F 4/29/2009 L thigh firm area of redness 1" diam
345702 5/5/2009 AZ 6 6 F 4/30/2009 Hives at injection site Benadryl 25 m
345703 5/5/2009 AZ 5 5 F 4/30/2009 Red swollen lump at injection site (R
345704 5/5/2009 TN 23 23 F 4/29/2009 c/o itching over all of body, tongue +
345705 5/5/2009 OK 1.3 1 0.3 M 4/28/2009 Varicella lesions eruption 4/27/09 A
345706 5/5/2009 FL 20 20 M 5/4/2009 Patient received both TWINRIX & T
345707 5/5/2009 IN 13 13 F 5/5/2009 Patient became lightheaded, pale, a
345708 5/5/2009 NC 15 15 F 5/5/2009 Parents concerned that vaccine (s)
345709 5/5/2009 NH 9 9 F 5/5/2009 Pt received Varicella vaccine on 4/3
345710 5/5/2009 TX 10 10 M 5/4/2009 8x4 cm redness + swelling at injecti
345711 5/5/2009 OH 11 11 M 4/29/2009 Redness/swelling @ upper arm - 8"
345712 5/5/2009 NE 1.3 1 0.3 M 5/1/2009 104 fever & fussiness 9 days after M
345713 5/5/2009 CA 4 4 F 4/22/2009 Local reaction swollen redness injec
345714 5/5/2009 CO 20 20 F 4/13/2009 04/06/09 Rash on Rt leg above kne
345715 5/5/2009 IL 42 42 M 5/1/2009 Pt started experiencing rash/hive ty
345716 5/5/2009 WI 11 11 M 4/30/2009 Local reaction right arm
345717 5/5/2009 NE 1.3 1 0.3 M 5/1/2009 Fever 102.8 at 5:00 pm day followin
345718 5/5/2009 WI 33 33 F 4/30/2009 Local reaction left arm
345719 5/5/2009 MD 29 29 F 5/5/2009 @ 1/2 hour after vaccine administra
345720 5/5/2009 GA 13 13 F 5/5/2009 Hives occured 9 days after administ
345721 5/5/2009 MD 39 39 M 5/5/2009 constipation, some lost of vision
345722 5/5/2009 NY 1.3 1 0.3 F 5/5/2009 VACCINES ADMINISTERED 4-13-0
345723 5/5/2009 MO 14 14 M 5/5/2009 Skin pale with heat and edema surr
345724 5/5/2009 SD 24 24 F 5/5/2009 Pt presented for pre-travel vaccinati
345725 5/5/2009 FL 68 67 M 5/5/2009 Rcvd call from pt. wife stating husba
345726 5/5/2009 FL 73 73 F 5/5/2009 Adm. zoster vax on 2/4/09. Rcvd ca
345727 5/5/2009 MO 0.2 0 0.2 M 5/5/2009 MOTHER CALLED AND STATED H
345728 5/5/2009 GA 68 68 F 5/5/2009 24 hrs following, swelling, itchiness
345729 5/5/2009 NY 28 28 F 5/5/2009 Guillain-Barre' Syndrom 6/8/09 Hos
345730 5/5/2009 NY 43 43 M 5/5/2009 Patient states that he developed dif
345731 5/5/2009 OK 50 50 M 5/5/2009 PNEUMOVAX .5 CC GIVEN R DEL
345732 5/5/2009 MO 5 5 M 5/5/2009 Child received the MMR vaccine an
345733 5/5/2009 SC 61 61 M 5/5/2009 dramatic swelling of the site w/ redn
345734 5/5/2009 CA 18 18 F 5/5/2009 Patient became lightheaded and los
345735 5/5/2009 OK 16 16 M 5/5/2009 Pt c/o tingling, itching on back of arm
345736 5/5/2009 CA 71 71 F 5/5/2009 Patient stated area of injection had
345737 5/5/2009 CA 64 64 F 5/5/2009 Approximately 4-5 hours after receiv
345745 5/5/2009 NM 0.3 0 0.3 M 5/5/2009 This case was reported by a physici
345747 5/5/2009 CA 0.2 0 0.2 M 5/5/2009 3 days of fever, 2 days of rash. Had
345748 5/5/2009 GA 58 58 M 3 times Emergency Rooms. 6 days
345749 5/5/2009 OR 1.3 1 0.3 F 5/5/2009 Increased redness & swelling @ site
345750 5/5/2009 PA 10 10 F 5/5/2009 Received TYLENOL at home. Pt. re
345751 5/5/2009 PA 52 52 F 5/5/2009 100 temp 24 after shot, erythema te
345752 5/5/2009 1.3 1 0.3 F 5/5/2009 Fever.
345753 5/5/2009 MI 37 37 F 5/5/2009 Client found out pregnant 2 wks afte
345754 5/5/2009 IL 81 81 F 5/5/2009 Patient had been diagnosed with sh
345755 5/5/2009 AR 13 13 F 5/5/2009 3 1/2 cm x 5 cm swelling and redne
345756 5/5/2009 CA 52 52 F 5/5/2009 Pt reported swelling, redness, and i
345757 5/5/2009 CO 14 14 F 5/5/2009 Immunization administered - child s
345758 5/5/2009 AR 3 3 F 5/5/2009 Pt received combination vaccine of
345759 5/5/2009 IL 1 1 0F 5/5/2009 Fever, redness, swelling at injection
345760 5/5/2009 NC 11 11 F 5/5/2009 Mother of child called Health Dept 5
345761 5/5/2009 CA 1 1 0M 4/16/2009 Per mom, child was in the ER last n
345762 5/5/2009 CA 72 72 F 4/22/2009 Blister rash present on knees, elbow
345764 5/5/2009 75 75 M 4/22/2009 Early June 2008, noticed large ecch
345738 5/6/2009 NY 4 4 M 5/6/2009 Administered 4:05pm. Reacted at 4
345740 5/6/2009 WA 2 2 0.3 M 5/6/2009 Fussiness, Tiredness and poor app
345791 5/6/2009 SC 64 65 M 5/6/2009 left arm turned red, very sore, itchy.
345792 5/6/2009 AZ 15 15 F 5/6/2009 Had Hep A vaccine--became dizzy a
345793 5/6/2009 VA 1.3 1 0.3 M 5/6/2009 Prior to shot child had some conges
345794 5/6/2009 NY 0.9 0 0.9 M 5/6/2009 PATIENT PRESENTED WITH TEM
345795 5/6/2009 IL 14 14 F 5/6/2009 CLIENT C/O BEING COLD, DIZZY,
345796 5/6/2009 MO 9 9 F 5/6/2009 9 year old female had foot stuck wit
345797 5/6/2009 PA 18 18 M 5/6/2009 Patient reported to student health se
345798 5/6/2009 OK 14 14 F 5/6/2009 Approximately 2 minutes after recei
345799 5/6/2009 NY 29 29 F 5/6/2009 received shot in a.m. on Monday 4/2
345800 5/6/2009 OH 66 66 F 5/6/2009 PT REPORTS DIFFICULTY BREAT
345801 5/6/2009 NC 64 64 F 5/6/2009 Two days after vaccine pt. reports a
345802 5/6/2009 IL 24 24 F 5/6/2009 ~ 24 hours after gardasil #1, patient
345803 5/6/2009 MI 6 6 F 5/6/2009 RED RASH AROUND INJECTION S
345804 5/6/2009 GA 11 11 M 5/6/2009 SITE OF INJECTION-LEFT ARM IS
345805 5/6/2009 IL 15 15 F 5/6/2009 Pt. received vaccines listed below a
345806 5/6/2009 MO 0.5 0 0.5 F 5/6/2009 within 3 hours of vaccine child had h
345807 5/6/2009 CA 16 16 U 5/6/2009 She also received TdaP and menac
345808 5/6/2009 FL 13 13 F 5/1/2009 This serious case was received on 2
345809 5/6/2009 F 5/5/2009 Initial report received on 28 April 20
345813 5/6/2009 1.1 1 0.1 M 5/5/2009 This case was considered medically
345818 5/6/2009 41 41 M 5/1/2009 See HPI: n/v fever, headaches 12-2
345819 5/6/2009 FL 0.2 0 0.2 F 5/6/2009 Crying inconsolable. Swelling of thig
345820 5/6/2009 WA 15 15 F 5/6/2009 Within 5 mins of receiving immuniza
345821 5/6/2009 NC 27 27 M 4/30/2009 Smallpox vaccine received 24MAR2
345822 5/6/2009 MI 18 18 F 5/5/2009 Immediately after receiving GARDA
345823 5/6/2009 TX 46 46 M 5/6/2009 None stated
345824 5/6/2009 VA 1.3 1 0.3 M 5/5/2009 Localized cellulitis 5 cm X 5 cm red,
345825 5/6/2009 VA 6 6 M Localized cellulitis at administration
345826 5/6/2009 MN 5 5 M 5/4/2009 about 4 - inch area of redness, warm
345827 5/6/2009 OH 51 51 F Went to ER on 4-29-09 c/o fever na
345828 5/6/2009 32 32 M 5/6/2009 Worsening joint pain, numbness (lef
345829 5/6/2009 NC 80 80 M 5/5/2009 Patient developed itching on his bac
345830 5/6/2009 MN 53 53 F 5/5/2009 Non stated
345831 5/6/2009 TX 34 34 F 5/6/2009 Rash appeared at site of vaccinatio
345832 5/6/2009 LA 10 10 M 5/6/2009 Redness after 24 hours and warmth
345833 5/6/2009 IL 5 5 M 5/6/2009 Erythema 10ml around injection of c
345834 5/6/2009 CA 4 4 M 5/5/2009 Left arm red, warm with pain -> trea
345835 5/6/2009 IA 1.5 1 0.5 M 5/6/2009 Lt leg @ injection site showed redne
345836 5/6/2009 FL 82 82 M 4/16/2009 Large local reaction redness & swel
345837 5/6/2009 PA 80 80 F Shooting @ throbbing pain L arm +
345838 5/6/2009 MA 60 60 F 5/6/2009 The patient developed shingles on l
345839 5/6/2009 WA 48 48 F 5/5/2009 Erythema of the Rt upper arm, temp
345840 5/6/2009 AR 5 5 F 5/6/2009 Pain, swelling, redness, large circle
345841 5/6/2009 NY 23 23 F 4/28/2009 Injection given @ 4:30 pm- Pt C/0 it
345842 5/6/2009 KY 25 25 F 5/6/2009 Pt complained of having dizziness,
345843 5/6/2009 MS 4 4 F Swollen right tricep area with indura
345844 5/6/2009 IL 18 18 F 4/30/2009 4" diameter erythema 1-2mm vesicl
345845 5/6/2009 WI 15 15 F 4/30/2009 Swelling in right arm post receiving
345846 5/6/2009 NY 4 4 F 5/1/2009 About 5-10 minutes after vaccinatio
345847 5/6/2009 RI 1.4 1 0.4 F 5/6/2009 Fever 102-103, rash on face - dry c
346131 5/6/2009 ME 41 41 F 4/2/2008 This case was received from a heal
346132 5/6/2009 VA 21 21 M 7/16/2008 Initial report received from a health
346133 5/6/2009 NY 18 F 7/31/2008 An 18-year-old female patient, who
346134 5/6/2009 MI 40 40 F 1/5/2009 Initial non-serious case received fro
346135 5/6/2009 WI 59 59 F 2/19/2009 Initial information was received on 0
346136 5/6/2009 NJ 67 67 F 8/12/2008 Initial non-serious case received fro
345850 5/7/2009 HI 23 23 F 5/6/2009 Information has been received from
345855 5/7/2009 CA 0.2 0 0.2 F 5/5/2009 Initial report received 29 April 2009
345857 5/7/2009 NY 57 57 F 5/5/2009 This serious case was received on 3
345859 5/7/2009 U 5/5/2009 This case was received on 01 May 2
345861 5/7/2009 UT 0.2 0 0.2 F 5/6/2009 Information regarding PREVNAR wa
345864 5/7/2009 MS 3 3 F 5/1/2009 4/28 had fever with chills - arm swol
345865 5/7/2009 NY 12 12 F 5/13/2009 Daily severe migraine headache un
345866 5/7/2009 ID 5 5 M 4/30/2009 On 4/28/09 Mom called on her son
345867 5/7/2009 NJ 70 70 F 5/3/2009 5 days after flu shot, I developed a r
345868 5/7/2009 AZ 2 2 0M 4/22/2009 Upper L arm was red/irritated no pa
345869 5/7/2009 PA 0.5 0 0.5 F 4/30/2009 Had ROTATEQ vaccine 4-14-09. De
345870 5/7/2009 AZ 3 3 M 4/22/2009 Rash all over body, swollen and hot
345871 5/7/2009 CA 77 F 5/7/2009 Fever up 102 for 3 days with mild po
345872 5/7/2009 TX 20 20 F 5/7/2009 Patients calls the day after immuniz
345873 5/7/2009 MD 12 12 F 5/7/2009 Localized reaction 13x26mm indura
345874 5/7/2009 TX 45 45 F 5/7/2009 30 cm X 10 cm length width erythem
345875 5/7/2009 NY 0.2 0 0.2 F 5/6/2009 Irritability for 5 hours crying, given T
345876 5/7/2009 NY 34 34 F 5/5/2009 2 days after administration of TDAP
345877 5/7/2009 NC 11 11 F 5/7/2009 Left upper arm red, warm to touch,
345878 5/7/2009 NC 63 63 F 5/6/2009 Arm sore, tired, muscle ache lasting
345879 5/7/2009 PA 17 17 F 5/7/2009 Mother of patient states patient rece
345880 5/7/2009 MI 52 52 M 5/7/2009 He states Imm given in AM. The foll
345881 5/7/2009 NC 1 1 0F 5/7/2009 EXTREME FUSSINESS AND 103 D
345882 5/7/2009 GA 1.5 1 0.6 M 5/7/2009 Fever highest 104.6, hives off and o
345883 5/7/2009 CT 2 2 0.6 M 5/7/2009 4/29/09 (Telephone consult) rash on
345884 5/7/2009 CO 35 36 M 5/7/2009 Aproximately 28 hours after vaccina
345885 5/7/2009 MD 35 35 F 5/7/2009 Developed 5 pox blisters/spots 11 d
345886 5/7/2009 KS 0.3 0 0.3 F 5/7/2009 Pt is only 4 months and was given v
345887 5/7/2009 WA 18 18 F 5/7/2009 SM tested negative BHCG on 30Ma
345888 5/7/2009 NC 1 0 1M 5/7/2009 Pt rec'd vaccines at 11a.m. and retu
345889 5/7/2009 NC 1 0 1M 5/7/2009 Pt rec'd vaccines at 11a.m. and retu
345890 5/7/2009 CA 11 11 M 5/7/2009 GAVE DTaP INSTEAD OF Tdap
345891 5/7/2009 NC 14 14 F 5/7/2009 Within approximately 5-10 minutes o
345892 5/7/2009 WA 23 23 M 5/7/2009 Pt. w/ peri-umbilical follicultis on 2 M
345893 5/7/2009 CA 4 4 M 5/7/2009 L arm redness and swelling 4 cm x5
345894 5/7/2009 CA 16 16 F 5/7/2009 Pt had syncopal episode 15 min afte
345895 5/7/2009 IN 1.1 1 0.1 M 5/7/2009 No adverse event reported. RN gav
345896 5/7/2009 IN 4 4 F 5/7/2009 Fell to floor after getting vaccines. P
345897 5/7/2009 VT 65 65 F 5/7/2009 L Deltoid muscle was extremely pai
345905 5/7/2009 NC 0.3 0 0.3 M 5/6/2009 Seizure activity 3-4 hrs after receivin
345906 5/7/2009 TX 29 29 M 5/7/2009 Coughing up blood, chest pain, and
345907 5/7/2009 KY 0.4 0 0.4 M 4/30/2009 Seizure - 11 AM 4/28/09 - taken by
345908 5/7/2009 MI 54 54 F 5/5/2009 Symptoms: 1. Rash 2. local swelling
345909 5/7/2009 WA 1 1 0F 5/1/2009 Pt was adopted at about 7 m/o from
345910 5/7/2009 AZ 4 4 M 5/7/2009 Redness and swelling at injection si
345911 5/7/2009 FL 4 4 M 5/7/2009 Cellulitis L thigh - fever 101.7 given
345912 5/7/2009 CT 2 2 0M 4/25/2009 3/10/09 - AM shaking arm when rea
345913 5/7/2009 CA 4 4 F Reddness & swelling noted at inject
345914 5/7/2009 FL 13 13 F 5/7/2009 Fever 103 degrees. Diarrhea. Vomit
345915 5/7/2009 NY 1.3 1 0.3 M 5/7/2009 Papulo-vesicular rash over torso / p
345916 5/7/2009 OH 19 19 F 5/7/2009 April 29, 09 - Injection given R shou
345917 5/7/2009 FL 0.6 0 0.6 M PE had a seizure like episode and s
345918 5/7/2009 TX 1 F 5/5/2009 Given 12 mo vaccines on 4/24/09.
345919 5/7/2009 NY 5 5 M 4/30/2009 6 cm x 7 cm area of erythema with s
345920 5/7/2009 OH 56 56 F 5/4/2009 Warmth erythema at injection site.
345922 5/7/2009 WA 17 17 F 5/7/2009 Pt had vaccines (shots) for flu, polio
345925 5/7/2009 VT 61 61 F 4/30/2009 Received vaccination in left arm on
345926 5/7/2009 OH 27 F Several areas other various location
345927 5/7/2009 RI 14 14 F 4/29/2009 Syncope after vaccination given, pa
345928 5/7/2009 CA 15 15 M 5/6/2009 Swelling, redness, and warmth.
345929 5/7/2009 OH 1 1 0M 5/3/2009 Left thigh - No initial local reaction u
345930 5/7/2009 SD 65 65 F 5/4/2009 Arm were ZOSTAVAX was given go
345931 5/7/2009 CO 50 50 F 5/1/2009 Sever headache and feeling of insid
345932 5/7/2009 TX M 5/1/2009 None Stated
345934 5/7/2009 FL 30 30 M 5/7/2009 Appx 0930 - vaccination administere
345935 5/7/2009 ME 81 81 F 5/6/2009 Patient felt a lump on left arm after a
345941 5/8/2009 IL U 5/7/2009 This case was considered medically
345944 5/8/2009 U 5/5/2009 This case was received on 01 May 2
345945 5/8/2009 CA 39 39 F 5/6/2009 Initial report received from a health
345948 5/8/2009 MD 17 17 F 5/8/2009 Pt & Foster Mother walked into Cen
345949 5/8/2009 TX 33 33 F 5/8/2009 At 48 hours, significant Local React
345950 5/8/2009 FL 66 66 F 5/8/2009 On 3/12/09 Tetanus/Diptheria toxoid
345951 5/8/2009 WA 22 22 M 5/7/2009 papular rash back of both hands an
345953 5/8/2009 KS 25 25 F 5/8/2009 Elevated temperature of 100 F withi
345954 5/8/2009 TX 11 11 F 5/8/2009 reddness swelling upper arms
345955 5/8/2009 78 -23 1M 5/8/2009 ONE WEEK AFTER SHINGLES VA
345958 5/8/2009 CA 3 3 M 5/8/2009 GAVE 3RD HEP A
345959 5/8/2009 MD 0.2 0 0.2 M 5/8/2009 My son was given his 2 month rout
345960 5/8/2009 AZ 37 37 F 5/8/2009 Small lump Lt upper arm at injection
345976 5/8/2009 CA 0.4 0 0.4 F 3/16/2009 Child received oral Rotavirus vaccin
345977 5/8/2009 NC 1 1 0F 5/8/2009 Prolonged fever 3/14/09 - 3/18/09 w
345978 5/8/2009 WA 47 47 F 4/14/2009 Rash, redness pain, swelling at and
345979 5/8/2009 WA 72 72 F 5/8/2009 Small red circle around shot. Now w
345980 5/8/2009 CA 4 4 M 5/8/2009 Pt had localized erythema/ induratio
345981 5/8/2009 PA 84 84 M 5/5/2009 Shaky No appetite Tremors Loss of
345982 5/8/2009 FL 35 35 F 5/5/2009 Pt was given shots on 5-1-09. 45 m
345983 5/8/2009 OR 1.6 1 0.6 M 5/4/2009 See accompanying note.
345984 5/8/2009 NJ 0.6 0 0.6 F 4/22/2009 Crying uncontrollably for 5 days afte
345985 5/8/2009 PA 5 5 F 5/4/2009 Varicella vaccine breakthrough diag
345986 5/8/2009 PA 9 9 M 5/4/2009 Varicella Vaccine Breakthrough. Dia
345987 5/8/2009 MD 1 1 0F 5/4/2009 Behavior change. Sleepy day after
345988 5/8/2009 IN 5 5 F 5/8/2009 Mother states pt has red, swollen, it
345989 5/8/2009 1.1 1 0.1 M 5/8/2009 12 mo received immunizations (Pre
345990 5/8/2009 FL 0.2 0 0.2 M 5/4/2009 Patient was lethargic moaned and m
345991 5/8/2009 GA 28 28 M 5/8/2009 We gave him a shot by annual chec
345992 5/8/2009 PA F 5/8/2009 Local, allergic reaction, rt arm redne
345993 5/8/2009 GA 4 4 F 5/8/2009 Hives with sig. facial swelling Benad
345994 5/8/2009 NJ 4 4 F 5/8/2009 L deltoid redness and hardness pt.
345995 5/8/2009 IA 0.6 0 0.6 F 5/8/2009 Client received vaccinations @ app
345996 5/8/2009 TN 5 5 M 5/7/2009 Both thighs red, swollen, hot to touc
345997 5/8/2009 NY 15 15 F 5/4/2009 c/o dizziness-instructed to lay down
346000 5/8/2009 NM 57 57 F 5/5/2009 swollen lymph nodes @ neck, rapid
346001 5/8/2009 WV 2 2 0F 5/2/2009 48 hours after receiving MMR she b
346002 5/8/2009 IN 1.1 1 0.1 M 5/5/2009 Fever started 6 days after vaccines
346004 5/8/2009 NJ 2 2 0.5 F 5/4/2009 4/28/09 fever 102 degrees - 103 de
346007 5/8/2009 PA 0 0 0M 5/4/2009 Varicella vaccine break through. Dia
346008 5/8/2009 CA 0.8 0 0.8 F 5/4/2009 Erythema multiforme- started 5/2/09
346010 5/8/2009 NC 2 2 0.4 F 4/24/2009 Fever 103
346184 5/8/2009 CA 16 16 F 4/15/2009 Initial report received on 02 April 20
345961 5/9/2009 NC 31 31 F 5/9/2009 Woke up with Very sore arm (painfu
345962 5/9/2009 CA 1 1 0F 5/9/2009 Febrile Seizure lasted 60 seconds s
345963 5/9/2009 47 M 5/9/2009 I'm currently serving my 4th deploym
345964 5/10/2009 LA 36 36 F 5/10/2009 Starting the day the first dose rabies
345965 5/10/2009 NV 4 4 M 5/10/2009 right deltoid with induration, mild ery
345966 5/10/2009 GA 65 65 F 5/10/2009 My arms swelled up to double its siz
346046 5/11/2009 CA 2 M 5/8/2009 Information has been received from
346052 5/11/2009 NC 13 13 F 5/8/2009 Initial and follow-up information has
346070 5/11/2009 WY 54 54 M 5/11/2009 5/5/09 At time of injections noted cli
346071 5/11/2009 MD 0.5 0 0M 5/11/2009 6 month old received immunizations
346072 5/11/2009 MD 7 7 F 5/11/2009 Patient and patient's father returned
346073 5/11/2009 NY 1.5 1 0.5 F 5/11/2009 RASH STARTED ON 5/10/2009 FR
346074 5/11/2009 IL 0.4 0 0.4 F 5/11/2009 Evening of injections got fussy, then
346075 5/11/2009 CA 50 50 F 5/11/2009 Developed fevers, malaise and hea
346076 5/11/2009 CA 32 32 F 5/11/2009 Skin Rash and/or Hives, swollen fee
346077 5/11/2009 WA 76 76 F 5/11/2009 On Day 2 after the injection (5/2), de
346078 5/11/2009 CA 61 61 M 5/11/2009 1/2 DOLLAR bill redness c some sw
346079 5/11/2009 MI 4 4 M 5/11/2009 LOCAL RXN R>L THIGH W/IN MIN
346080 5/11/2009 VA 10 10 M 5/11/2009 Tdap was administered in school se
346081 5/11/2009 MI 4 4 U 5/11/2009 LOCAL RXN R THIGH W/IN MINUT
346082 5/11/2009 NY 22 22 F 5/11/2009 Approx. 20 hours after receiving vac
346083 5/11/2009 AL 15 15 F 5/11/2009 Parent states that patient had on lef
346084 5/11/2009 CA 5 5 F 5/11/2009 Noted slight swelling of the left delto
346096 5/11/2009 VA 4 4 M 5/7/2009 Toxic synovitis (L) hip. 6/24/09 Hosp
346097 5/11/2009 11 F 5/7/2009 Received second dose of GARDAS
346098 5/11/2009 TX 32 32 M 5/8/2009 None Stated.
346099 5/11/2009 NC 87 87 F 5/11/2009 Tingly pains in left hip with weaknes
346100 5/11/2009 KS 12 12 F 5/8/2009 Pt Developed a right upper extremit
346101 5/11/2009 GA 39 39 M 5/4/2009 Patient reported C/o redness and so
346102 5/11/2009 IA 15 15 F 5/8/2009 3-4 Months after 3rd dose of GARD
346103 5/11/2009 CA 4 4 F 5/8/2009 Swelling, redness, pain. Entire delt
346104 5/11/2009 ME 2 2 0F 5/11/2009 Vaccine given instead of VARIVAX
346105 5/11/2009 ME 12 12 F 4/30/2009 Hives - began around 6pm on 4/28/
346106 5/11/2009 VA 57 57 F 5/11/2009 May 7 after shot arm sore and some
346107 5/11/2009 TX 72 72 M 5/11/2009 Loss of sensation in right arm; arm i
346108 5/11/2009 NV 0.7 0 0.7 F 5/11/2009 02/24/2009 Severe Seizures < 3 da
346109 5/11/2009 GA 11 11 M 5/11/2009 Local reaction, quarter sized erythe
346110 5/11/2009 MO 10 10 F 5/11/2009 Redness Swelling itching warm to to
346111 5/11/2009 NM 22 22 M 5/11/2009 Developed tender mildly pruritic ery
346112 5/11/2009 NJ 11 11 F 5/11/2009 Within 24 hrs following vaccinations
346113 5/11/2009 FL 16 16 F 5/11/2009 Pt fainted, gave oxygen and checke
346114 5/11/2009 NY 5 5 M 4/30/2009 6cm x 7cm area of erythema with sl
346115 5/11/2009 ME 2 2 0.6 F 5/6/2009 Diffuse papular/macular erythemato
346116 5/11/2009 DC 60 60 F Minor swelling + tenderness at injec
346117 5/11/2009 ME 1.3 1 0.3 U Diffuse macular erythematous rash
346118 5/11/2009 CA 5 5 F 4/30/2009 Rec'd vacc 4:30 p 4/27. Pt went to s
346119 5/11/2009 MN 17 17 F 5/4/2009 About 5 hours after shot developed
346120 5/11/2009 NJ 40 40 F 5/11/2009 Erythema local. Myalgias. Arthralgia
346121 5/11/2009 OH 30 30 M 5/11/2009 Pt rec VARICELLA vaccine on 4/20
346122 5/11/2009 CA 58 58 F 4/17/2009 4-17-09 9:10 AM Pt. c/o ears tinglin
346123 5/11/2009 FL 13 13 F 5/5/2009 Syncopal episode - hit head.
346124 5/11/2009 WI 14 14 F 4/20/2009 Patient received shots on 4-14-09.
346125 5/11/2009 IA 4 4 M 5/6/2009 Mother PHONED 5/5 @ 1 pm. Rep
346130 5/11/2009 GA 0.2 M 5/5/2009 This case was reported by a healthc
346139 5/12/2009 WV 54 M 5/7/2009 Initial report received on 04 May 20
346145 5/12/2009 OK 11 11 M Imm - ADACEL, MENACTRA, varic
346151 5/12/2009 NY 2 2 0.6 M 4/20/2009 Mild fever within 1 week change in c
346153 5/12/2009 DC 0.4 0 0.4 M 5/11/2009 Information has been received from
346155 5/12/2009 KY 10 10 F 5/6/2009 Cellulitis at injection site of varicella
346156 5/12/2009 PA 2 2 0.7 M 5/4/2009 Mom called 5/1/09, c/o pain. "limpin
346157 5/12/2009 38 38 F None Stated
346158 5/12/2009 LA 20 20 F 4/29/2009 None stated
346161 5/12/2009 NC 30 30 F 5/6/2009 Localized induration, fever, chills, m
346163 5/12/2009 PA 11 11 F 5/4/2009 L arm pain initially & then recurred w
346165 5/12/2009 SC 15 15 M 5/7/2009 "Breaking out in bumps all over his
346170 5/12/2009 IN 22 M 5/6/2009 Popular rash on R deltoid began 5/4
346171 5/12/2009 OH 13 13 F 5/7/2009 Arm soreness, fever, joint pains, he
346172 5/12/2009 MD 59 59 F 5/15/2009 5/5/09 Administration of L arm eryth
346173 5/12/2009 CA 53 53 F 5/2/2009 Less than 24 hrs after injection site
346174 5/12/2009 LA 11 11 F 5/7/2009 11 y/o female was administered VA
346175 5/12/2009 IL 0.5 0 0.5 M 5/7/2009 Rash appeared 3 days after vaccine
346176 5/12/2009 PA 60 60 F 5/10/2009 Began 12 hours post vaccination: F
346177 5/12/2009 TX 39 39 F 5/7/2009 Red, fever, painful. 3rd day reaction
346178 5/12/2009 TX 39 39 F 5/6/2009 (1) Hives, (2) SOB, (3) Throat swelli
346179 5/12/2009 NC 4 4 M 5/7/2009 Redness, warmth, induration - diffus
346180 5/12/2009 NY 0.2 0 0.2 M 5/8/2009 Vaccine given 4/23/09 - Pt began ha
346181 5/12/2009 PA 19 19 F 5/8/2009 None
346182 5/12/2009 OH 5 5 M 5/4/2009 12 cm diameter redness, warmth, sw
346183 5/12/2009 MO 5 5 F 5/7/2009 None (received Td. - Should have re
346186 5/12/2009 MI 0.2 0 0.2 M 5/6/2009 Blood in stool noted 4-29-09 5 days
346187 5/12/2009 IN 5 5 M 5/6/2009 Patient felt weak, lost balance, beca
346188 5/12/2009 SC 12 12 M 4/30/2009 Right deltoid swelling, heat, pain. L
346189 5/12/2009 MI 1.3 1 0.3 M Possible seizure activity, brief altera
346190 5/12/2009 VT 1.3 1 0.3 F 5/6/2009 High fever followed by seizure 24 af
346191 5/12/2009 WV 13 13 F 5/7/2009 Patient's arm red, swollen and fever
346192 5/12/2009 ME 68 68 F 5/5/2009 (Vac. 4-30-09) - site irritation only th
346193 5/12/2009 NH 31 31 M 5/6/2009 Temp 101.7 Po since evening after
346194 5/12/2009 LA 33 33 F 5/8/2009 None stated
346195 5/12/2009 CT 11 11 M 5/5/2009 Red, swelling and pain at the site of
346196 5/12/2009 CT 12 12 M 5/5/2009 Red, swelling & pain at the site of in
346197 5/12/2009 CA 5 5 M 5/5/2009 48 hrs post administration child had
346198 5/12/2009 OH 1.3 1 0.3 F 5/5/2009 Rash & fever 11 days post vaccine
346200 5/12/2009 KY 11 11 F 5/5/2009 Rash 1st noticed behind ears, now
346201 5/12/2009 NM 20 20 M 5/1/2009 C/O sore throat, difficulty swallowing
346202 5/12/2009 KY 1 1 0F 5/4/2009 5/1/09 Patient received immunizatio
346203 5/12/2009 CA 5 5 U 5/1/2009 Swollen, red & hot to the touch.
346204 5/12/2009 OH 24 24 F 5/12/2009 4 DAYS AFTER RECIEVING ANTH
346205 5/12/2009 KS 15 15 M 5/12/2009 Experienced fever (102.0 degrees F
346206 5/12/2009 IL 0.2 0 0.2 M 5/12/2009 Foster parent says that patient only
346207 5/12/2009 ME 4 4 F 5/12/2009 Parents noticed rash on upper arm
346208 5/12/2009 KS 14 14 M 5/12/2009 Arm was sore, low grade fever, felt
346209 5/12/2009 KS 12 12 M 5/12/2009 Sore arm, low grade fever, fatigue
346210 5/12/2009 CA 1.1 1 0.1 M 5/12/2009 IMMEDIATELY AFTER GIVING MM
346211 5/12/2009 CA 20 19 F 5/12/2009 Redness and swelling at injection si
346212 5/12/2009 OH 61 61 F 5/12/2009 On 1/9/09 the patient called the offic
346213 5/12/2009 OH 4 4 M 5/12/2009 Patient received the vaccination on
346214 5/12/2009 NY 1.5 1 0.5 M 5/12/2009 Infant screaming in tantrums which
346215 5/12/2009 OH 1.3 1 0.3 F 5/12/2009 Per ER Physician varicella rash on b
346216 5/12/2009 MD 71 U 5/12/2009 Subject in pneumococcal vaccine tr
346218 5/12/2009 OH 64 63 M 5/12/2009 Pt received Tdap injection 3/17/09.
346219 5/12/2009 AL 0 0 0F 5/12/2009 patient had no signs of complication
346220 5/12/2009 AZ 4 4 M 5/12/2009 5-7-09 Crying, sore arms, couldn't m
346221 5/12/2009 MA 70 70 F 5/12/2009 pT DEVELOPED SIGNS AND SYM
346222 5/12/2009 CA 0.2 0 0.2 M 5/12/2009 A hard, red lump the size of a blueb
346223 5/12/2009 CA 36 36 F 5/12/2009 On Wednesday May 13th I visited m
346224 5/12/2009 NC 1 1 0F 5/12/2009 FEVER BETWEEN 102.5 AND 103
346229 5/12/2009 FL 12 12 F 5/1/2009 Dx-encephalitis etiology unkonwn. F
346230 5/12/2009 CT 22 22 F 3/15/2009 At 1248am, I fainted, had possible s
346231 5/12/2009 NM 12 12 M Swelling, warmth & hardness at site
346232 5/12/2009 IA 74 74 F 1/15/2009 12/27/08 --> Lt scapular pain - gen O
346233 5/12/2009 WA 4 4 M 5/12/2009 ?Neck swelling w/ slight tenderness
346234 5/12/2009 WA 4 4 M 5/8/2009 Inflammation , tenderness left uppe
346235 5/12/2009 CA 0.5 0 0.5 M 5/12/2009 Per Dr possible granuloma.
346237 5/12/2009 WA 27 27 F 5/12/2009 Patient fainted after administration o
346238 5/12/2009 CA 11 11 M 5/11/2009 About 20 minutes after receiving im
346239 5/12/2009 KY 4 4 M 5/6/2009 Mother of child reports that child ha
346240 5/12/2009 NC 1.6 1 0.6 M 5/15/2009 Pt developed urticaria (generalized)
346241 5/12/2009 MN 77 77 F 5/11/2009 Pt walked into clinic at 10:00 am on
346242 5/12/2009 CT 12 12 F 5/12/2009 HPV vaccine give with expired date
346243 5/12/2009 MI 30 30 F 5/11/2009 Approximately 24 hrs post receiving
346245 5/12/2009 PA 61 61 F 5/11/2009 Injection site {erythema warm sensa
346246 5/12/2009 OH 71 71 F 5/1/2009 Client had ZOSTAVAX injection 5/2
346247 5/12/2009 OR 73 73 F 5/7/2009 Rash, pain, loss of eye sight for 2 w
346248 5/12/2009 NC 1 1 0M 5/12/2009 Multiple papules + pustuls on back +
346249 5/12/2009 NJ 13 13 F 5/12/2009 Pt was home 1 1/2 hrs post vaccine
346250 5/12/2009 TX 48 48 F 5/12/2009 Left arm pain and swelling saw Dr 5
346251 5/12/2009 UT 11 11 F 5/12/2009 5/9 Cellulitis left arm s/p Tdap place
346252 5/12/2009 MI 67 67 M 5/7/2009 Next day developed cough and con
346253 5/12/2009 OH 4 4 M 5/6/2009 DTaP administered @ thigh on 5-3-
346254 5/12/2009 KY 61 61 F 5/1/2009 Local edema, pain, redness.
346255 5/12/2009 MN 26 26 F 5/12/2009 Probable secondary transmission of
346260 5/13/2009 85 85 F 5/3/2009 Pt receives a PNA vaccine on 5-2-0
346262 5/13/2009 94 94 F 5/6/2009 Pt called around 2100 on 5/2/09; sp
346263 5/13/2009 25 U 4/17/2009 Pt c/o lip tingling and respiratory sym
346264 5/13/2009 TX 63 63 F 5/13/2009 Patient states awoke to arm red swo
346265 5/13/2009 PA 1 1 0F 5/12/2009 Rash on back itchy, especially on A
346266 5/13/2009 GA 17 17 F 5/11/2009 Patient give hep B (peds) on 5-1-09
346267 5/13/2009 NJ 46 46 F 5/7/2009 Vaccine administered to pt on 4-1-0
346268 5/13/2009 AR 4 4 F 5/4/2009 L upper 2 length area of redness + l
346269 5/13/2009 WI 4 4 M 5/8/2009 8 by 7 cm area of erythema + warm
346270 5/13/2009 WI 1 1 0M 5/7/2009 None Stated
346271 5/13/2009 MD 38 38 M 5/5/2009 Constipation, some lost of vision.
346272 5/13/2009 MD 48 48 M 5/13/2009 This case was reported by a lawyer
346276 5/13/2009 GA 43 43 F 5/13/2009 "...began to hve severe joint pain
346277 5/13/2009 MI 10 10 F 5/13/2009 Patient was given a Zostavax vaccin
346278 5/13/2009 SC 0.3 0 0.3 F 5/13/2009 Pt seen in hospital on May 11, 2009
346279 5/13/2009 KY 33 33 F 5/13/2009 Employee received 2nd dose of Hep
346280 5/13/2009 KY 5 5 F 5/13/2009 Immunizations administered at 12:4
346281 5/13/2009 FL 4 4 F 5/13/2009 AS SOON AS THE VARICELLA AN
346282 5/13/2009 SC 30 30 F 5/13/2009 Pt developed a raised red area on b
346283 5/13/2009 MI 38 38 F 5/13/2009 Ct satates that a couple of hours aft
346284 5/13/2009 PA 31 31 F 5/13/2009 Patient stated she had received a M
346285 5/13/2009 NY 0.3 0 0.3 F 5/13/2009 Patient ran a 102 fever, breathing v
346286 5/13/2009 PA 26 26 M 5/13/2009 Reported to clinic 4/21/2009 with sw
346287 5/13/2009 PR 0.3 0 0.5 M 5/13/2009 PATIENT'S MOTHER REFERS RA
346288 5/13/2009 AK 1 1 0F 5/13/2009 Local hives and swelling at site of V
346289 5/13/2009 NY 44 44 F 5/13/2009 PATIENT DEVELOPED ITCHY HIV
346290 5/13/2009 VA 17 17 F 5/13/2009 Started developing warts on inside o
346292 5/13/2009 OR 19 19 F 5/12/2009 Pt saw PCP on 2/4/09 for GYN/PAP
346293 5/13/2009 NE 1.2 1 0.2 M 5/13/2009 Ear infection 1 week prior to abnorm
346294 5/13/2009 CA 4 4 M 4/26/2009 The following day, noted increased
346295 5/13/2009 IL 70 70 F 5/12/2009 Examined by MD 5-12-09 in Derma
346296 5/13/2009 MD 1.1 1 0.1 M 10mm induration with redness R lat
346297 5/13/2009 AZ 0.5 0 0.5 F 5/8/2009 Parents took child across street to g
346298 5/13/2009 WI 20 20 F 5/13/2009 15-20 seconds after injection becam
346299 5/13/2009 IA 1 1 0M 5/13/2009 Fever X 9 days vomiting X 2 days
346300 5/13/2009 PA 4 4 M 5/13/2009 Local redness approximately 10mm
346301 5/13/2009 OR 2 2 0.1 M 5/13/2009 Pt reacted immediately to VAR + MM
346302 5/13/2009 MD 1 1 0F 5/13/2009 40mm X 30mm area of induration o
346303 5/13/2009 GA 0.4 0 0.4 F 5/13/2009 No adverse event of symptoms, wro
346304 5/13/2009 TX 9 9 M 5/13/2009 Achy headache, fatigue, tremors, ar
346306 5/13/2009 CA 0.2 0 0.2 M 5/13/2009 Infant with "milk protein allergy" at 1
346307 5/13/2009 MO 16 16 F 5/13/2009 Deep, aching pain in Rt arm, very te
346291 5/14/2009 TX 17 17 F 5/14/2009 First complaint was neck arm stiffne
346312 5/14/2009 MI 0.2 M 5/13/2009 Information has been received from
346316 5/14/2009 IL 0.6 0 0.6 F Diagnosed with rotavirus on 4/30/09
346317 5/14/2009 WI 57 57 F 4/27/2009 5-day(s) hospitalization for IVIG - ex
346318 5/14/2009 NC 21 21 M 5/11/2009 21 y/o patient seen for F/U s/p hosp
346319 5/14/2009 19 19 M 3/18/2009 Pt woke up with CP and SOB in the
346321 5/14/2009 IL 60 60 M 5/8/2009 "Cold sore on lower lip within 48 hou
346322 5/14/2009 IL 11 11 F 5/11/2009 Rt. arm red, slightly warm to touch,
346323 5/14/2009 NC 0.8 0 0.8 M 5/14/2009 Patient c/o fever 102,less of appetit
346324 5/14/2009 0.4 0 0.5 M 5/14/2009 Patient given Rotarix vaccine. On fir
346325 5/14/2009 OH 0.4 0 0.4 M 5/14/2009 Pt was found Y face down in his crib a
346326 5/14/2009 CA 5 5 F 5/14/2009 Received vaccination on Friday, by
346327 5/14/2009 WI 4 4 F 5/14/2009 Warm, red, hard 2.5 X 3 inch cellulit
346328 5/14/2009 OH 5 5 M 5/14/2009 On 5-11-09 mom called and spoke
346329 5/14/2009 KY 24 24 F 5/14/2009 after few hours of taking the vaccine
346330 5/14/2009 TX 1 1 0.1 M 5/14/2009 Received Varicella and Hepatitis A v
346331 5/14/2009 40 40 M 5/14/2009 Chest Pain 786.5 (5-000008) 5/19
346332 5/14/2009 MA 25 25 F 5/14/2009 was administered Tdap, no previous
346333 5/14/2009 PA 30 30 F 5/14/2009 sore, warm, red, bruised spot on the
346334 5/14/2009 SD 4 4 F 5/7/2009 Right upper arm redden and swollen
346335 5/14/2009 TX 25 25 F 5/14/2009 Patient presented to the emergency
346336 5/14/2009 VA 11 11 M 5/14/2009 injection site red and swollen x 1 da
346337 5/14/2009 VA 16 16 F 5/14/2009 During the series of 3 injections and
346338 5/14/2009 AL 14 14 F 5/14/2009 Patient reports that after receiving s
346339 5/14/2009 TX 0.5 0 0.3 F 5/14/2009 PATIENT SEEMED TO HAVE PRO
346340 5/14/2009 AZ 25 24 F 5/14/2009 pt was given hpv vaccine pt was the
346344 5/14/2009 ME 52 52 F 5/6/2009 - Hallucinations. - Fever, chills. - Loc
346345 5/14/2009 NY 3 3 M 5/14/2009 Cranky and decreased appetite star
346346 5/14/2009 IA 1.3 1 0.3 F 5/13/2009 Patient presented to hospital with 1-
346347 5/14/2009 CA 5 5 M 5/14/2009 R arm swelling, redness within 48 o
346348 5/14/2009 MI 65 65 F 5/6/2009 Developed redness, swelling locally
346349 5/14/2009 MD 1 1 0M 5/14/2009 Pt received Varicella vaccine (lot #0
346350 5/14/2009 NJ 10 10 F 5/14/2009 Pt. received vaccines TDAP, Hep A
346351 5/14/2009 TX 11 11 M 5/14/2009 Swelling, redness, pain, warmth at i
346352 5/14/2009 NC 10 10 F 5/14/2009 1 inch X 1 1/4 inch upper arm redne
346353 5/14/2009 CA 17 17 F 5/13/2009 Urticaria- Erythematous Wheals all
346354 5/14/2009 SC 4 4 F 5/14/2009 Mom noted redness, heat and swell
346355 5/14/2009 IN 1 1 0M 5/14/2009 On 5/3/09 Mother noticed L arm red
346356 5/14/2009 NC 22 22 F ### 22 y/o pregnant female, ADSM, rep
346357 5/14/2009 CA 1.2 1 0.2 F 5/2/2009 Local allergic reaction at site of injec
346358 5/14/2009 NC 21 21 F 3/19/2009 21 y/o AD female presents for walk-
346359 5/14/2009 NC 45 45 M ### 45 y/o male, ADSM, is referred to th
346360 5/14/2009 NC 22 22 M 5/7/2009 Dr. calls clinic (06May09) re 22 y/o A
346361 5/14/2009 NY 49 49 F 5/12/2009 Pt has rash left arm, swelling, no fev
346362 5/14/2009 IA 14 14 F 5/9/2009 Swelling, itchiness, redness at site o
346363 5/14/2009 OH 0.7 0 0.7 M 5/7/2009 Lip droops down on R side of face w
346364 5/14/2009 IL 4 U Large 3 1/2" urticarial patch over inj
346365 5/14/2009 NC 11 11 F 5/11/2009 After vaccination on way home mom
346366 5/14/2009 PA 60 60 M 4/10/2009 Noticed 2 swollen lymph nodes und
346367 5/14/2009 MA 64 64 F 5/9/2009 1 wk symptoms 2 wk recovery comp
346368 5/14/2009 TN 4 4 F 5/8/2009 2 1/2 round rash on 1 thigh, warm to
346369 5/14/2009 GU 23 23 M 5/14/2009 0840- IM injection given - HEPA. HE
346444 5/14/2009 CA 63 63 F 5/15/2009 Shingles vaccination: Next few days
346371 5/15/2009 IN 10 10 M 5/15/2009 Localized erythema - mom describe
346372 5/15/2009 IN 36 36 M 5/15/2009 05-12-09, Feverish, C/o "feeling sick
346373 5/15/2009 PA 4 4 M 5/3/2005 Immunization (KINRIX) given on 5/1
346374 5/15/2009 IL 16 16 F 5/8/2009 Scattered hives occurred that pm or
346375 5/15/2009 OR 4 4 M 4/30/2009 4/29/09 - Rt arm inflamed and swoll
346376 5/15/2009 IL 18 18 F 5/8/2009 Hives and blisters up both arms. Tre
346377 5/15/2009 PA 1.6 1 0.6 U Mild hives treated with BENADRYL
346379 5/15/2009 NJ 4 4 M 5/15/2009 Localized reaction at IM injection sit
346380 5/15/2009 CT 0.4 0 0.4 F 3/23/2009 Low grade fever (101), diarrhea, mil
346381 5/15/2009 TN 32 32 M 5/1/2009 Pain, redness and swelling in L arm
346382 5/15/2009 TN 26 26 F Itching, onset one hour after vaccina
346383 5/15/2009 VA 10 10 F 5/8/2009 Received Tdap around 9:00-9:30 am
346384 5/15/2009 GA 11 11 M 5/8/2009 Nurse administered 0.5 cc of Tdap t
346385 5/15/2009 NV 1.1 M 5/5/2009 Received IZ's 4.29.09 - 5-1-09 pale
346386 5/15/2009 CA 77 76 F 5/8/2009 24 hours -->72 hours : 5 x 7 cm eryt
346387 5/15/2009 CA 13 13 M 5/7/2009 Hives began at injection sites on rig
346388 5/15/2009 RI 54 54 M 5/8/2009 Rigors, increased temperature. See
346389 5/15/2009 CA 5 5 F 5/8/2009 Right arm- red and swollen with sma
346390 5/15/2009 VA 27 27 F 3/4/2009 2/27/09 Day 8- joint and muscle pai
346391 5/15/2009 VA 13 13 M 5/15/2009 vaccinate site red and swollen x 1 d
346392 5/15/2009 VA 5 5 M 5/15/2009 Child was brought in for office visit t
346393 5/15/2009 VA 4 4 M 5/15/2009 Child was brought in for an office vis
346394 5/15/2009 NY 32 32 F 5/15/2009 Received vaccine on may 12,2009 a
346395 5/15/2009 MA 14 14 F 5/15/2009 Patient presented to our office on 5/
346397 5/15/2009 MN 5 5 F 5/15/2009 3 inch red, swollen, hot area on left
346398 5/15/2009 KS 29 29 F 5/15/2009 Ct received her first rabies vaccine o
346399 5/15/2009 CA 15 15 M 5/15/2009 Right outer aspect of arm extending
346400 5/15/2009 CA 15 15 F 5/15/2009 developed chest pain and palpation
346401 5/15/2009 AZ 10 10 F 5/15/2009 Warm, erythamatous, tender lesion
346402 5/15/2009 SC 11 11 F 5/15/2009 Rt arm swollen and knot the size of
346403 5/15/2009 NC 4 4 M 5/15/2009 Received 5 yo vaccines today, kinrix
346404 5/15/2009 IL 14 14 M 5/15/2009 Patient was given Gardisil instead o
346405 5/15/2009 38 38 M 5/15/2009 Chest Pain (786.59) 5-000009 6/1
346406 5/15/2009 FL 11 11 M 5/15/2009 Within a few days of receiving Mena
346407 5/15/2009 PA 79 79 F 5/15/2009 Patient presented 24 hours later wit
346408 5/15/2009 MI 13 13 F 5/15/2009 3 RED "WELTS" ON LT ARM TOW
346409 5/15/2009 LA 4 4 M 5/15/2009 4 year 7 month old male presents w
346410 5/15/2009 MD 40 40 F 5/15/2009 New admission from E.R.,recieved P
346411 5/15/2009 NM 17 17 F 5/15/2009 Student came in to my office 5/15/0
346413 5/15/2009 WI 13 13 F 5/15/2009 Patient was given MCV4 and Var #2
346414 5/15/2009 OH 24 25 M 5/15/2009 I had only experienced a short dura
346415 5/15/2009 CA 16 16 F 5/15/2009 10 X 9 welt with swelling and redne
346423 5/15/2009 MA 2 2 0.8 F 5/16/2009 (L) upper arm injection site swelling
346424 5/15/2009 AZ 1 1 0M 5/15/2009 Developed erythematous rash at sit
346425 5/15/2009 UT 0.6 0 0.6 F 5/15/2009 Woke up day after shot with a rash
346426 5/15/2009 25 F 5/13/2009 Seriousness Criteria: Other- Medica
346427 5/15/2009 CO 5 5 U L thigh 7X9 cm, warm, erythematou
346433 5/15/2009 NE 5 5 F 5/13/2009 4" x 5" red reaction right thigh.
346439 5/15/2009 NC 76 76 F 5/12/2009 Patient received vaccine 5-8-09; no
346440 5/15/2009 MO 3 3 M 5/15/2009 Have noticed redness @ swelling to
346441 5/15/2009 IN 5 5 M 5/15/2009 Red area of inflammation occurred i
346442 5/15/2009 VA 5 5 F 5/14/2009 Indurated red skin in roughly rectan
346443 5/15/2009 FL 13 13 F 5/15/2009 1:35 Pt complaints of dizziness, Pt p
346445 5/15/2009 IL 78 78 F 5/13/2009 12-18 Hours after receiving injection
346446 5/15/2009 MO 4 4 F 5/15/2009 Developed 4.5mm x 5mm areas + r
346447 5/15/2009 LA 4 4 M 5/15/2009 Local reaction Left deltoid; erythema
346448 5/15/2009 NC 53 53 F 5/15/2009 Arm sore, red and swollen.
346416 5/16/2009 NC 12 12 M 5/16/2009 Severe hives over entire body, head
346417 5/16/2009 37 37 M 5/16/2009 Generalized vaccinia with diffuse ra
346419 5/16/2009 KY 41 41 F 5/16/2009 On the day of the shot, the injection
346421 5/16/2009 AK 1 1 0F 5/16/2009 11-28-08 Mom reports body rash fo
346452 5/18/2009 OK 0.5 0 0.5 M 5/15/2009 Information has been received from
346462 5/18/2009 FL 0.6 0 0.6 M 5/7/2009 Influenza vaccines rec'd 10/18/07 a
346463 5/18/2009 TN 44 44 F 4/28/2009 Pt called 4/28/09 after sx has resolv
346464 5/18/2009 WI 18 18 F 5/18/2009 3x3.75 inches erythematous area o
346465 5/18/2009 MI 11 11 M Erythema @ injection site edema pa
346466 5/18/2009 IA 13 13 F 5/18/2009 Pt. at clinic received HPV, MENACT
346467 5/18/2009 PA 6 6 F 5/14/2009 Patient received VARIVAX immuniz
346468 5/18/2009 65 65 F 5/18/2009 Bell's Palsy
346469 5/18/2009 MD 7 7 M 5/18/2009 On day of vaccination, (hours later)
346470 5/18/2009 TX 4 4 F 5/18/2009 localized alergic reaction to left thigh
346471 5/18/2009 PA 1.1 1 0F 5/18/2009 macular papular rash post auricular
346472 5/18/2009 OH 67 67 F 5/18/2009 Patient presented to the Emergency
346473 5/18/2009 MA 15 15 F 5/18/2009 Pt was given Menningicoccal vaccin
346474 5/18/2009 MI 17 17 F 5/18/2009 On 5/15/09 Adriana returned to hav
346475 5/18/2009 GA 32 32 M 5/18/2009 client complained swollen area abou
346476 5/18/2009 NY 11 11 F 5/18/2009 Patient tolerated vaccine well, but u
346477 5/18/2009 VA 19 19 M 5/18/2009 PT BROKE OUT WITH PIMPLES O
346478 5/18/2009 MO 38 38 F 5/18/2009 Pt reports slight fever and flu like sy
346479 5/18/2009 TX 35 35 F 5/18/2009 Delivered baby on 5/11/09. Got MM
346480 5/18/2009 GA 65 65 F 5/18/2009 Pt reported localized swelling at inje
346481 5/18/2009 KS 37 F 5/18/2009 Developed hard bump in arm that g
346482 5/18/2009 UT 19 19 M 5/18/2009 Client was administered vaccines, b
346483 5/18/2009 IA 2 2 0M 5/18/2009 Patient was given Vaccines and 48
346484 5/18/2009 MA 18 18 F 5/18/2009 On 4/28/09 the patient was given th
346485 5/18/2009 NC 25 26 F 5/18/2009 extreme fatigue, migraines, nose ble
346486 5/18/2009 SC 24 24 F 5/18/2009 The site where the vaccine was adm
346487 5/18/2009 NC 26 26 F 5/18/2009 diffuse itching began less tan 12 ho
346488 5/18/2009 CA 4 4 F 5/18/2009 rash left deltoid from Prevnar admin
346489 5/18/2009 CA 3 3 F 5/18/2009 rash at site of vaccine(prevnar) left d
346490 5/18/2009 MO 14 14 F 5/18/2009 Pt became weak and dizzy while wa
346491 5/18/2009 MI 69 69 F 5/18/2009 Client received Zostavax in am on 0
346492 5/18/2009 MT 18 15 M 5/18/2009 Fever (101.9), achiness, headache,
346493 5/18/2009 MI 60 60 F 5/18/2009 RAISED INDURATED AND ERYTH
346494 5/18/2009 CA 12 1 0F 5/18/2009 THE VACCINE WAS INJECTED ON
346495 5/18/2009 PA 16 7 M 5/18/2009 Rash started 4/15/09, chicken pox.
346496 5/18/2009 PA 14 14 M 5/18/2009 syncope after vaccines
346497 5/18/2009 MO 12 12 F 5/18/2009 Left Deltoid raised, reddened, appro
346498 5/18/2009 CO 69 69 F 5/18/2009 pt. received in clinic Td and Pneumo
346499 5/18/2009 PA 11 11 M 5/18/2009 fine red rash all over body, no urtica
346500 5/18/2009 WI 15 15 F 5/18/2009 Shortly after her first shot patient sta
346501 5/18/2009 NY 13 13 F 5/18/2009 She has had dizziness, nausea and
346502 5/18/2009 KY 27 27 F 5/18/2009 With the first booster injection given
346503 5/18/2009 CA 27 28 M 5/18/2009 Large lump at injection site. Sore a
346505 5/18/2009 WA 0.2 0 0.2 M 5/18/2009 Eyes twitching, unresponsive. Fussi
346507 5/18/2009 CA 5 5 F 5/18/2009 Left deltoid swollen with redness an
346508 5/18/2009 GA 0 0 0M 5/18/2009 This case was reported by a pharma
346509 5/18/2009 TX 16 16 F 5/18/2009 Fever 103-104 X 2 days
346510 5/18/2009 AL 5 5 M 5/18/2009 Site swollen/red 2 days after vaccin
346512 5/18/2009 VA 23 23 U 5/18/2009 Pt had AVA and Influenza shot on 4
346515 5/18/2009 ND 14 14 F 5/18/2009 In evening of day of shots - She dev
346516 5/18/2009 SC 4 4 F 5/15/2009 DTap #5 given in R thigh- 48 hours
346517 5/18/2009 VA 35 35 M 5/5/2009 HEPATITIS B #2 (accelerated sche
346518 5/18/2009 CA 4 4 M 4/23/2009 L deltoid inflammation 3 cm Rx for B
346519 5/18/2009 AR 0.4 0 0.4 M 5/11/2009 Fine rash systemically see clinical d
346520 5/18/2009 OH 4 4 F 5/11/2009 Redness, swelling-hard and warm to
346521 5/18/2009 NC 30 30 F None stated
346522 5/18/2009 NE 5 5 M 5/11/2009 None stated
346523 5/18/2009 MN 1.5 1 0.5 M 5/7/2009 Erythematous, swollen, large local r
346524 5/18/2009 FL 4 4 M 5/4/2009 Hives
346525 5/18/2009 PA 2 2 0.7 F 5/7/2009 Right thigh red, indurated 1 1/2 - 2"
346529 5/18/2009 CT 3 3 F 5/13/2009 Vomiting, which began a couple of h
346532 5/18/2009 IN M 5/13/2009 Site on upper right arm appeared re
346533 5/18/2009 LA 17 17 F 5/6/2009 Pt's aunt called back 2 days after ER
346535 5/18/2009 0.3 U 5/18/2009 This case was reported in a literatur
346537 5/18/2009 LA 45 45 F 5/6/2009 Patient came in for Flu vaccine, Rig
346539 5/18/2009 MT 11 11 M 5/11/2009 Itching at injection site, right arm. Er
346544 5/18/2009 CA 4 4 F 5/11/2009 Left deltoid 13X14 CM Swollen, Red
346545 5/18/2009 OR 39 39 F 5/12/2009 Patient should have received a Tda
346546 5/18/2009 OR 20 20 F 5/8/2009 Client reports that after HPV vaccine
346547 5/18/2009 2 2 0.1 F 5/9/2009 Red swollen lump L thigh.
346548 5/18/2009 AL 8 8 F 5/13/2009 Several vesicles at injection site, fol
346549 5/18/2009 GA 11 11 F 5/11/2009 Patient received VARIVAX vaccine
346550 5/18/2009 MA 38 38 U Vaccine given 5/1/09 pri 5/1 - 5/09 R
346551 5/18/2009 PA 4 4 M 36% After receiving vaccine, mild sw
346552 5/18/2009 MI 21 M 5/13/2009 None Stated
346554 5/18/2009 TX 1.6 1 0.6 F 5/12/2009 Urticaria, generalized. Benadryl 6.25
346555 5/18/2009 23 23 M 5/18/2009 25 y/o WM ADSM is referred from a
346557 5/18/2009 NY 4 4 F 5/18/2009 DDX reaction to the pertussis in DT
346558 5/18/2009 TN 17 17 F 4/29/2009 4-28-2009 1150/AM.- MMR #2 give
346559 5/18/2009 17 F 5/12/2009 Daughter received first GARDASIL
346560 5/18/2009 WI 69 M 3/24/2009 Pt seen by MD on 3/13/09. Pt c/o ra
346663 5/18/2009 KS F 5/14/2009 Information has been received from
346668 5/18/2009 AZ 15 F 5/14/2009 Information hs been received from a
346793 5/18/2009 IA U 5/14/2009 Information has been received from
346796 5/18/2009 22 22 U 5/14/2009 Information was received from a nur
346805 5/18/2009 LA 14 14 U 5/14/2009 Information has been received from
346865 5/18/2009 U 5/14/2009 Information hs been received from a
346876 5/18/2009 10 F 5/14/2009 Information hs been received from a
346885 5/18/2009 NH 14 14 F 5/14/2009 Information has been received from
346886 5/18/2009 F 5/14/2009 Initial information was received from
346887 5/18/2009 TX 11 11 U 5/14/2009 Information has been received from
346898 5/18/2009 16 16 F 5/14/2009 Information has been received via m
346901 5/18/2009 NJ F 5/14/2009 Initial and follow-up information has
346906 5/18/2009 22 F 5/14/2009 Information has been received for th
346917 5/18/2009 NY U 5/14/2009 Information has been received from
346918 5/18/2009 NM 14 14 F 5/14/2009 Information hs been received from a
346924 5/18/2009 OH U 5/14/2009 Information has been received from
346983 5/18/2009 NM F 5/14/2009 Information has been received from
346984 5/18/2009 MN F 5/14/2009 Information has been received from
346989 5/18/2009 20 19 F 5/14/2009 Initial information was received from
346577 5/19/2009 CA 3 3 F 4/24/2009 3yo with isolated IgA deficiency, adm
346579 5/19/2009 CA 37 F 5/14/2009 Initial report received from a consum
346580 5/19/2009 MO 41 41 F 5/15/2009 This case was received on 13 May 2
346583 5/19/2009 TX 65 65 F 5/11/2009 Pt developed pain, swelling and red
346584 5/19/2009 MA 14 14 F 5/12/2009 Mother states pt received vaccine th
346585 5/19/2009 OH 2 2 0.1 M 5/15/2009 6.5 cm long by 8 cm wide erythema
346586 5/19/2009 TX 0.2 0 0.2 M 5/15/2009 Abrupt onset (10-12 hours) post vac
346587 5/19/2009 PA 18 18 F 4/20/2009 Pt was given Adacel, Menactra + PP
346588 5/19/2009 IL 65 65 F 5/8/2009 3 days later, I awoke with a 3 inch r
346589 5/19/2009 PA 11 11 M 5/14/2009 Pt was given MENACTRA 0.5 ml @
346590 5/19/2009 TX 12 12 M 5/19/2009 Within 24 hours- Left arm (between
346591 5/19/2009 NM 4 M 5/19/2009 Approximately 24 post Kinrix vaccin
346592 5/19/2009 TX 17 17 F 5/19/2009 HPV #3 GIVEN 4-14-09 AND PATIE
346593 5/19/2009 WI 47 47 F 5/19/2009 Temp - 102 degrees Body aches.ch
346594 5/19/2009 AZ 20 20 M 5/19/2009 Patient recieved smallpox vaccine th
346595 5/19/2009 MI 16 16 F 5/19/2009 Patient received MCV4 in Left delto
346597 5/19/2009 CA 0.3 0 0.3 F 5/19/2009 Adverse side effects include: diarrhe
346599 5/19/2009 NC 71 71 M 5/19/2009 None
346602 5/19/2009 CO 22 22 M 5/19/2009 Patient recieved smallpox vaccine th
346603 5/19/2009 OK 16 16 F 5/19/2009 Patient had baseball size knot with
346604 5/19/2009 AZ 22 -1 0.6 M 5/19/2009 Patient recieved smallpox vaccine th
346606 5/19/2009 HI 62 62 F 5/19/2009 Accidently administered an expired
346607 5/19/2009 AZ 19 19 F 5/19/2009 Patient recieved smallpox vaccine th
346608 5/19/2009 CA 11 11 F 5/19/2009 3 days after second gardasil, pt wen
346609 5/19/2009 WA 67 67 F 5/19/2009 Pt. brought immigration form from c
346614 5/19/2009 MS 41 41 M 5/19/2009 5 days after receiving vaccines, he
346615 5/19/2009 NY 28 28 M 5/19/2009 First a feeling of nausia. Sycope wi
346616 5/19/2009 CA 4 4 M 5/19/2009 PT COM[PLAINING OF VOMITING
346617 5/19/2009 WA 29 29 F 5/19/2009 Extreme pain in arm of injection, ina
346618 5/19/2009 WA 67 67 F 5/18/2009 Pain, erythema, vesicular rash in de
346619 5/19/2009 PA 0.2 0 0.2 F 5/14/2009 Immediately post immunizations bab
346620 5/19/2009 PA 1.2 1 0.2 M 5/14/2009 Patient returned 30 min after immun
346621 5/19/2009 MD 4 4 F 5/14/2009 Localized warmth, erythema approx
346622 5/19/2009 MT 18 18 M 5/13/2009 No adverse effects noted per patien
346623 5/19/2009 MT 14 14 M 5/13/2009 His father stated that his "arm is sor
346624 5/19/2009 KS 11 11 F 5/12/2009 IM injections were given at 2:30 pm
346625 5/19/2009 AL U 5/19/2009 This case was reported by a physici
346626 5/19/2009 AL U 5/19/2009 This case was reported by a physici
346629 5/19/2009 NC 13 13 F 5/12/2009 C/o pain in muscles, joints. Felt hot
346630 5/19/2009 NE 0.5 0 0.5 F 5/14/2009 Fever 102.5 within 24 hrs of vaccine
346631 5/19/2009 CA 42 42 F 5/19/2009 Severe back ache in mid + lower ba
346632 5/19/2009 ND 9 9 F 5/18/2009 - Pain & bruised at injection site - hi
346633 5/19/2009 AZ 4 4 F 5/13/2009 Noticed L upper pain with 3" swellin
346634 5/19/2009 NC 10 10 F 5/8/2009 Redness, swelling, 6" down arm, 3-
346636 5/19/2009 OR 1.1 1 0.1 F Fever, lethargy, rash started 6 days
346637 5/19/2009 PA 66 66 F 5/18/2009 Fever blisters branching out / poppi
346638 5/19/2009 NJ 41 41 M 5/8/2009 Pt. developed rash behind his leg, f
346639 5/19/2009 MA 14 14 F 5/15/2009 Bell's palsy - few hrs. after Gardasil
346640 5/19/2009 CA 43 43 M 5/18/2009 Arm swollen and red at injection site
346641 5/19/2009 MT 1.7 1 0.7 F 5/14/2009 KINRIX prepared for older sister & a
346642 5/19/2009 LA 36 36 F 5/11/2009 HA, dizziness, malaise, swelling of l
346643 5/19/2009 CA 17 17 F 5/18/2009 Patient received Hep A on right arm
346644 5/19/2009 CA 15 15 F 5/19/2009 Pt received Tdap, HPV and Menact
346645 5/19/2009 MN 2 2 0.5 M 5/15/2009 Patient was fatigued a few hours aft
346646 5/19/2009 CA 62 62 M 5/19/2009 Fever, arm swelling, leg and back -
346647 5/19/2009 VA 14 14 F 5/7/2009 Nausea, dizziness, pulse rate 100, l
346648 5/19/2009 CA 16 16 F 5/19/2009 Patient fainted about 10 minutes aft
346649 5/19/2009 CA 0.3 0 0.3 F 5/19/2009 Crying alot. Extreme fussiness trou
346650 5/19/2009 MO 5 5 F 5/15/2009 Red, swollen, warm, painful area to
346651 5/19/2009 CA 1.2 1 0.2 F 5/19/2009 Patient had high fever to 104 with le
346652 5/19/2009 WA 68 68 F 5/8/2009 5/4/09 ZOSTAVAX administered; pa
346653 5/19/2009 NC 35 35 M None stated
346654 5/19/2009 AR 0.2 0 0.2 F 5/19/2009 Localized reaction with redness & s
346655 5/19/2009 NY 5 5 U Patient presented shortly after recei
346656 5/19/2009 WV 5 5 F 3/19/2009 Pt received #2 Hep A vaccine. 3 m
346657 5/19/2009 ND 1 1 0M 5/11/2009 Evening of 5-8-09. Mom noticed a r
346658 5/19/2009 19 19 M 4/27/2009 Over 3 day weekend, use bandages
346673 5/20/2009 PA 37 37 M 5/18/2009 Initial reportYreceived from an assist
346674 5/20/2009 12 F 5/19/2009 InformationYhas been received from
346677 5/20/2009 NY 76 76 M 5/8/2009 Pt s/p TD vaccine 3/1/09, developed
346679 5/20/2009 85 85 F 5/10/2009 85 yo female presented to the office
346686 5/20/2009 NY 67 67 M 4/23/2009 6 hours after - chills - increased puls
346687 5/20/2009 NM 0.2 0 0.2 M R thigh red with bruise @ site of imm
346689 5/20/2009 GA 55 M 5/19/2009 The subject identified himself as a c
346690 5/20/2009 PA 76 76 M 5/18/2009 Typhoid Herpes Zoster - began 5-3-
346692 5/20/2009 MD 1.2 1 0.2 F 5/15/2009 L thigh rash "hives" x 3 days; improv
346702 5/20/2009 AZ 1 1 0M 5/19/2009 Information has been received from
346721 5/20/2009 MD 12 12 M 5/20/2009 Received Menactra on 5/13/09 and
346722 5/20/2009 SC 0 0 0F 5/20/2009 Patient received a Hepatitis B vacci
346723 5/20/2009 FL 15 15 F 5/20/2009 Patient received the HPV vaccine in
346724 5/20/2009 TX 38 38 F 5/20/2009 6 days after receiving VZV#2, felt co
346725 5/20/2009 VA 2 2 0.3 M 5/20/2009 Father reports they were awakened
346726 5/20/2009 SD 1.5 1 0.5 M 5/20/2009 Mother reported that child's entire le
346727 5/20/2009 27 27 F 5/20/2009 Had employee PE 11/10/08. Receiv
346728 5/20/2009 CO 5 5 F 5/20/2009 Had DTaP and IPV vaccines on 4/2
346729 5/20/2009 WI 18 18 F 5/20/2009 Pain at injection site, difficulty breat
346730 5/20/2009 CA 59 59 M 5/20/2009 Within a few months of the vaccinat
346731 5/20/2009 TX 41 41 F 5/20/2009 On March 11, 2009, I went in for a c
346732 5/20/2009 NV 70 70 M 5/20/2009 Patient experienced chest pain and
346733 5/20/2009 AL 38 38 M 5/20/2009 Patient was immunized with Yellow
346734 5/20/2009 RI 4 4 F 5/20/2009 Large hot red spot at injection site; s
346735 5/20/2009 MI 61 61 F 5/20/2009 Patient described a tightness in che
346736 5/20/2009 MI 68 F 5/20/2009 12-24 hours after injection, patient d
346737 5/20/2009 NC 0.3 0 0.3 M 5/20/2009 na
346738 5/20/2009 MI 12 12 F 5/20/2009 C/O OF ARM NUMBNESS AFTER
346740 5/20/2009 NJ 48 48 M 5/20/2009 Hepatitis B Vaccine, Dose 2 adminis
346741 5/20/2009 LA 68 68 M 5/20/2009 S+O;WALKIN;CC swelling and redn
346742 5/20/2009 NY 72 72 M 5/20/2009 Developed herpes simplex in the ey
346743 5/20/2009 SC 54 54 F 5/20/2009 Despite have no known allergies (es
346744 5/20/2009 UT 0.2 0 0.2 M 5/20/2009 DEVELOPED HIGH-PITCHED SCR
346757 5/20/2009 CA 0.5 0 0.5 F 5/20/2009 Seizure requiring 2 doses of IV med
346758 5/20/2009 OK 0.6 0 0.6 F 5/19/2009 At 1150 injection administered. Imm
346759 5/20/2009 FL 4 4 F 5/20/2009 Left deltoid swollen, hard, hot & red
346760 5/20/2009 TX 28 28 M 5/20/2009 Fever, chills, muscle aches.
346761 5/20/2009 MN 0.3 0 0.3 M 5/18/2009 None Stated
346762 5/20/2009 TX 0.8 0 0.8 M 5/19/2009 Rash on face, trunk and extremities
346763 5/20/2009 MD 12 12 F 5/20/2009 15-20 minutes after vaccine adminis
346764 5/20/2009 AR 28 28 F 5/20/2009 Vomiting- (R) arm- swollen, unable
346765 5/20/2009 CT 18 18 F 5/19/2009 Pt felt faint after receiving ADACEL,
346766 5/20/2009 VA 16 16 F 5/20/2009 Sleepy, Swollen, Eye lid, decreased
346767 5/20/2009 NC 21 21 F 5/20/2009 Husband vaccinated with SPV arou
346768 5/20/2009 CA 4 4 M 5/20/2009 L arm 2x2 in erythema edema and p
346769 5/20/2009 CA 6 6 F 5/13/2009 1 d post vaccine onset redness @ v
346770 5/20/2009 MD 66 66 F 5/20/2009 Cellulitis R upper extremity treated w
346771 5/20/2009 CA 1 1 0F 5/19/2009 - Febrile illness. - Generalized skin r
346772 5/20/2009 OK 25 24 M ### Description: the day after receiving
346773 5/20/2009 NC 29 29 M 5/19/2009 29 y/o Hispanic male, PVT, ADSM r
346774 5/20/2009 GU 4 4 M 5/21/2009 3.5 cm x 5 cm slightly tender red sw
346775 5/20/2009 CA 0.4 0 0.4 M 5/19/2009 None.
346776 5/20/2009 NC 66 66 F 5/20/2009 5/1/09 - Vaccine administered - no a
346777 5/20/2009 KY 0.2 0 0.2 M 5/20/2009 Right leg red, warm, and swollen cry
346745 5/21/2009 MI 60 60 F 5/21/2009 Patient came down with shingles an
346812 5/21/2009 IN 55 54 F 5/21/2009 clinet c/o fine red rash on both her a
346813 5/21/2009 NE 66 66 M 5/21/2009 Pt developed a rash thought to be S
346814 5/21/2009 MI 12 12 F 5/21/2009 5 vaccines were administered to this
346815 5/21/2009 AL 15 15 F 5/21/2009 Received HAV and Depo Provera a
346816 5/21/2009 NJ 4 4 F 5/21/2009 Seen in our office on 5/12/09 for 4 y
346817 5/21/2009 CA 77 77 F 5/21/2009 Next day left deltoid to elbow redne
346820 5/21/2009 OK 5 5 F 5/21/2009 Received call from Mom 5/21/2009
346821 5/21/2009 22 22 M 5/21/2009 Pt developed myocarditis. Symptom
346822 5/21/2009 NM 17 17 F 5/21/2009 Administered vaccines at 11:40; pro
346823 5/21/2009 CA 1.5 1 0.5 F 5/20/2009 Shingles - Zoster- Appeared on pati
346824 5/21/2009 NC 20 21 M 5/21/2009 SICK, RASHES, JOINT PAIN , MUS
346825 5/21/2009 MD 13 13 F 5/21/2009 After receiving vaccinations, patient
346826 5/21/2009 MT 61 61 F 5/21/2009 Exactly 7 days after receiving Zosta
346827 5/21/2009 NY 1 1 0M 5/21/2009 Complaint of rash and swollen on b
346828 5/21/2009 KS 55 55 F 5/21/2009 Allergic reaction - itching - immediat
346829 5/21/2009 MO 24 24 F 5/21/2009 Patient came in on 8/12/08 for Gard
346830 5/21/2009 CA 1.8 1 0.8 M 5/21/2009 Patient returned to clinic two days p
346831 5/21/2009 KY 0.6 0 0.6 F 5/14/2009 Notified Provider pt seen in ER 5/13
346832 5/21/2009 PA 54 54 F 5/21/2009 Patient stated she had localized sw
346833 5/21/2009 CA 1.3 1 0.3 M 5/21/2009 5/21/09 Fever 101.8, eating ok, not
346834 5/21/2009 CA 31 31 F 5/21/2009 HAVRIX given at about 12:30pm. B
346836 5/21/2009 CO 1.3 1 0.3 M 5/21/2009 Erythema multiforme 4 days after ad
346838 5/21/2009 MA 25 25 F 5/20/2009 Arm pain and tenderness with local
346839 5/21/2009 TX 16 16 F 5/21/2009 Urticaria, rash, hives around injectio
346841 5/21/2009 CA 4 4 F 5/20/2009 (Rt) deltoid (+) erythema and edem
346843 5/21/2009 TX 37 37 M 5/21/2009 Err:508
346844 5/21/2009 IN 16 16 F 5/19/2009 The patient fainted immediately (30
346845 5/21/2009 DE 19 19 F 5/15/2009 3rd GARDASIL injected into left del
346846 5/21/2009 IN 16 16 F 5/19/2009 The patient turned pale, felt tingling
346847 5/21/2009 AR 16 16 F 5/21/2009 Right arm is red, swollen, tingling fe
346848 5/21/2009 MA 9 9 F 5/21/2009 4 inch diameter erythema/induration
346849 5/21/2009 VT 70 70 M 5/13/2009 Local pain (L) deltoid area began pr
346850 5/21/2009 VA 19 19 F 5/20/2009 HPV vaccine number 1 given . Sync
346851 5/21/2009 GA 9 9 M 5/21/2009 Whelp left upper arm-hot to touch- V
346853 5/21/2009 DE 22 22 U Patient called 2 1/2 hours after shot
346854 5/21/2009 65 65 F 5/11/2009 I received a PNEUMOVAX shot on
346855 5/21/2009 WV 0.5 0 0.5 F 5/21/2009 Starring spells X 5 lasting approx 3
346856 5/21/2009 81 81 F 5/19/2009 Patient given varivax 5/8/9. On 5/14
346857 5/21/2009 IL 2 2 0.9 M 5/14/2009 Vaccine given Approx 6pm on 5/12/
346858 5/21/2009 GA 16 16 F 5/21/2009 Mom called our office on 5-21-09 to
346860 5/21/2009 CA 4 4 F 5/21/2009 Redness and induration (R) thigh.
346861 5/21/2009 NJ 0.2 0 0.2 F 5/21/2009 ROTATEQ oral vaccine administere
347039 5/21/2009 OK 38 38 F 5/15/2009 Information has been received throu
347051 5/21/2009 IL 22 22 F 5/15/2009 Information has been received throu
347052 5/21/2009 WI 16 16 F 5/15/2009 Information has been received throu
347066 5/21/2009 MA 11 11 F 5/15/2009 Initial and follow-up information has
347077 5/21/2009 LA 1 1 0F 5/15/2009 Information has been received from
347078 5/21/2009 WI 1 1 0M 5/15/2009 Information has been received from
347079 5/21/2009 OH 1.2 1 0.2 F 5/15/2009 Information has been received from
347083 5/21/2009 NY 1 U 5/15/2009 Information has been received from
347084 5/21/2009 IN 1 1 0F 5/15/2009 Information has been received from
347085 5/21/2009 CT 1 1 0M 5/15/2009 Information has been received from
347089 5/21/2009 VA 1 1 0M 5/15/2009 Information has been received from
347092 5/21/2009 TX 1.1 1 0.1 U 5/15/2009 Information has been received from
347097 5/21/2009 CA 1 1 0M 5/15/2009 Information has been received from
347098 5/21/2009 MA 1.3 U 5/15/2009 Information has been received from
347100 5/21/2009 IA 1.5 F 5/15/2009 Information has been received from
347103 5/21/2009 MD 1.1 1 0.1 F 5/15/2009 Information has been received from
347105 5/21/2009 MD M 5/15/2009 Information has been received from
347106 5/21/2009 LA M 5/15/2009 Information has been received from
347116 5/21/2009 IL 1.3 M 5/15/2009 Information has been received from
347130 5/21/2009 FL 72 U 5/15/2009 Information has been received from
347133 5/21/2009 MO 1.1 1 0.1 U 5/15/2009 Information has been received from
347136 5/21/2009 KY 1 1 0F 5/15/2009 Information has been received from
347139 5/21/2009 NJ 1.3 1 0.3 F 5/15/2009 Information has been received from
347141 5/21/2009 ND 1.1 1 0.1 M 5/15/2009 Information has been received from
347146 5/21/2009 NJ 1.1 F 5/15/2009 Information has been received from
347152 5/21/2009 ID 4 M 5/15/2009 Information has been received from
347155 5/21/2009 MA 14 14 M 5/15/2009 Information has been received from
347157 5/21/2009 WA 0.6 0 0.6 F 5/15/2009 Information has been received from
347161 5/21/2009 MA 1 1 0F 5/15/2009 Information has been received from
347162 5/21/2009 MA U 5/15/2009 Information has been received from
347163 5/21/2009 IN 12 F 5/15/2009 Information has been received from
347164 5/21/2009 MA 1 1 0M 5/15/2009 Information has been received from
347190 5/21/2009 1 1 0M 5/15/2009 Information has been received fro a
347213 5/21/2009 MI 1 0 1M 5/15/2009 Information has been received from
347224 5/21/2009 2 2 0.3 F 5/15/2009 Information has been received from
347241 5/21/2009 NJ 1.3 1 0.3 F 5/15/2009 Information has been received from
347255 5/21/2009 MN U 5/15/2009 Information has been received from
347262 5/21/2009 AZ 5 5 U 5/15/2009 Information has been received from
347268 5/21/2009 ME 1 1 0M 5/15/2009 Information has been received from
347291 5/21/2009 MI 5 5 M 5/15/2009 Initial and follow-up information has
347293 5/21/2009 TX 1.2 1 0.2 F 5/15/2009 Information has been received from
347300 5/21/2009 WA 1.2 M 5/15/2009 Information has been received from
347301 5/21/2009 CT 1 1 0U 5/15/2009 Information has been received from
347304 5/21/2009 WI 1.5 1 0.5 M 5/15/2009 Information has been received from
347306 5/21/2009 NY 1.3 1 0.3 F 5/15/2009 Information has been received from
347309 5/21/2009 AL 1.3 M 5/15/2009 Information has been received from
347310 5/21/2009 AL 1.3 F 5/15/2009 Information has been received from
347311 5/21/2009 AZ 1.2 U 5/15/2009 Information has been received from
347318 5/21/2009 AL 9 9 F 5/15/2009 Information has been received from
347319 5/21/2009 AL 9 9 M 5/15/2009 Information has been received from
347320 5/21/2009 AL 9 9 M 5/15/2009 Information has been received from
347324 5/21/2009 NJ F 5/15/2009 Information hs been received from a
347325 5/21/2009 NJ 14 14 F 5/15/2009 Information hs been received from a
347327 5/21/2009 TX 74 74 U 5/15/2009 Information has been received from
347329 5/21/2009 PA 1.3 1 0.3 M 5/15/2009 Initial and follow-up Information has
347330 5/21/2009 OR 42 42 F 5/15/2009 Initial and follow up information has
347332 5/21/2009 PA 2 U 5/15/2009 Information has been received from
347334 5/21/2009 NJ 1 1 0F 5/15/2009 Initial and follow-up information hav
347337 5/21/2009 PA M 5/15/2009 Information has been received from
347338 5/21/2009 KY 11 11 M 5/15/2009 Information has been received from
347339 5/21/2009 KY U 5/15/2009 Information has been received from
347341 5/21/2009 NY 73 73 M 5/15/2009 Initial and follow-up information has
347346 5/21/2009 SC 1 1 0M 5/15/2009 Information has been received from
347348 5/21/2009 MI 5 5 M 5/15/2009 Information has been received from
347349 5/21/2009 64 U 5/15/2009 Information hs been received from a
347351 5/21/2009 MO 1 1 0F 5/15/2009 Information has been received from
347354 5/21/2009 1 1 0F 5/15/2009 Information has not been received f
347355 5/21/2009 AR 9 9 F 5/15/2009 Information has been received rega
347356 5/21/2009 7 7 F 5/15/2009 Information has been received conc
347357 5/21/2009 MA 11 11 F 5/15/2009 Information has been received form
347358 5/21/2009 MI 16 16 M 5/15/2009 Information has been received form
347360 5/21/2009 OR U 5/15/2009 Information has been received from
347368 5/21/2009 TX 2.7 F 5/15/2009 Information has been received from
347373 5/21/2009 AZ 68 M 5/15/2009 Information has been received from
347378 5/21/2009 IA 10 M 5/15/2009 Initial follow-up information has bee
347394 5/21/2009 KY 1.1 1 0.1 F 5/15/2009 Information has been received from
347402 5/21/2009 AZ 1.6 M 5/15/2009 Information has been received from
347408 5/21/2009 MA 1.8 M 5/15/2009 Information has been received from
347409 5/21/2009 NE 1 1 0M 5/15/2009 Information has been received from
347410 5/21/2009 TX 12 12 M 5/15/2009 Initial and follow-up information has
347416 5/21/2009 MA 1.5 1 0.5 M 5/15/2009 Information has been received from
347428 5/21/2009 NY 2 2 0.2 F 5/15/2009 Information has been received from
347439 5/21/2009 KY 1 1 0F 5/15/2009 Information has been received from
347441 5/21/2009 LA F 5/15/2009 Information has been received from
347442 5/21/2009 CA 60 M 5/15/2009 Information was been received from
347473 5/21/2009 VA 1 1 0F 5/15/2009 Information has been received from
347477 5/21/2009 MI M 5/15/2009 Information has been received from
347513 5/21/2009 CA 1 1 0F 5/15/2009 Information has been received from
347530 5/21/2009 GA U 5/15/2009 Information has been received from
347537 5/21/2009 TX 1 1 0M 5/15/2009 Information has been received from
347606 5/21/2009 CO 1 1 0F 5/15/2009 Information has been received from
347619 5/21/2009 AZ 1.1 1 0.1 F 5/15/2009 Information has been received from
347622 5/21/2009 AZ 5 U 5/15/2009 Information has been received from
347624 5/21/2009 KS 17 17 F 5/15/2009 Initial and follow-up information has
347625 5/21/2009 KY 1 1 0M 5/15/2009 Initial and follow-up information has
347631 5/21/2009 CA 1 1 0U 5/15/2009 Information has been received from
347635 5/21/2009 PA 10 10 M 5/15/2009 Initial and follow-up information has
347643 5/21/2009 VI 15 15 F 5/15/2009 Information has been received from
347649 5/21/2009 MN 16 16 M 5/15/2009 Information has been received from
347660 5/21/2009 SD 1 1 0F 5/15/2009 Information has been received from
347661 5/21/2009 ME 18 18 F 5/15/2009 Initial and follow-up information has
347663 5/21/2009 MA 2 2 0.8 M 5/15/2009 Information has been received from
347672 5/21/2009 OH 1 1 0M 5/15/2009 Information has been received from
347675 5/21/2009 MO 10 10 F 5/15/2009 Initial and follow-up information has
347678 5/21/2009 VA 9 M 5/15/2009 Initial and follow up information has
347684 5/21/2009 CA 1 1 0F 5/15/2009 Information has been received from
347688 5/21/2009 F 5/15/2009 Initial and follow-up information has
347689 5/21/2009 PA 5 5 F 5/15/2009 Initial information has been received
347694 5/21/2009 GA 7 M 5/15/2009 Information has been received from
347695 5/21/2009 FL 1.4 1 0.4 F 5/15/2009 Initial and follow-up information has
347696 5/21/2009 NE 1.1 1 0.1 F 5/15/2009 Information has been received from
347697 5/21/2009 FL 5 5 M 5/15/2009 Initial and follow-up information has
347699 5/21/2009 TN 16 16 M 5/15/2009 Initial and follow-up information has
347701 5/21/2009 OH 2 2 0.2 F 5/15/2009 Information has been received from
347706 5/21/2009 11 10 M 5/15/2009 Information has been received form
347707 5/21/2009 IN 1.1 1 0.1 F 5/15/2009 Initial and follow-up information has
347714 5/21/2009 6 M 5/15/2009 Initial and follow-up information has
347732 5/21/2009 CT 1.3 1 0.3 F 5/15/2009 Information has been received from
347745 5/21/2009 KS 67 67 F 5/15/2009 Initial and follow-up information has
347751 5/21/2009 KS 68 68 M 5/15/2009 Initial and follow-up information has
347759 5/21/2009 47 F 5/15/2009 Information has been received via li
347764 5/21/2009 NY M 5/15/2009 Information has been received from
347767 5/21/2009 IL 7 M 5/15/2009 Information has been received from
347768 5/21/2009 LA 4 4 M 5/15/2009 Information has been received from
347769 5/21/2009 LA 60 U 5/15/2009 Information has been received from
347770 5/21/2009 NJ 10 U 5/15/2009 Information has been received from
347771 5/21/2009 CA 1.1 F 5/15/2009 Information has been received from
347772 5/21/2009 MA 1.3 F 5/15/2009 Information has been received from
347776 5/21/2009 OR 1.1 1 0.1 M 5/15/2009 Information has been received from
347778 5/21/2009 IN 0.2 0 0.2 U 5/15/2009 Information has been received from
347779 5/21/2009 CT 5 5 M 5/15/2009 Information has been received from
347781 5/21/2009 CA 1.6 1 0.6 M 5/15/2009 Initial and follow-up information has
347789 5/21/2009 KY 1.3 F 5/15/2009 Information has been received from
347793 5/21/2009 MA 1.3 U 5/15/2009 Information has been received from
347802 5/21/2009 OH 1 U 5/15/2009 Information has been received from
347805 5/21/2009 GA 4 U 5/15/2009 Information has been received from
347810 5/21/2009 KY 1.3 M 5/15/2009 Information has been received from
347812 5/21/2009 VA 2 M 5/15/2009 Information has been received from
347820 5/21/2009 MD 1 1 0F 5/15/2009 Information has been received from
347824 5/21/2009 NJ 1 0 1M 5/15/2009 Information has been received from
347834 5/21/2009 AR U 5/15/2009 Information has been received from
347838 5/21/2009 NH 1.2 M 5/15/2009 Information has been received from
347849 5/21/2009 IN 1 1 0M 5/15/2009 Information has been received from
347853 5/21/2009 U 5/15/2009 This report was identified from a line
347857 5/21/2009 MT 9 M 5/15/2009 Information has been received from
347867 5/21/2009 NY 15 15 F 5/15/2009 Initial and follow-up information has
347868 5/21/2009 OK M 5/15/2009 Information has been received from
347870 5/21/2009 CT U 5/15/2009 Information has been received from
347882 5/21/2009 DE 8 8 M 5/15/2009 Information has been received from
347884 5/21/2009 IL 10 10 M 5/15/2009 Information has been received from
347889 5/21/2009 1.5 1 0.5 M 5/15/2009 Information has been received for a
347892 5/21/2009 FL 2 2 0F 5/15/2009 Information has been received from
347902 5/21/2009 3 3 M 5/15/2009 Information has been received heal
347904 5/21/2009 VA 1 0 1M 5/15/2009 Information has been received from
347907 5/21/2009 TX 63 U 5/15/2009 Information has been received from
347930 5/21/2009 MI 4 M 5/15/2009 Information has been received from
347973 5/21/2009 IL 5 5 M 5/15/2009 Initial and follow-up information has
347978 5/21/2009 CO 10 M 5/15/2009 Information has been received from
347990 5/21/2009 IN 9 9 M 5/15/2009 Information has been received from
347999 5/21/2009 PA 1.3 1 0.3 F 5/15/2009 Information has been received from
348020 5/21/2009 TN U 5/15/2009 Information has been received from
348021 5/21/2009 OH 1.2 1 0.2 F 5/15/2009 Information has been received from
348026 5/21/2009 NY 1 1 0M 5/15/2008 Information has been received from
348027 5/21/2009 AZ 1.5 1 0.5 M 5/15/2009 Information has been received from
348040 5/21/2009 NE 1 1 0F 5/15/2009 Information has been received from
348054 5/21/2009 SC 9 9 F 5/15/2009 Initial and follow-up information has
348058 5/21/2009 AZ 6 6 M 5/15/2009 Information has been received conc
348059 5/21/2009 NH 1 1 0F 5/15/2009 Initial information has been received
348062 5/21/2009 1 U 5/15/2009 Information has been received form
348066 5/21/2009 MD F 5/15/2009 information has been received from
348073 5/21/2009 CO 1.1 1 0.1 M 5/15/2009 Information has been received from
348075 5/21/2009 MA 1 1 0M 5/15/2009 Information has been received from
348076 5/21/2009 KY 1.3 U 5/15/2009 Information has been received from
348080 5/21/2009 MI 1.5 F 5/15/2009 Information has been received from
348082 5/21/2009 PA 2.5 M 5/15/2009 Information has been received from
348090 5/21/2009 MS 1 1 0F 5/15/2009 Information has been received from
348107 5/21/2009 LA 9 U 5/15/2009 Information has been received from
348112 5/21/2009 9 9 U 5/15/2009 Information haws been received fro
348114 5/21/2009 IN 2 2 0.1 F 5/15/2009 Information has been received from
348125 5/21/2009 FL 9 9 M 5/15/2009 Initial and follow-up information has
348126 5/21/2009 CA 60 U 5/15/2009 Information has been received from
348134 5/21/2009 OH 29 28 M 5/26/2009 Pt. stated he had vaccine on May 2
346932 5/22/2009 NJ F 5/18/2009 Vaccine Adm. 3/18/09 for 6 mos. w
346934 5/22/2009 MA 1.2 1 0.2 F 5/19/2009 Mom called starting 5/18 that Pt has
346938 5/22/2009 MS 1.1 1 0.1 F 5/15/2009 Pt started breaking out into rash on
346942 5/22/2009 PA 66 66 F 5/18/2009 Fever blisters breaking out/popping
346944 5/22/2009 CO 4 4 F 5/9/2009 Immediate hypersensitivity reaction
346946 5/22/2009 KY 0.6 0 0.6 F 5/6/2009 Patient broke out in a rash after RO
346949 5/22/2009 TX 32 32 M 5/14/2009 Alvarado stated - that after thigh vac
346952 5/22/2009 GA 39 39 F 5/18/2009 Swelling of arm, redness, severe pa
346955 5/22/2009 MN 0.3 F 5/18/2009 Red papular rash appeared on foreh
346960 5/22/2009 TX 26 M None stated.
346966 5/22/2009 MA 70 70 F 5/19/2009 Apparent vaccine failure. Pt present
346969 5/22/2009 NE 0.2 0 0.2 M 5/19/2009 Patient had irregular breathing with
346971 5/22/2009 NY 1.3 M 5/18/2009 Red mark to R thigh, area hard, red
346976 5/22/2009 AL 10 10 M 5/18/2009 24 hours after vaccine redness & sw
346978 5/22/2009 WI 18 18 M 4/25/2009 -Develop fever of 102 degrees F ora
346991 5/22/2009 MI 36 36 F 5/22/2009 4x2.5" area of severe swelling aroun
346992 5/22/2009 GA 23 23 F 5/22/2009 As medication was being injected, b
346993 5/22/2009 SD 1.6 1 0.4 F 5/22/2009 A 5th Pneumococcal vaccination wa
346994 5/22/2009 OH 5 4 F 5/22/2009 Local reaction with arm swelling
346995 5/22/2009 KS 5 5 F 5/22/2009 Clinic observation: slight diffuse indu
346996 5/22/2009 ID 0.8 0 0.8 F 5/22/2009 Pentacel administered in Right delto
346997 5/22/2009 MD 27 27 F 5/22/2009 Pt c/o pain in left arm after receiving
346998 5/22/2009 TX 20 20 F 5/22/2009 CLIENT RECEIVED VACCINE ON
346999 5/22/2009 NJ 15 15 F 5/22/2009 Immediately after administering the
347000 5/22/2009 KS 47 47 M 5/22/2009 Patient started having reaction to va
347001 5/22/2009 OH 10 10 F 5/22/2009 Family called in on very hectic day w
347002 5/22/2009 IN 18 18 F 5/22/2009 Patient complained of dizziness, na
347003 5/22/2009 TX 54 53 M 5/22/2009 altered mental status per MD
347004 5/22/2009 CA 25 25 F 5/22/2009 Headache and worsening myalgias
347005 5/22/2009 HI 25 25 F 5/22/2009 ~2 days after receiving smallpox an
347006 5/22/2009 NH 22 22 F 5/22/2009 Pt was given Pneumovax on 5/11/0
347007 5/22/2009 OK 1 1 0F 5/22/2009 fever, vomiting, eyes rolling to back
347008 5/22/2009 SD 1 1 0.1 M 5/22/2009 Presented to cinic with herpes zoste
347009 5/22/2009 WV 47 47 M 5/22/2009 Rash at injection site and on the ba
347010 5/22/2009 CO 11 11 M 5/22/2009 patient sitting in chair for injection. a
347011 5/22/2009 MA 5 5 U 5/22/2009 Shortly after DTAP vaccine his left u
347012 5/22/2009 CA 1.5 1 0.5 M 5/22/2009 After receiving Varicella vaccine on
347013 5/22/2009 CA 0.5 0 0.5 M 5/22/2009 Pt received Rotavirus vaccine on 4/
347014 5/22/2009 OR 65 65 F 5/22/2009 Patient developed three lesions at 2
347015 5/22/2009 HI 77 76 M 5/22/2009 Pt. developed gradually worsening m
347026 5/22/2009 GA 0.2 0 0.2 F 5/22/2009 Baby was brought in today by her m
347027 5/22/2009 PA 67 67 M 5/21/2009 Severe local swelling and tendernes
347028 5/22/2009 TX 0.4 0 0.4 M 5/24/2009 Patient had soft node to R/L anterio
347029 5/22/2009 WI 62 62 M 5/24/2009 Developed shingles on forehead - re
347030 5/22/2009 IL 11 11 F 5/23/2009 (R) Posterior arm - 1 area maculopa
347031 5/22/2009 CA 0.5 0 0.5 M 5/22/2009 Started with fever - 103 - last night +
347032 5/22/2009 CA 13 13 M 5/22/2009 Pt felt dizzy about 2-3 minutes after
347033 5/22/2009 CA 52 52 F 5/22/2009 Painful upper (L) arm: Pain radiates
347034 5/22/2009 PA 79 79 F 5/22/2009 Patient developed firey red rash on
347035 5/22/2009 AZ 5 5 F 5/22/2009 Day after injection (L) arm was swol
347036 5/22/2009 NJ 1.3 1 0.3 M Temp 103 degree 6 days later - Chr
347037 5/22/2009 NC 4 4 M 5/22/2009 New onset rash on anterior R thigh,
347038 5/22/2009 TX 1.8 1 0.8 F 5/24/2009 Pt was administered a TD vaccine w
347040 5/22/2009 IL 3 3 M 5/22/2009 DTAP/IPV combination given into L
347041 5/22/2009 KS 1.5 1 0.5 M 5/22/2009 Patient in office for well child visit. G
347042 5/22/2009 AR 0.2 0 0.2 F 5/20/2009 Per CoronerY mom was in bed with b
347044 5/22/2009 MA 9 9 F 5/27/2009 6 - 7 cm oval red, raised area at site
347045 5/22/2009 OH 14 14 M 5/22/2009 Fever to 104 F and whole upper arm
347047 5/22/2009 MS 23 23 F 5/21/2009 Initial VAERS filed Feb 2003. This 3
347048 5/22/2009 VA 5 5 M 4/29/2009 6 X 5 cm urticarial plaque on left lat
347049 5/22/2009 TX 8 8 F Shot given on 5-20-09 Pt came bac
347050 5/22/2009 NJ 4 4 M 5/22/2009 5/21/09 Swollen, reddened, tender a
347055 5/22/2009 TX 40 40 M 5/22/2009 None stated
347057 5/22/2009 TX 16 16 F 5/21/2009 Received vacc. approx 1500 5/20/0
347058 5/22/2009 AR 10 10 F 5/24/2009 Redness and swelling to left arm ap
347060 5/22/2009 NM 5 5 M 5/20/2009 Left deltoid, warm to touch, red, ext
347062 5/22/2009 NM 5 5 F 5/20/2009 Left deltoid, slight swelling, light red
347063 5/22/2009 NC 49 49 F 5/21/2009 Left arm red, swollen at sight of inje
347065 5/22/2009 PA 67 67 F 5/21/2009 5cm x 3cm erythematous indurated
347017 5/23/2009 AZ 0.3 0 0.3 F 5/23/2009 high pitched crying for at almost 12
347018 5/24/2009 CA 45 45 F 5/24/2009 I lost about a cubic inch of muscle, b
347019 5/24/2009 CA 4 F 5/24/2009 Extreme swelling at injection site, si
347020 5/24/2009 MD 43 43 M 5/24/2009 103 fever, tachycardia, myalgias, se
347021 5/25/2009 20 20 M 5/25/2009 PT PRESENTED WITH COMPLAIN
347022 5/25/2009 CA 66 66 F 5/25/2009 red inflammed area 8 inches by 3 1
347023 5/26/2009 NY 25 25 M 5/26/2009 Severe muscle pain in shoulder whe
347024 5/26/2009 CA 15 15 M 5/26/2009 Day 2 (May 23rd) after vaccination o
347025 5/26/2009 FL 42 F 5/22/2009 This case was reported by a physici
347172 5/26/2009 UT 4 4 F 5/21/2009 Kawasaki's syndrome. Received IVI
347185 5/26/2009 CA 10 10 F 5/20/2009 Was given SANOFI PASTEUR'S TD
347188 5/26/2009 NC 4 4 M 5/20/2009 Huge area of erythema 5" x 5", left u
347192 5/26/2009 PA 1.2 1 0.2 F 5/15/2009 5/15 presents with maculopapular p
347193 5/26/2009 MT 1 1 0M 5/21/2009 5/13/09 Per nurse child was seen to
347194 5/26/2009 OR 1.1 1 0.1 M 5/13/2009 One hour after receiving vaccines, p
347195 5/26/2009 LA 0.2 0 0.2 F 5/19/2009 Localized reaction to PENTACEL va
347196 5/26/2009 NM 12 12 F 5/18/2009 Adolescent received vaccines on 3/
347198 5/26/2009 NJ 63 63 F ### Initial non-serious case received fro
347200 5/26/2009 MI 48 48 F 5/20/2009 Vaccine given 5/8/09. Fever to 101.
347204 5/26/2009 VA 16 16 F 5/20/2009 Sleepy, Swollen eyelid, decreased a
347205 5/26/2009 AL 22 22 M 5/21/2009 Patient Rt arm with redness from sh
347206 5/26/2009 TN 1.3 1 0.3 F 5/13/2009 Immediately after vaccine administr
347242 5/26/2009 PA 10 10 M 5/21/2009 Severe local reaction 4 X 5 cm Eryth
347243 5/26/2009 CA 1 1 0M 5/22/2009 While nursing began to scratch ears
347244 5/26/2009 GA 1.3 1 0.3 M 5/26/2009 Seizure/fever.
347245 5/26/2009 MD 25 25 F 5/26/2009 24 hours after receiving GARDASIL
347246 5/26/2009 TX 26 26 F 5/21/2009 None
347247 5/26/2009 OH 14 14 F 5/22/2009 Mom called @12:30 am 5/22/2009 s
347248 5/26/2009 FL 2 2 0F 5/26/2009 None noted.Y Pt was not seen in our
347249 5/26/2009 WI 1.6 1 0.6 F 5/19/2009 Patient with fever, irritability and cry
347250 5/26/2009 CA 1.1 F 5/12/2009 T 101 about 12 hours after vaccinat
347251 5/26/2009 PA 4 4 M 5/26/2009 Parent noticed increased redness +
347252 5/26/2009 KS 15 15 F 5/26/2009 On 5/7/09 patient reports almost im
347265 5/26/2009 SC 14 14 M 5/26/2009 Several weeks (end of November) a
347269 5/26/2009 IL 59 59 F 5/26/2009 Three days following administration
347270 5/26/2009 IN 18 18 F 5/26/2009 tingling of lips and tongue 30 min af
347271 5/26/2009 PR 0.3 0 0.3 M 5/26/2009 MOTHER REFERS THAT THE NEX
347272 5/26/2009 GA 19 19 F 5/26/2009 THE PT FAINTED AT A RESTURA
347273 5/26/2009 NY 45 45 F 5/26/2009 Lesions on chest, back, and arms p
347275 5/26/2009 TN 1.2 1 0.2 F 5/26/2009 Patient was healthy at the time she
347276 5/26/2009 MD 0.2 0 0.2 M 5/26/2009 Fever
347277 5/26/2009 CO 0.2 0 0.2 M 5/26/2009 Necrotizing enterocolitis, symptoms
347278 5/26/2009 GA 1 1 0M 5/26/2009 blanching macules on trunk, extrem
347279 5/26/2009 TX 10 10 F 5/26/2009 Patient developed mucosal wart ins
347280 5/26/2009 CA 0.2 0 0.2 M 5/26/2009 Pt was taken to facility on 5/21. Re
347283 5/26/2009 CA 4 4 M 5/26/2009 After receiving last vaccine MMR no
347284 5/26/2009 WA 62 62 F 5/26/2009 Pt reported a swollen arm that subs
347285 5/26/2009 HI 1 1 0M 5/21/2009 5/21/09 developed chickenpox rash
347286 5/26/2009 CA F 5/26/2009 11 days after MMR, developed itch
347281 5/27/2009 WA 0.3 0 0.4 M 5/27/2009 Approximately five hours after the v
347282 5/27/2009 GA 19 19 M 5/27/2009 memory loss, achy muscles and join
347446 5/27/2009 GA 0.2 0 0.2 M 5/18/2009 5/5/09 Pt was Y brought into ED by EM
347448 5/27/2009 OR 45 45 F None stated. 9/9/09 Rheumatology
347450 5/27/2009 NY 0.2 M 5/19/2009 Fever to 103; diarrhea; lethargy; de
347452 5/27/2009 NH 50 50 M 5/21/2009 Weakness and pain in arm. No feve
347454 5/27/2009 CA 48 48 F 5/19/2009 4-5 inch swelling with hard middle, i
347455 5/27/2009 CA 0.3 0 0.3 M 5/14/2009 8-4-08, received PEDIARIX, HIB an
347457 5/27/2009 NE 5 5 M 5/21/2009 L upper deltoid with 100 cm of eryth
347459 5/27/2009 TX 14 14 M 5/22/2009 Initial report received on 13 May 20
347460 5/27/2009 CA 4 4 F 5/20/2009 woke up and left deltoid dark red, pu
347461 5/27/2009 TX 13 13 M 5/22/2009 Initial report received on 13 May 20
347462 5/27/2009 NC 11 11 M 5/20/2009 Red swollen area on deltoid of right
347463 5/27/2009 TX 16 16 F 5/22/2009 Initial report received on 13 May 20
347467 5/27/2009 MN 18 18 F 5/18/2009 After vaccine given, pt complained o
347468 5/27/2009 IN 11 11 M 5/20/2009 Large area of erythema and swellin
347469 5/27/2009 IL 25 25 M 5/20/2009 C/o tightness in chest & throat 20 m
347470 5/27/2009 IL 22 22 F 5/28/2009 C/o swelling of throat after receiving
347479 5/27/2009 U None stated.
347481 5/27/2009 CO 0.5 0 0.5 F 5/12/2009 Had generalized tonic - clonic seizu
347482 5/27/2009 24 24 F Patient was administered SMALLPO
347485 5/27/2009 MA 46 46 M 5/19/2009 Patient reports redness at injection
347486 5/27/2009 IL 10 10 F 4/1/2009 With erythema and swelling on Rt d
347489 5/27/2009 WI 5 5 M 5/19/2009 5/15 TC from mom reporting child d
347490 5/27/2009 AK 60 60 F 5/18/2009 Pt fainted 10 min. after leaving phar
347492 5/27/2009 CO 5 5 M 5/18/2009 Local reaction - pain, erythema star
347495 5/27/2009 IN 37 37 F 5/19/2009 Joint pain and exhaustion started 1s
347496 5/27/2009 NC 13 13 M 5/12/2009 5/12/09 PC received from guardian
347497 5/27/2009 AR 0.3 0 0.3 M 5/18/2009 This patient was accidently given HP
347498 5/27/2009 IN 1.1 1 0.1 M 5/18/2009 Pt. developed 2 cm erythema at loc
347499 5/27/2009 WA 1.4 1 0.4 M 5/19/2009 1 red spot on belly 5-17-09 in AM, 1
347500 5/27/2009 MD 4 4 M 5/21/2009 Swelling with redness, itchiness ove
347501 5/27/2009 LA 36 36 F 5/4/2009 Please see attached encounter
347505 5/27/2009 IL 44 M 5/18/2009 NONE
347506 5/27/2009 CO 26 26 M 5/4/2009 ~ 7-10 vesicles at site of injection of
347508 5/27/2009 NC 42 42 F 5/27/2009 None stated
347510 5/27/2009 CA 65 65 M 5/19/2009 Pt developed diffuse Myalgias appro
347512 5/27/2009 FL 65 65 F 5/20/2009 3 areas (small) of red flat rash in up
347514 5/27/2009 CA 7 7 F 5/18/2009 Pustule at VZV injection site on 5/12
347515 5/27/2009 IN 1.3 1 0.3 F 5/20/2009 Local reaction on left and right ante
347520 5/27/2009 IN 1.4 1 0.4 F 5/20/2009 Mother called the office at 230 PM o
347523 5/27/2009 PA 5 5 M 5/20/2009 Varicella vaccine breakthrough. Had
347525 5/27/2009 NC F 5/19/2009 None stated.
347526 5/27/2009 NC 20 20 M 5/19/2009 None stated.
347543 5/27/2009 NM 0.2 0 0F 5/27/2009 prevnar was given twice, no adverse
347544 5/27/2009 TN 53 53 F 5/27/2009 Patient reports a gradual onset of e
347545 5/27/2009 CA 49 F 5/27/2009 Severe Hair loss (alopecia) around
347546 5/27/2009 GA 0.6 0 0.6 F 5/27/2009 Presented via EMS to Emergency D
347547 5/27/2009 MA 16 17 F 5/27/2009 Patient received the Typhoid Vaccin
347548 5/27/2009 TN 26 26 F 5/27/2009 I have random twitches and involun
347549 5/27/2009 TX 0.2 0 0.2 F 5/27/2009 local reaction red, hot and swollen a
347550 5/27/2009 WI 44 44 F 5/27/2009 Pt experiencing flu like symptoms w
347551 5/27/2009 NH 5 5 M 5/27/2009 Six days after vaccine administratio
347552 5/27/2009 20 20 F 5/27/2009 10July08-First Anthrax vaccination
347553 5/27/2009 MA 21 21 F 5/27/2009 Three days after experienced fever
347554 5/27/2009 MD 23 23 M 5/27/2009 tightness in chest, shortness of brea
347555 5/27/2009 TX 35 44 F 5/27/2009 HAS HX OF GRAVES DISEASE SI
347556 5/27/2009 MA 79 79 F 5/27/2009 Received ZOSTAVAX 4/16/09. Dev
347557 5/27/2009 CA 5 5 M 5/22/2009 ZOSTAVAX given to 5 year old with
347558 5/27/2009 TX 1 1 0M 5/27/2009 Fever, Tmax 103.8. Multiple tonic /
347559 5/27/2009 24 M 5/27/2009 Client seen at ED on 5/11/09 for c/o
347560 5/27/2009 CA 42 42 F 5/27/2009 Info reported to our clinic by patient
347561 5/27/2009 TX 66 66 M 5/27/2009 48 hours after vaccine administratio
347562 5/27/2009 FL 58 58 F 5/27/2009 Called on 5/25 to report severe mus
347563 5/27/2009 OR 7 7 M 5/27/2009 Generalized varicella-like rash, grea
347564 5/27/2009 WA 68 68 U 5/27/2009 Unintentionally gave expired Pneum
347565 5/27/2009 AZ 52 52 M 5/27/2009 pt left hand and forearm had slight s
347566 5/27/2009 CA 28 28 F 5/27/2009 paresthesias of bilateral feet and low
347567 5/27/2009 GU 3 3 F 5/27/2009 Fever over 103 F 12 hours later last
347568 5/27/2009 FL 0.6 0 0.6 M 5/27/2009 Temperature 101-103 approximatel
347569 5/27/2009 WI 19 19 M 5/27/2009 Hep A given- immediately after patie
347571 5/27/2009 WA 4 4 F 5/27/2009 Patient developed hives about 22 h
347573 5/27/2009 TX 1.3 1 0.3 M 5/13/2009 Patient received DTAP, HIB + HEP
347574 5/27/2009 NC 81 81 F 5/27/2009 Patient came to office 5-26-09 + rep
347578 5/27/2009 NY 1.5 1 0.5 F 4/24/2009 1st Hep A vaccination 2/20/09 - only
347580 5/27/2009 IL 8 8 M 5/27/2009 Patient c/o itching at the site, 5min l
347581 5/27/2009 IL 5 5 F 5/21/2009 Rash at injection site right deltoid (1
347587 5/27/2009 MN 9 9 M 5/26/2009 No adverse event. Mis administratio
347594 5/27/2009 AZ 5 5 M 5/22/2009 KINRIX & VARICELLA vaccine give
347597 5/27/2009 AZ 2 2 0.5 M 5/22/2009 DAPTACEL and VARIVAX vaccines
347599 5/27/2009 MI 31 31 F 5/26/2009 Rash on arm next day, took BENAD
347734 5/28/2009 VA 22 22 F 5/28/2009 Pt passed out
347735 5/28/2009 FL 11 11 F 5/28/2009 Urticaria/Hives neck back, abdomen
347743 5/28/2009 KY 33 33 M 5/21/2009 L. arm "PPD" testing using ANTHRA
347746 5/28/2009 SC 5 5 F 5/27/2009 None. HPV vaccine ordered by phy
347749 5/28/2009 1.5 1 0.5 F 5/21/2009 Papular (raised) rash in crops over t
347752 5/28/2009 WA 81 81 F 5/22/2009 Reaction at Inj site. Red itchy rash
347755 5/28/2009 7 7 F 5/15/2009 erythematous patch over the vaccin
347913 5/28/2009 OH 5 M 5/28/2009 Would consider this a vaccine failur
347914 5/28/2009 MA 55 55 M 5/28/2009 Vaccine was administered to left de
347915 5/28/2009 SC 19 19 F 5/28/2009 Quarter-sized area of enduration 2-
347916 5/28/2009 NY 27 27 M 5/28/2009 Member had small pox vaccine on
347917 5/28/2009 OH 4 F 5/28/2009 This should probably be considered
347919 5/28/2009 CA 4 4 F 5/28/2009 Low grade fever (not even 100) 5/26
347920 5/28/2009 MO 1.2 1 0.2 F 5/28/2009 Mom noticed swelling and redness a
347921 5/28/2009 FL 0.3 0 0.4 F 5/28/2009 TELEPHONE CALL FROM MOTHE
347922 5/28/2009 ND 63 63 F 5/28/2009 2nd day after receiving TdaP imm.,
347923 5/28/2009 CA 12 12 F 5/28/2009 Rash, decreased sensation and dec
347924 5/28/2009 OR 24 23 F 5/28/2009 patient had rash c/ second injection
347925 5/28/2009 LA 32 32 F 5/28/2009 Tingling, numbness, pain, limited RO
347926 5/28/2009 OR 4 4 F 5/28/2009 Three vaccines given to pt, Lt leg V
347927 5/28/2009 MN 1.5 F 5/28/2009 Rash developed 48 hours after imm
347928 5/28/2009 OR 50 50 F 5/28/2009 I received this second HB shot durin
347947 5/28/2009 TX 1 1 0M 5/28/2009 Mom called stated Pt had started ge
347949 5/28/2009 NY 4 4 F 5/28/2009 Patient with reddened raised area a
347950 5/28/2009 MI 0.3 0 0.3 F 5/28/2009 Inconsolable crying with head twitch
347951 5/28/2009 FL 1 1 0F 5/26/2009 Hives on arm, legs + face.
347952 5/28/2009 SC 52 52 F 5/27/2009 - Fever body aches, arm pain. Appr
347953 5/28/2009 FL 18 18 F 5/22/2009 Patient complained of "high" fever s
347954 5/28/2009 GA 4 4 M 5/27/2009 Vomited x 1; eyes and lips became
347955 5/28/2009 U Redness- painful - swelling (L) thigh
347956 5/28/2009 PA 1.1 1 0.1 F 5/26/2009 None stated.
347957 5/28/2009 44 44 M 5/28/2009 2 days post 1st dose pt noted flashe
347958 5/28/2009 NC 1 1 0M 5/28/2009 Multiple Vesicles
347959 5/28/2009 MA 45 45 F 5/28/2009 Generalized rash developed within
347960 5/28/2009 WA 37 37 M 5/28/2009 Deltoid muscle pain and swelling. S
347929 5/29/2009 CA 53 53 F 5/29/2009 Patient developed myalgias in the n
348120 5/29/2009 MN 0.2 0 0.2 M 5/28/2009 Information has been received from
348128 5/29/2009 F 5/29/2009 We received from a consumer the fo
348135 5/29/2009 NY 68 68 F 5/22/2009 Administered ZOSTAVAX vaccine 5
348136 5/29/2009 KY 4 4 F 5/21/2009 5/9/09 went to ED with swelling to ri
348137 5/29/2009 AR 0.2 0 0.2 F 4/1/2009 Red, hot, firm area on Rt deltoid app
348138 5/29/2009 AR 0.6 0 0.6 F 4/1/2009 Rash on back, abdomen, arms, face
348139 5/29/2009 NY 1 1 0F 5/24/2009 Chief Complaint (1/1): This 12 mont
348140 5/29/2009 GA 11 11 F 5/26/2009 2:10 fainted after vaccination and bu
348141 5/29/2009 GA 30 30 M 5/22/2009 Right thorax- rash and pain. Treated
348142 5/29/2009 GA 30 30 M 5/22/2009 Rash on right thorax returned after 2
348143 5/29/2009 MA 10 10 F 5/26/2009 Received VARIVAX 5-21-09, seen i
348144 5/29/2009 MA 9 9 F 5/26/2009 On 5/18/09 given VARIVAX, develo
348145 5/29/2009 PA 67 67 F 5/29/2009 Rash at injection site
348146 5/29/2009 CA 56 56 M 5/29/2009 Approximate 4 minutes after receivi
348147 5/29/2009 MD 4 4 M 5/29/2009 4 inch circular redness with warmth.
348148 5/29/2009 TX 23 23 M 5/29/2009 Patient states that he had vaccinatio
348149 5/29/2009 CA 56 56 F 5/29/2009 Approximate 2 minutes after receivi
348150 5/29/2009 CA 26 F 5/29/2009 a few minutes after i got the 1st sho
348151 5/29/2009 OK 21 21 F 5/29/2009 tdap booster given approx 10 am on
348152 5/29/2009 GA 0.6 0 0.6 M 5/29/2009 TEMP103LN,VOMITING,URI.sYMP
348153 5/29/2009 WI 11 11 F 5/29/2009 Woke early AM 5/19/09 with frequen
348154 5/29/2009 WV 4 4 F 5/29/2009 5/28, mother called and reported tha
348155 5/29/2009 VT 72 72 M 5/29/2009 Pt went to a pharmacy clinic to rece
348156 5/29/2009 SC 48 48 F 5/29/2009 1-2-09 Tdap administered R deltoid
348157 5/29/2009 GA 76 76 F 5/29/2009 within 24 hrs after vaccination, arm
348158 5/29/2009 MI 48 48 F 5/29/2009 Hep B #1 adm. 2:30pm,Fri.22 May 2
348159 5/29/2009 OK 77 77 F 5/29/2009 localized reaction distal to injection
348161 5/29/2009 HI 18 19 F 5/29/2009 Has fever, generalized body aches
348162 5/29/2009 TX 4 4 M 5/29/2009 August 18, 1991. "Hold up four finge
348163 5/29/2009 NV 50 50 M 5/29/2009 Pt presented 13 days s/p vaccinatio
348170 5/29/2009 TX 5 5 M Vesicular rash on trunk 26 days afte
348171 5/29/2009 KS 12 12 M 5/28/2009 Patient received vaccines at 12:00 a
348173 5/29/2009 NJ 0.4 0 0.4 M 5/29/2009 Pt had been lethargic, decreased ap
348174 5/29/2009 AZ 33 33 F 5/29/2009 Received MMR and VARIVAX vacc
348175 5/29/2009 PA 36 36 M 5/26/2009 Large, red area on arm; Warm to to
348178 5/29/2009 11 11 F 5/29/2009 2 days after, redness 2-3 " down arm
348182 5/29/2009 MA 55 55 M 5/29/2009 Site reaction. mild edema, tenderne
348185 5/29/2009 WI 31 31 F 5/29/2009 2-2 1/2 inch area around injection s
348189 5/29/2009 MI 24 24 F 5/19/2009 Patient was given initial dose of Gar
348192 5/29/2009 IN 4 4 M 5/29/2009 Redness, swelling, warmth, bruising
348194 5/29/2009 56 56 M 5/29/2009 This case was reported via a statem
348195 5/29/2009 VI 54 54 F 5/29/2009 Patient came in clinic stating that sh
348196 5/29/2009 PA 57 57 M 5/29/2009 Pt called on 5/26/09 c/o feeling nerv
348197 5/29/2009 TX 4 4 M 5/29/2009 Blotchy, red-macular rash to left thig
348198 5/29/2009 NY 17 17 F 5/28/2009 Tdap vaccine given, Patient with h/o
348199 5/29/2009 AK 58 58 F 5/29/2009 Patient received Subcutaneous dos
348200 5/29/2009 CA 19 19 M 5/21/2009 About 5-10 mm after immunizations
348201 5/29/2009 WI 1.3 1 0.3 M 5/29/2009 Approx 15 min after 1 mms given, c
348202 5/29/2009 NY 0.2 0 0.2 M 5/29/2009 Fever 101.7 degrees F, vomiting, irr
348203 5/29/2009 OH 4 4 F On Tues 05/18/2009 pt told mom le
348206 5/29/2009 MT U 5/27/2009 This case was reported by a healthc
348215 5/29/2009 CA 4 4 M 5/27/2009 This case was reported by a physici
348164 5/30/2009 NY 0.4 0 0.4 M 5/30/2009 Urticarial rash at vaccine site and on
348165 5/30/2009 AL 73 73 F 5/30/2009 Shingle Shot;It was not until 3rd day
348166 5/30/2009 MN 12 12 F 5/30/2009 Fever - 102.7; Headache; Fatigue; W
348167 5/31/2009 NJ 4 4 F 5/31/2009 Large area of induration at injection
348168 5/31/2009 WA 1.3 1 0.3 F 5/31/2009 Patient had gunk in her eyes real ba
348169 6/1/2009 19 19 M 5/31/2009 Patient was vaccinated with Smallpo
348218 6/1/2009 CA 5 5 M 5/29/2009 Patients arm swelled up to the wrist
348219 6/1/2009 MD 47 47 F 5/28/2009 Feverish, body aches - Patients rela
348220 6/1/2009 GA 4 4 F 5/29/2009 Patient in for immunizations on 5/28
348221 6/1/2009 OH 1 0 1F 5/29/2009 Mother called, client had high tempe
348222 6/1/2009 FL 1.5 1 0.5 M 5/28/2009 Fast heart rate, fever, vomiting, diar
348223 6/1/2009 OR 1.1 1 0.1 M 5/19/2009 Vaccinated 4/29/09. Mother noticed
348224 6/1/2009 OR 51 51 F 5/27/2009 Took 1st Typhoid cap appropriately
348225 6/1/2009 WA 68 68 F 5/27/2009 Redness, swelling pruritus in place
348226 6/1/2009 LA 0.5 0 0.5 M 5/28/2009 Fever 12-14 hours after vaccines ad
348232 6/1/2009 WI 11 11 F 5/27/2009 5/27/09 about 12:00 patient became
348234 6/1/2009 CA 28 28 F 5/7/2009 Pain and area of redness over the s
348235 6/1/2009 MD 70 70 M 11:30 AM severe hives.
348238 6/1/2009 FL 18 18 F 5/26/2009 Patient complain of muscle pain in l
348239 6/1/2009 CA 0.5 0 0.5 F 3/12/2009 Rotavirus is not to be started after 1
348241 6/1/2009 M 5/29/2009 Information has been received via a
348242 6/1/2009 LA 43 43 F 5/13/2009 Patient returned to clinic on 5-13-09
348245 6/1/2009 LA 16 16 F 4/24/2009 Dizzy head spinning, stomach sore,
348247 6/1/2009 AR 4 4 F 5/22/2009 Mom stated redness and swelling b
348254 6/1/2009 WA 4 4 F 5/30/2009 Cellulitis 4 x 2 1/2 cm indurated, inc
348255 6/1/2009 AR 42 42 F 6/1/2009 Pain, swelling, redness, heat, and ra
348256 6/1/2009 MI 9 9 F 6/1/2009 Pt came into office and never was im
348257 6/1/2009 MI 11 11 M 6/1/2009 N/A, Pt was administered the DTaP
348258 6/1/2009 TN 0.5 0 0.5 M 6/1/2009 4 days after dose of Rota vaccine g
348259 6/1/2009 MI 10 10 M 6/1/2009 N/A, the patient was given the MCV
348260 6/1/2009 FL 12 12 F 6/1/2009 I assessed a 12 year old female wh
348261 6/1/2009 MO 1.3 1 0.3 M 6/1/2009 Patient received MMR and Varicella
348262 6/1/2009 CA 12 12 F 6/1/2009 severe swelling in lympyh node on s
348263 6/1/2009 NC 3 3 F 6/1/2009 Based on photographs the patient d
348264 6/1/2009 MI 9 9 F 6/1/2009 Child woke up the night of vaccinati
348265 6/1/2009 25 M 6/1/2009 Left Shoulder soft tissue infection w
348266 6/1/2009 NY 54 54 M 6/1/2009 Swelling, Tenderness at surroundin
348267 6/1/2009 KS 14 14 F 6/1/2009 Became ill Saturday 05/30/2009 wit
348268 6/1/2009 KS 17 17 F 6/1/2009 Day following administration of vacc
348269 6/1/2009 IL 51 51 F 6/1/2009 Vaccine given on 5/26/09. Day after
348270 6/1/2009 CA 4 4 F 6/1/2009 Reacted post vaccine 2 days ago, n
348271 6/1/2009 CA 0.2 0 0.2 F 6/1/2009 Tonic Clonic Seizure acttivity lasting
348272 6/1/2009 CA 11 11 U 6/1/2009 Rash to face torso arms and legs on
348273 6/1/2009 TX 11 11 M 6/1/2009 After the vaccine was administered,
348278 6/1/2009 NJ 20 20 F 6/1/2009 Diffuse maculopapular rash on face
348279 6/1/2009 CA 10 10 M 5/21/2009 Swelling over injection site - X 2 day
348280 6/1/2009 CA 5 5 F 5/21/2009 Swelling at injection site x 2 days. T
348281 6/1/2009 TX 12 12 F 6/1/2009 Immediately following injection patie
348282 6/1/2009 CA 6 6 F 6/1/2009 Feverish on 5/29/09, raised, itchy, p
348283 6/1/2009 IL 4 4 F 6/1/2009 Erythema at site of injection up to 1
348284 6/1/2009 AZ 44 44 M 5/8/2009 SM reports receipt of third AVA vacc
348285 6/1/2009 GA 53 53 F 4/15/2009 Patient received Tdap IM R arm on
348286 6/1/2009 GA 4 4 F 4/3/2009 Client presented in clinic on 4/3/09 @
348287 6/1/2009 GA 53 53 F 2/3/2009 Head ache and vomiting within a few
348288 6/1/2009 GA 18 18 F 4/9/2009 Immunization were given at 5:25pm
348289 6/1/2009 GA 9 9 M 4/14/2009 1635 Generalized itching right shou
348290 6/1/2009 GA 1.3 1 0.3 M 3/30/2009 Client received Immunization on 3/2
348291 6/2/2009 IL 13 13 F 5/26/2009 Pt had unwitnessed seizure on 5/21
348292 6/2/2009 PR 32 32 M 5/23/2009 Left, vocal cord, right vocal cord, po
348293 6/2/2009 LA 0 0 0M 5/22/2009 Seizures - 4/14/09, diarrhea, diaper
348294 6/2/2009 LA 57 57 M 5/26/2009 Numbness in face, body, hands, fee
348295 6/2/2009 AR 0.3 0 0.3 M 5/26/2009 Fever; febrile seizure; Negative wo
348296 6/2/2009 TN 0.2 0 0.2 M 5/27/2009 Child developed poor appetite with
348297 6/2/2009 U None stated.
348299 6/2/2009 NH 12 12 F 5/28/2009 L arm swollen, itchy & hot to touch.
348300 6/2/2009 PA 1 1 0F 5/27/2009 Varicella vaccine breakthrough. Dia
348301 6/2/2009 OH 55 55 F 5/20/2009 Swelling + redness at injection site.
348302 6/2/2009 OR 37 37 F 5/26/2009 Tingling in left arm, jaw, left leg for t
348303 6/2/2009 CA 1 1 0F 5/27/2009 Patient developed an erythematous
348304 6/2/2009 OH F 5/22/2009 Patient developed furuncle abscess
348305 6/2/2009 KS 4 4 F 5/28/2009 Left thigh erythema and induration a
348306 6/2/2009 NY 1 1 0F 5/28/2009 Approx. 2 days after inj pt was seen
348317 6/2/2009 OR F 5/29/2009 This case was received from a cons
348324 6/2/2009 MO 0.2 0 0.2 M 5/21/2009 Approximately two minutes after inje
348325 6/2/2009 ME 5 5 M 5/28/2009 On 5/27/2009 24 hours after immun
348326 6/2/2009 ID 52 52 F 5/22/2009 Patient got a Tdap 5/14/09 and dev
348327 6/2/2009 ID 24 24 F 5/20/2009 Pt received ADACEL 4/27/09- And d
348328 6/2/2009 ID 4 4 M 4/20/2009 On 4-16-09 Patient received DTaP
348329 6/2/2009 MD 4 4 M 5/29/2009 Febrile Seizure.
348330 6/2/2009 NY 0.2 0 0.2 M 5/26/2009 Infant rec'd PENTACEL 3/3/09 @ 2
348331 6/2/2009 MI 82 82 F 5/26/2009 Patient was given Tdap in error as t
348332 6/2/2009 PA 1.3 1 0.3 M 5/27/2009 Varicella vaccine breakthrough. Dia
348333 6/2/2009 MD 5 M 5/27/2009 Swelling and bruising at site with pa
348334 6/2/2009 FL 1 1 0F 5/27/2009 Typical shingles of L chest and arm
348335 6/2/2009 F None stated.
348336 6/2/2009 TX 11 11 F 5/28/2009 Left deltoid area developed erythem
348337 6/2/2009 MD 5 5 F 5/27/2009 Leg Swollen, hard to touch, painful
348338 6/2/2009 GA 1 1 0M 6/2/2009 Developed diarrhea for 3 weeks, fev
348339 6/2/2009 GA 1 1 0M 6/2/2009 Diarrhea x 3 weeks
348340 6/2/2009 CT 35 35 F 6/2/2009 Pain in the right deltoid since injecti
348341 6/2/2009 MO 17 17 F 6/2/2009 Headache and dizziness s/p Tdap a
348342 6/2/2009 OK 2 2 0F 6/2/2009 Progressing ataxia with onset appro
348343 6/2/2009 TX 24 24 F 6/2/2009 5-28-09 Loss of felling in left arm, h
348344 6/2/2009 WI 2 2 0.3 M 6/2/2009 CLient received dose #4 of DTAP IM
348345 6/2/2009 CO 5 5 F 6/2/2009 Menactra administered instead of M
348346 6/2/2009 IL 0.5 0 0.5 F 6/2/2009 this patient recevied 3rd dose of Ro
348347 6/2/2009 FL 30 30 M 6/2/2009 Vaccine was administered on 5/26/0
348348 6/2/2009 CA 49 48 F 2/5/2009 Patient woke up the next day with ra
348349 6/2/2009 CA 4 4 F 6/2/2009 Patient returned to clinic 3 days pos
348350 6/2/2009 ID 1.3 1 0.3 M 6/2/2009 Developed fever 103 with diffuse sw
348351 6/2/2009 AZ 1 1 0M 6/2/2009 ERYTHEMA, EDEMA AND INDURA
348352 6/2/2009 CA 14 14 F 6/2/2009 My daughter fainted and was taken
348353 6/2/2009 WI 0.2 0 0.2 M 6/2/2009 This case was reported by a healthc
348356 6/2/2009 NY 0.5 0 0.5 F 6/2/2009 Fever - seizures - 5-20 minutes of s
348357 6/2/2009 CA 16 16 F 5/18/2009 After 3 vaccines given Pt c/o dizzine
348358 6/2/2009 MI 0.7 0 0.7 F 5/18/2009 None - 5/20/09 Spoke to Dad - baby
348359 6/2/2009 IA 21 21 F 5/26/2009 Given Immunizations Thurs. PM 5/2
348360 6/2/2009 WI 18 18 F 5/21/2009 5/21/09 Midmorning patient develop
348361 6/2/2009 CA 4 4 F 48 hr Evolution-Progressive swelling
348362 6/2/2009 TX 0.2 0 0.2 F 5/21/2009 Pt. developed petechiae of lower ex
348363 6/2/2009 IL 1.3 1 0.3 M 5/26/2009 Fever started Saturday 5/23/09 102
348364 6/2/2009 KY 1 1 0M 5/26/2009 Scattered chicken pox lesions- head
348365 6/2/2009 OH 67 67 F 5/26/2009 Generalized urticarial rash at site L
348366 6/2/2009 MA 43 43 F 5/26/2009 Received Tdap to right deltoid 5/22;
348367 6/2/2009 NE 23 23 F 6/2/2009 Headache, too warm, flushing and n
348368 6/2/2009 AZ 13 13 F 6/2/2009 Day after HPV she was weak, T.100
348369 6/2/2009 CA 30 30 F 6/2/2009 Left deltoid muscle and tender pain
348370 6/2/2009 TX 4 4 F 5/26/2009 Leg swollen, shortness of breath. M
348371 6/2/2009 PA 72 72 F 5/20/2009 Swelling, redness, and soreness lef
348372 6/2/2009 NY 77 77 F 6/2/2009 Approximately 3 weeks post ZOSTA
348373 6/2/2009 CA 4 4 F 5/22/2009 Red, swollen, cellulitis (TYLENOL).
348374 6/2/2009 CA 4 4 M 5/29/2009 Erythema and edema, warm to touc
348375 6/2/2009 MD 9 9 F 5/22/2009 Fever started 1 day after receiving v
348376 6/2/2009 NM 22 22 F 6/1/2009 At site check, Day 7, c/o some naus
348377 6/2/2009 CA 17 17 F 5/17/2009 c/o "sick stomach", shaky, jittery, ch
348378 6/2/2009 AZ 1.1 1 0.1 F 5/28/2009 Red raised bump at the injection sit
348379 6/2/2009 CA 26 26 F 5/11/2009 C/O HA radiating to her jaw, should
348380 6/2/2009 CA 13 13 F 5/15/2009 Per Pt's mother at approx. 9 pm on
348381 6/2/2009 WI 0.2 0 0.2 F 6/1/2009 Mom reports child vomited on Thurs
348382 6/2/2009 CA 20 20 F c/o dizzy 5/19, 20 c/o pain lt side o
348383 6/2/2009 NC 40 40 M 5/26/2009 A few days after 3 17-09 injections (
348384 6/2/2009 CA F 5/27/2009 Patient with c/o rash on chest and b
348385 6/2/2009 VA 1 1 0M 6/1/2009 Received MMR shot on 1/16/09. Dia
348386 6/2/2009 TX 74 74 F 5/25/2009 Patient returned to the pharmacy co
348387 6/2/2009 OR 5 5 M 6/1/2009 Marked local swelling and erythema
348388 6/2/2009 IA 57 57 F 6/2/2009 Shot given 5/28/09 patient noticed n
348389 6/2/2009 NY 14 14 F 6/2/2009 Pt felt lightheaded & thinks she may
348390 6/2/2009 MA 43 43 F 5/26/2009 Received Tdap to R Deltoid 5/22; d
348391 6/2/2009 VA 1.5 1 0.5 M 5/27/2009 Woke up 5 AM on 5/27/09 T 102 Cr
348392 6/2/2009 OH 1.1 1 0.1 F 6/2/2009 Err:508
348393 6/2/2009 GA 10 10 M 5/27/2009 Patient given a TB vaccine while he
348394 6/2/2009 CO 6 6 F 5/28/2009 On 5/14/09 - pt had swelling & redn
348395 6/2/2009 CA 43 43 F 5/29/2009 Left upper arm became very red, wa
348406 6/3/2009 2 2 0M 6/3/2009 Patient while at home developed 10
348407 6/3/2009 VA 21 21 F 6/3/2009 PT PRESENTED WITH COMPLAIN
348408 6/3/2009 OH 27 27 F 6/3/2009 Returned to clinic 5/29/09 with 1 da
348409 6/3/2009 MI 5 5 M 6/3/2009 Within 7 hrs of receiving vaccines p
348416 6/3/2009 WA 22 22 M 6/3/2009 Developed chest pain and was adm
348417 6/3/2009 23 F 3/27/2009 Patient admitted to hospital with par
348418 6/3/2009 18 18 F 5/29/2009 The date above is simply the most r
348419 6/3/2009 CA 40 40 F 6/3/2009 R deltoid with erythema, mildly infla
348420 6/3/2009 TX 12 M 6/3/2009 5/27/09 Immunizations administered
348421 6/3/2009 WI 1.3 1 0.3 M 6/1/2009 Full body rash Tylenol given as nee
348423 6/3/2009 TN 35 35 F 5/27/2009 Severe pain in left arm w/tingling se
348424 6/3/2009 MI 15 15 F 6/2/2009 Nausea, vomiting, fatigue.
348425 6/3/2009 NY 14 14 F 5/20/2009 I took my daughter to a physician sh
348426 6/3/2009 NY 4 4 M 6/3/2009 Patient vaccinated on 5/28/09, went
348427 6/3/2009 MO 13 13 M 6/3/2009 After leaving our office, the patient p
348428 6/3/2009 CT 5 5 M 6/3/2009 7 days after receiving the MMR vac
348429 6/3/2009 FL 0.6 0 0.6 M 6/3/2009 Mom called approx 1530 on 6/3/09
348430 6/3/2009 CA 67 67 M 6/2/2009 1. discomfort in abdomen, like cram
348431 6/3/2009 NJ 22 22 F 5/26/2009 A LARGE RED BUMP FIRST SHOW
348432 6/3/2009 CA 9 9 F 6/3/2009 Cellulitis of right arm where vaccine
348433 6/3/2009 OH 22 22 F 6/3/2009 I felt intense headaches and fainted
348434 6/3/2009 22 F 5/24/2009 About 5 hours after receiving the thi
348435 6/3/2009 MA 34 34 M 5/26/2009 Close to 9 months after being given
348436 6/3/2009 39 39 F 6/3/2009 On Tuesday arm (R) became painfu
348438 6/3/2009 CA 4 4 M 6/3/2009 R deltoid edema erythema hyperem
348439 6/3/2009 MO 29 29 F 6/3/2009 5/29/09 Approx. 10:45 AM - Pt faint
348440 6/3/2009 GA 69 69 F 5/27/2009 Td given 5/21/09 LDT - RTC 5/27/0
348441 6/3/2009 OH 4 4 F 6/3/2009 Itchy, erythematous, macular rash o
348442 6/3/2009 CA 4 4 M 6/2/2009 Lt arm lateral 5 inches x 2 inches te
348443 6/3/2009 PA 62 62 M 6/3/2009 Immediate red rash raised bumps (h
348444 6/3/2009 MA 27 27 F 6/3/2009 Client called Health center on 6/3/09
348445 6/3/2009 WA 11 11 M 6/3/2009 Pt had a swollen arm. was seen a E
348446 6/3/2009 CA 54 54 M 6/2/2009 Patient given Pneumovax on 5-26-0
348447 6/3/2009 IN 15 15 F 6/3/2009 4-30-09 VARICELLA vaccine given
348422 6/4/2009 VA 18 18 M 6/1/2009 After receiving immunizations and w
348448 6/4/2009 MD 1.2 1 0.2 M 6/4/2009 fever over 103 for 3 days, loss of ap
348449 6/4/2009 MO 14 14 F 6/4/2009 w/in 3 minutes of receiving the 1st d
348450 6/4/2009 IN 13 13 F 6/4/2009 FEVER OF 101.8, ACHY ALL OVER
348452 6/4/2009 PA 1.6 1 0.6 M 6/2/2009 Within 15 minutes cheeks were red
348454 6/4/2009 KY M 6/3/2009 Information has been received from
348456 6/4/2009 GA 49 49 F 6/3/2009 Initial information has been received
348459 6/4/2009 VA 7 7 M 5/29/2009 Pt c/o redness, swelling and itchy @
348460 6/4/2009 PA 2 2 0.9 M 5/29/2009 Generalized nodular papular rash
348461 6/4/2009 WI 38 38 F 5/5/2009 Redness. swelling, heat @injection
348462 6/4/2009 NE 4 4 F 5/29/2009 Redness on the area of injection 5x
348463 6/4/2009 PA 1.3 1 0.3 M 5/29/2009 Varicella vaccine break through. Dia
348464 6/4/2009 GA 13 13 F 5/28/2009 Ascending motor paralysis 6/9/09 H
348465 6/4/2009 WI 64 64 M 5/29/2009 None stated.
348466 6/4/2009 WI 5 5 F 6/1/2009 Patient came to the clinic 6-1-09. S
348467 6/4/2009 NY 18 18 U Sensation of chest tightness within
348469 6/4/2009 AZ 10 10 F 5/21/2009 Pt denied being preg. 12/31/08. Ha
348470 6/4/2009 KS 11 11 F 6/4/2009 06/04/2009 MILD Other - Fatigue, S
348471 6/4/2009 CA 11 11 F 6/3/2009 Received vaccine 5/27/2009 and se
348472 6/4/2009 MA 58 58 F 6/4/2009 Large red mildly itching rash, 10 cm
348473 6/4/2009 NY 38 38 F 6/4/2009 Periphral Neuropathy. 3-6mo after
348474 6/4/2009 PA 4 4 M 6/4/2009 1 day following vaccination, child de
348475 6/4/2009 IN 13 13 F 6/4/2009 RECIEVED TDAP, GARDISIL, MEN
348477 6/4/2009 MO 65 65 M 6/4/2009 PATIENT HAD PNEUMOVAX ON R
348478 6/4/2009 NY 60 60 F 6/4/2009 PATIENT STATED THAT SHE EXP
348479 6/4/2009 31 31 F 6/4/2009 Called Immunization clinic 6/04/09 a
348480 6/4/2009 GA 1.1 1 0.1 F 6/4/2009 Pt started with rash and fever of 102
348481 6/4/2009 PA 11 11 M 6/4/2009 Pt received vaccines on 6/2/09. On
348482 6/4/2009 NC 2 0.6 M 6/4/2009 rash, redness, swelling at site, starte
348483 6/4/2009 MI 1.4 1 0.4 F 6/4/2009 facial swelling morning after vaccine
348484 6/4/2009 NM 63 63 M 6/4/2009 Shingles symptoms appears one we
348485 6/4/2009 CA 13 13 F 6/4/2009 Approx 5 min after receiving immz,
348486 6/4/2009 OK 1.1 1 0.1 F 6/4/2009 After well-baby check-up and vaccin
348487 6/4/2009 CA 14 14 F 6/4/2009 Was standing in line 5-10 minutes a
348488 6/4/2009 CA 12 12 F 6/3/2009 Given 3rd GARDASIL on 5/27/2009
348489 6/4/2009 VA 1.6 1 0.6 F 6/8/2009 10 days after receiving MMR, patien
348490 6/4/2009 PA 26 26 F 6/4/2009 Hives all over body.
348491 6/4/2009 KS 13 13 M 6/4/2009 Felt bad last PM (about 5-6 hours a
348492 6/4/2009 AZ 4 4 F 6/4/2009 Very itchy rash on chest, abdomen,
348493 6/4/2009 AZ 11 11 F 6/4/2009 Pt experienced (L) arm pn @ injecti
348494 6/4/2009 AZ 78 78 F 6/4/2009 Rash developed one month after th
348495 6/4/2009 TX 1.1 1 0.1 M 6/4/2009 Rash - Red, papular to trunk & limbs
348496 6/4/2009 VA 1.6 1 0.6 F 6/4/2009 Projectile vomiting approximately 8-
348497 6/4/2009 OR 49 49 M 6/4/2009 Pt received immunization 9:05 AM,
348501 6/4/2009 MO 22 22 M 5/28/2009 Employee had c/o nausea with eme
348505 6/4/2009 IA 2 2 0.1 M 6/1/2009 2 doses PEDIARIX given simultane
348515 6/4/2009 GA 8 8 F 5/1/2009 3 X 3 cm induration (R) arm
348516 6/4/2009 GA 4 4 M 6/4/2009 Baby given VYANESE doses after v
348517 6/4/2009 ND 5 5 M 6/3/2009 Pt received shot Fri - Pt brought in M
348519 6/5/2009 5 M 5/1/2009 This case was reported by the moth
348520 6/5/2009 61 F 5/1/2009 This case was reported by an other
348523 6/5/2009 CA 2 U 5/1/2009 This case was reported by a physici
348524 6/5/2009 0.5 U 5/1/2009 This case was reported by a physici
348525 6/5/2009 NV 4 4 M 5/1/2009 This case was reported by a physici
348530 6/5/2009 DE U 5/1/2009 This case was reported by a physici
348531 6/5/2009 IL U 5/1/2009 This case was reported by a physici
348533 6/5/2009 IN 4 4 M 5/1/2009 This case was reported by the moth
348535 6/5/2009 TX 4 U 5/1/2009 This case was reported by a physici
348536 6/5/2009 MN 1.6 1 0.6 F 5/1/2009 This case was reported by a healthc
348537 6/5/2009 MN 5 5 F 5/1/2009 This case was reported by a healthc
348538 6/5/2009 MN 5 M 5/1/2009 This case was reported by a healthc
348539 6/5/2009 U 5/1/2009 This case was reported by a pharma
348540 6/5/2009 WV 0.3 M 5/1/2009 This case was reported by a healthc
348541 6/5/2009 WI U 5/1/2009 This case was reported by a healthc
348545 6/5/2009 TN 0.4 0 0.4 F 5/16/2009 3hrs after vaccine administered, mo
348546 6/5/2009 CT 68 68 M 5/29/2009 68yo M h/o BPH, intra-cranial hemo
348547 6/5/2009 M 6/3/2009 Born without legs.
348548 6/5/2009 NC 12 12 F 6/3/2009 Temp. 100.5 degrees F, achy joints
348549 6/5/2009 NY 4 4 F 6/2/2009 Received KINREX + MMR on R del
348550 6/5/2009 LA 11 11 F 6/2/2009 Approx 5 minutes after injection Pt b
348551 6/5/2009 NJ 43 43 M 6/1/2009 100 - 102 degree F fever, body ach
348552 6/5/2009 AZ 16 16 F 5/29/2009 Pt was injected with 2nd GARDASIL
348553 6/5/2009 PA 7 7 M 5/29/2009 Rash- 20-30 papules on trunk and g
348554 6/5/2009 LA 11 11 F 5/29/2009 9 cm X 5cm red whelp to (R) deltoid
348555 6/5/2009 WI 5 5 M 6/1/2009 Mom stated pt came home form Da
348556 6/5/2009 PA 0.2 0 0.2 M 6/1/2009 About 6 hrs after receiving vaccines
348557 6/5/2009 NM 51 51 F 5/29/2009 Swelling, redness, heat, bruising aft
348558 6/5/2009 NM 61 61 F 5/21/2009 (L) arm SQ site redness, heat. Pt sa
348559 6/5/2009 NJ 18 18 F 6/1/2009 Urticaria on arms / legs about 1 hou
348565 6/5/2009 M 6/4/2009 It was reported in a news magazine
348570 6/5/2009 OR 23 23 M 5/27/2009 5/24/09 experienced swelling in the
348573 6/5/2009 NV 5 5 F 5/28/2009 5cm erythema and induration at arm
348575 6/5/2009 SD 4 4 F 6/1/2009 Entire (R) thigh red/warm swollen w
348576 6/5/2009 IL 15 15 F 5/13/2009 Patient given dose #2 of GARDASIL
348577 6/5/2009 VA 1.4 1 0.4 M 6/3/2009 Swelling and erythema at Lt site of i
348578 6/5/2009 NM 2 2 0.2 M 5/31/2009 (L) thigh with erythema and purpura
348579 6/5/2009 IN 49 M 6/2/2009 None stated
348580 6/5/2009 TX 34 34 F 5/19/2009 Left arm - substantial swelling of inje
348581 6/5/2009 NY 3 M 6/2/2009 Erythema Multiforme rash started on
348582 6/5/2009 MO 4 4 M 5/29/2009 Pain and swelling of R deltoid area.
348583 6/5/2009 CT 22 22 M 6/5/2009 Within 5 min of receiving JE vaccina
348584 6/5/2009 NY 11 11 M 6/4/2009 c/o itchiness on neck, arms, legs, ab
348585 6/5/2009 IN 0.3 0 0.3 F 6/4/2009 Right knee swollen warm to touch.
348589 6/5/2009 CO 4 F 5/1/2009 This case was reported by a physici
348591 6/5/2009 CO 1 M 5/1/2009 This case was reported by a physici
348592 6/5/2009 CO 4 M 5/1/2009 This case was reported by a physici
348593 6/5/2009 RI 5 5 M 5/1/2009 This case was reported by a healthc
348594 6/5/2009 CO 5 5 F 5/1/2009 This case was reported by a healthc
348596 6/5/2009 NH 0.5 0 0.5 F 5/1/2009 This case was reported by a healthc
348598 6/5/2009 CA 0.3 F 5/1/2009 This case was reported by the gran
348601 6/5/2009 UT 4 4 F 5/1/2009 This case was reported by a healthc
348602 6/5/2009 GA 4 4 F 6/5/2009 redness and swelling in a 6x6 are to
348603 6/5/2009 TX 37 37 M 6/5/2009 - Received shot Tues afternoon; min
348604 6/5/2009 FL 11 11 F 6/5/2009 rash began 2 days following the inje
348605 6/5/2009 PA 61 61 M 6/5/2009 A feeling of malaize approximately 1
348606 6/5/2009 MA 4 4 F 6/5/2009 Mom reports child developed night t
348607 6/5/2009 15 15 F 6/5/2009 06052009@9:16am MOC t.c. c/o m
348608 6/5/2009 TX 1.5 1 0.5 M 6/5/2009 Developed urticaria all over body 3
348609 6/5/2009 TX 19 19 F 6/5/2009 Above client had 3 vaccines admini
348610 6/5/2009 NY 69 69 F 6/5/2009 Erythema, Swelling, Tenderness, fe
348611 6/5/2009 ND 1.2 1 0.2 M 6/5/2009 TC FROM MOTHER REQUESTING
348612 6/5/2009 VA 0.4 0 0.4 F 6/5/2009 Child received rotateq on 4/3/09 and
348613 6/5/2009 CA 23 23 M 6/5/2009 swelling in left arm wth mild erythem
348614 6/5/2009 KS 13 13 F 6/5/2009 Patient's mother calls to report that
348615 6/5/2009 PA 1.3 1 0.3 M 6/5/2009 He received Hib and DTP/DTap vac
348616 6/5/2009 WA 3 3 M 6/5/2009 VARICELLA FROM VACCINE
348617 6/5/2009 AR 1.3 1 0.3 F 6/5/2009 Mom reports child had 1st seizure 6
348618 6/5/2009 NC 0.6 -1 0.5 F 6/5/2009 2 WEEKS OF DIARRHEA (5 TIMES
348619 6/5/2009 OH 27 27 F 6/5/2009 Around 4 days after Hepatitis B vac
348620 6/5/2009 NY 50 50 F 6/5/2009 Dizziness, vomiting, headaches, pa
348621 6/5/2009 CA 1.3 1 0.4 M 6/5/2009 child experienced generalized macu
348622 6/5/2009 TX 57 67 F 6/5/2009 pt received vaccine on 6-2-09. on 6
348623 6/5/2009 NY 1 1 0M 6/5/2009 Child break out in hive after MMR a
348624 6/5/2009 CO 45 45 F 6/5/2009 Intense pain in deltoid area, swelling
348625 6/5/2009 TX 60 60 F 6/5/2009 6/3: Injection site became itchy with
348626 6/5/2009 CA 11 11 M 6/5/2009 GAVE 2ND TdAP
348627 6/5/2009 OR 69 99 M 6/5/2009 During the evening on the day of inj
348628 6/5/2009 TX 78 78 F 6/5/2009 Pt. described itching during the nigh
348629 6/5/2009 AZ 0.2 0 0.2 F 6/5/2009 MOTHER NOTICED ON 06/04/2009
348630 6/5/2009 OR 63 63 M 6/5/2009 The injection site was found to be s
348631 6/5/2009 IA 1.7 1 0.6 F 6/5/2009 Pt comes for evaluation of red swoll
348634 6/5/2009 CA 66 66 F 6/3/2009 An hour later of administration of the
348635 6/5/2009 IN 4 4 F 6/5/2009 Skin swelling, erythema (10 x 10 cm
348642 6/5/2009 IN 5 5 F 6/6/2009 4.0cm x 6.5 cm erythema around in
348643 6/5/2009 NY 11 11 F 6/5/2009 Severe swelling, tenderness, redne
348644 6/5/2009 TX 4 4 M 6/4/2009 Lower 2/3 of left arm with edema an
348645 6/5/2009 CO 65 65 M 6/5/2009 Localized reaction. Sore and swellin
348646 6/5/2009 CO 53 53 M 6/5/2009 Patient had severe localized reactio
348647 6/5/2009 VA 45 F 6/5/2009 This case was reported by a healthc
348648 6/5/2009 CA 1.3 1 0.3 U 2/5/2009 Child presented to clinic 6-4-09 w. c
348649 6/5/2009 VA 81 M 6/5/2009 This case was reported by a consum
348652 6/5/2009 CA 22 22 F 6/5/2009 Shortness of breath and dizziness
348655 6/5/2009 NC 11 11 M 6/5/2009 Pt was admitted to clinic with warm
348656 6/5/2009 MA 12 12 F 6/5/2009 1 inch diameter induration with 2 in
348657 6/5/2009 FL 1.6 1 0.6 F 6/5/2009 Pt started 2 days after vaccine T. 10
348658 6/5/2009 WA 5 5 F 6/4/2009 Redness, pain, swelling left arm ons
348660 6/5/2009 NJ 24 24 M 6/1/2009 5/23/09 - chest & back rash red, bum
348663 6/5/2009 24 24 M 6/3/2009 Red, irritated skin under bandage a
348664 6/5/2009 AZ 0.6 0 0.6 M 6/5/2009 Pt developed intussusception requir
348665 6/5/2009 DE 16 16 F 6/5/2009 Low grade fever, overall "joint achin
348666 6/5/2009 NH 21 21 F 6/5/2009 Acute muscle spasms to arm x 24hr
348667 6/5/2009 CA 4 4 M 6/5/2009 Right deltoid with erythema and swe
348668 6/5/2009 CO 67 67 F 6/5/2009 Swelling, excessive of arm, shoulde
348669 6/5/2009 CA 57 57 F Redness and swelling after 6 hours
348670 6/5/2009 NJ 3 3 M Acute onset of wheezing approx 10
348632 6/6/2009 MD 18 18 F 6/6/2009 Patient had received the Typhoid va
348633 6/6/2009 OH 34 34 M 6/6/2009 Received Tetanus booster and Hep
348636 6/6/2009 WA 22 22 M 6/6/2009 PT CAME IN TO RECIEVE ANTHR
348641 6/6/2009 OH 0.2 0 0.2 F 6/6/2009 Pedal pecechiae & edema - transien
348637 6/7/2009 38 38 M 6/7/2009 Soreness in all muscle groups, Fatig
348638 6/7/2009 CA 1 1 0M 6/7/2009 Child went from a typically developin
348639 6/7/2009 DE 1 1 0M 6/7/2009 Broke out in hives (10/19/07). Deve
348640 6/7/2009 IL 4 4 M 6/7/2009 Left upper thigh was red, warm, swo
348671 6/8/2009 CA 32 32 M 6/8/2009 Two weeks after the vaccination, I'm
348672 6/8/2009 PA 69 69 F 6/2/2009 It looked like a huge hive 2 x 3 1/2 i
348673 6/8/2009 FL 10 10 M 5/29/2009 Reddness, swelling and warmth to s
348674 6/8/2009 MI 57 57 F 5/12/2009 After each rabies vaccine, had prog
348675 6/8/2009 MI 1 1 0F 5/7/2009 Patient's mom, states she tried to fe
348676 6/8/2009 OR 11 11 F 5/27/2009 Has hard, red swollen area at one in
348677 6/8/2009 AR 1 1 0M 5/28/2009 Received immunizations @ 9AM - b
348678 6/8/2009 PA 14 14 F 6/4/2009 Immediately following administration
348679 6/8/2009 MI 1.5 1 0.5 F 3/16/2009 Vaccines 2/20/09 ----> mom reports
348681 6/8/2009 CA 15 15 F 5/14/2009 Pt had small area of urticaria @ flex
348683 6/8/2009 CA 16 16 F 5/14/2009 Pt developed severe urticaria over e
348687 6/8/2009 HI 3 3 M 5/29/2009 Redness and induration at injection
348691 6/8/2009 NC 1 1 0F 6/4/2009 Morbilliform rash 24-36 degrees afte
348700 6/8/2009 MA 1 1 0M 6/8/2009 5/7/09 VARIVAX + PCV given. 5/15
348701 6/8/2009 IA 18 18 F 6/8/2009 Reddened, raised, tender, warm to
348702 6/8/2009 IL 9 9 M 6/8/2009 6/5/09 - Mom brought child in, Dr sa
348703 6/8/2009 AL 1.4 1 0.2 F 6/8/2009 Parent stated 18 hrs after vaccine c
348704 6/8/2009 FL 36 35 M 6/8/2009 Nausea, diarrhea, vomiting, fatique,
348705 6/8/2009 TX 29 29 F 6/8/2009 Diarrhea and itching palms on even
348706 6/8/2009 WA 20 20 M 6/8/2009 3 weeks following vaccination with A
348707 6/8/2009 CA 55 55 M 6/8/2009 Pneumococcal vaccine given at 090
348708 6/8/2009 MN 30 30 M 6/8/2009 Headache and diplopia accompany
348709 6/8/2009 CA 27 27 M 6/8/2009 Tonic Seizure lasted 1 min about 2
348710 6/8/2009 FL 12 12 F 6/8/2009 I ASSESSED A 12 YEAR OLD FEM
348712 6/8/2009 NY 12 12 F 6/8/2009 fever, nasal congestion, lost voice, b
348713 6/8/2009 NY 43 43 F 6/8/2009 Within 12 hours: Significant swelling
348714 6/8/2009 CO 18 18 F 6/8/2009 Varicella administered on Tuesday,6
348715 6/8/2009 IN 72 72 F 6/8/2009 On 6/2/09 / 6 days post vaccine not
348716 6/8/2009 KS 14 14 M 6/8/2009 Patient woke up with a very sore arm
348717 6/8/2009 LA 4 4 F 6/8/2009 Immediately after having vaccines, p
348718 6/8/2009 WA 56 56 F 6/8/2009 Patient received injection on 5/26/09
348719 6/8/2009 CA 64 64 M 6/8/2009 Onset of head ache, nausea, bloatin
348720 6/8/2009 OR 1 1 0F 6/8/2009 PARENT RECORD OF FEVER x48
348721 6/8/2009 MN 48 48 F 6/8/2009 breast on side of injection swelled s
348722 6/8/2009 GA 52 52 F 6/8/2009 Pt's states her arm was very swollen
348724 6/8/2009 FL 4 4 F 6/8/2009 Developed a large local reaction at
348725 6/8/2009 NJ 31 31 F 6/8/2009 Fever x 24 hours, body ache and so
348723 6/9/2009 CA 35 35 F 6/9/2009 Tetanus shot was given on Friday, J
348736 6/9/2009 TX 1.1 1 0.1 M 6/2/2009 Fever 104.7, Myoclonic movements
348737 6/9/2009 MI 26 26 F 6/4/2009 GARDASIL vaccine - neuritis (LUE
348738 6/9/2009 OH 17 17 F 6/3/2009 Joint pain in arms & shoulders. Eva
348739 6/9/2009 NC 53 53 F 6/4/2009 Dtap given in LDMIM. 30 minutes af
348740 6/9/2009 PA 7 7 F 6/3/2009 Redness and induration at site injec
348741 6/9/2009 IA 36 36 F 6/4/2009 Patient reports pain at site, fever, so
348742 6/9/2009 CT 4 4 F 6/4/2009 Total body urticaria, agitation about
348743 6/9/2009 VA 5 5 F 6/4/2009 Induration and warmth to left thigh a
348744 6/9/2009 MI 4 4 M 4/20/2009 (R) Leg reaction to KINRIX DTAP-P
348745 6/9/2009 OR 0.2 0 0.2 M 6/5/2009 Patient received PENTACEL vaccin
348747 6/9/2009 DE 66 F 6/4/2009 Pt states 6/3/09 she noticed onset o
348749 6/9/2009 IN 53 53 F 5/1/2009 Sore arm and low grade temperatur
348750 6/9/2009 AR 0.3 0 0.3 F 6/3/2009 103 degree temperature and letharg
348751 6/9/2009 OR 0.3 0 0.3 M 6/5/2009 Pt. was given PENTACIL at 9:00 am
348752 6/9/2009 ME 27 27 U Pain with arm swollen below injectio
348756 6/9/2009 CA 5 5 M 6/3/2009 ER Report states: Left upper extrem
348758 6/9/2009 NE 69 69 F 6/3/2009 Large red rash at injection site. Ras
348759 6/9/2009 AZ 0.3 0 0.3 F 6/2/2009 Persistent inconsolable crying. DTa
348760 6/9/2009 NY 4 4 M 6/5/2009 Hives, eye swelling approximately 1
348761 6/9/2009 CA 0.3 0 0.3 U Persistent diarrhea 12-15 x 1 day. L
348762 6/9/2009 CA 0.3 0 0.3 U Persistent diarrhea 12-15 x 1 day la
348763 6/9/2009 VA 22 22 F 6/3/2009 Per patient legs broke out in hives e
348764 6/9/2009 OH 14 14 F 2/26/2009 Weakness, fatigue, rapid HR, abd p
348765 6/9/2009 IL 4 4 F 6/4/2009 Child's mother states that pt was a l
348766 6/9/2009 VA 0.2 0 0.2 M 6/3/2009 High pitch cry for 4 hrs - hard to con
348767 6/9/2009 FL 4 4 F 6/3/2009 Left upper thigh, redness, some pai
348768 6/9/2009 IA 0.5 0 0.5 M 6/2/2009 Mom noticed hives on torso, no feve
348769 6/9/2009 WA 0.6 0 0.6 F 6/1/2009 Pt given vaccines and approximatel
348770 6/9/2009 CA 4 4 F 6/1/2009 Gave school IZ's 5/26/09, when chil
348771 6/9/2009 KS 33 33 F 5/29/2009 7 x 10 cm Erythema
348772 6/9/2009 MA 13 13 F 6/2/2009 Pt fainted 5 min after 3rd GARDASI
348773 6/9/2009 MA 0.5 0 0.5 F 6/3/2009 Temp 101-102 rash on 6-3-09 seen
348774 6/9/2009 IA 1.2 1 0.2 M 6/2/2009 Red, raised rash. Started on 5/30/09
348775 6/9/2009 LA 18 18 F 2X5 cm whelps, cellulitis treated wit
348776 6/9/2009 FL 1.2 1 0.2 M 5/28/2009 Rash head to toe entire body on 5/2
348777 6/9/2009 AR 4 4 M 5/22/2009 Right upper arm red, swollen, and w
348778 6/9/2009 TX 8 8 M 6/4/2009 Pt got fever, T: 99 - 101 degree F fr
348779 6/9/2009 PA 1.4 1 0.4 M 6/4/2009 "(+) Local reaction to INFANRIX vac
348780 6/9/2009 PA 6 6 F 6/5/2009 Varicella vaccine break through. Dia
348781 6/9/2009 WA 1 F 6/9/2009 Pt was given HIB that was expired.
348782 6/9/2009 WA 37 37 F 4/27/2009 Swelling redness pain at injection si
348783 6/9/2009 NC 28 28 M 6/4/2009 None Stated
348784 6/9/2009 NY 72 72 F 6/3/2009 Pt received ENGERIX B vaccine IM
348785 6/9/2009 AZ 22 22 F 5/30/2009 Arm pain, redness, and swelling ext
348786 6/9/2009 PA 4 4 M 6/8/2009 Client inadvertently received ZOSTA
348787 6/9/2009 NJ 20 20 F 6/8/2009 Passed out after received shot with
348788 6/9/2009 DE 22 22 F 6/9/2009 Patient received #2 GARDASIL on 5
348789 6/9/2009 IN 4 4 F 6/8/2009 10 cm erythematous indurated lesio
348790 6/9/2009 IA 16 16 F 6/8/2009 Pt. stated stomach felt queasy; sat d
348791 6/9/2009 TX 36 36 F 6/5/2009 None stated.
348792 6/9/2009 AZ 49 49 F 6/8/2009 Employee given 5th HEP B today w
348793 6/9/2009 GA 1 1 0F 5/19/2009 The above named patient was seen
348794 6/9/2009 CT 64 64 F 5/29/2009 Sterile abcess @ site of injection. N
348796 6/9/2009 TN 4 4 F 6/9/2009 Mom states high temp starting 1 ho
348797 6/9/2009 CA 85 85 F 6/9/2009 85 y/o F NKA, PMH: Dementia, Hyp
348798 6/9/2009 CO 24 F 6/9/2009 Patient did not know she was pregn
348799 6/9/2009 CT 4 4 F 6/9/2009 Developed meningitic like illness wh
348800 6/9/2009 PA 0.2 0 0.2 F 6/9/2009 3-5 minutes after receiving Pediarix
348801 6/9/2009 FL 20 20 F 6/9/2009 Beginning with 2nd gardasil vaccina
348802 6/9/2009 MN 20 20 F 6/9/2009 The client's sister also received an i
348803 6/9/2009 TX 11 11 F 6/9/2009 Syncope <5 min. after admin of vac
348804 6/9/2009 OH 1.2 1 0.2 M 6/9/2009 ANTHONY DEVELOPED HIGH FEV
348805 6/9/2009 WA 1.3 1 0.3 M 6/9/2009 2 episodes of L facial drooping sinc
348806 6/9/2009 IA 18 18 M 6/9/2009 None
348807 6/9/2009 TX 17 17 F 6/9/2009 Gardasil #1 (1423X) given in right a
348810 6/9/2009 CA 65 65 F 6/9/2009 Pt c/o redness, swelling of about 3 i
348811 6/9/2009 OR 76 76 F 6/9/2009 Drunk stare, drooling, swelling of inj
348812 6/9/2009 AZ 51 F 6/4/2009 Severe rash on arms and hives + jo
348813 6/9/2009 WI 18 18 F Within 24 hours of vaccine c/o sore
348814 6/9/2009 AZ 0.2 0 0.2 F 6/9/2009 Fever even with TYLENOL, fussines
348815 6/9/2009 NC 4 4 M 6/9/2009 Fever 104 degrees about 12 hours
348816 6/9/2009 WA 7 7 M 6/8/2009 Arm swollen 2X NL size, Red, hot v
348817 6/9/2009 NC 68 68 F 6/4/2009 Fever 102 - large hives at site of inje
348818 6/9/2009 MA 15 15 F 6/9/2009 1 day after the immunization, child d
348819 6/9/2009 NV 5 5 F 6/8/2009 Erythematous swelling, right deltoid
348820 6/9/2009 TX 22 22 M 5/7/2009 A 22 year old male patient received
348821 6/9/2009 TX 12 12 F 5/27/2009 This non serious case was received
348823 6/9/2009 OH 1 1 0M 6/9/2009 Rash started on (L) ear - Spread do
348824 6/10/2009 MO 15 15 F 6/5/2009 Patient had syncope episode imme
348826 6/10/2009 IN 24 24 F 5/1/2009 None stated
348827 6/10/2009 MA 56 56 F 6/3/2009 Within 4 hours, fever (up to 101 deg
348828 6/10/2009 NC 0.4 0 0.4 M 6/3/2009 Petechiae and small purpuric areas
348829 6/10/2009 OH 11 11 M 6/4/2009 Started 24-36 hours after vaccine (R
348839 6/10/2009 CA 58 58 M 6/8/2009 Initial report received on 29 May 20
348846 6/10/2009 CA 4 4 F 6/9/2009 Received MMR II and HAVRIX vacc
348847 6/10/2009 MD 44 44 M 6/10/2009 Patient received DT on 6/1/09. Star
348848 6/10/2009 OH 1 1 0F 6/9/2009 Vaccines given 5/26/2009. Left leg
348849 6/10/2009 MI 65 65 F 6/9/2009 "Tennis ball" sized area around inje
348850 6/10/2009 WA 60 60 F 6/9/2009 Noticed low fever, broke out in tiny h
348851 6/10/2009 CO 52 52 F 6/8/2009 Headache within 2 hours. Had fastin
348852 6/10/2009 DE 25 25 F 6/10/2009 Patient had severe vaso response a
348853 6/10/2009 MI 64 64 F 6/10/2009 Right upper extremity cellulitis. Swo
348854 6/10/2009 VA 11 11 F 6/10/2009 Patient received Tdap vaccine durin
348855 6/10/2009 VA 4 4 F 6/10/2009 Swelling to right thigh 5 cm around
348856 6/10/2009 MD 29 29 F 6/10/2009 Pt received Hep B #2 dose on 06/08
348857 6/10/2009 VA 0.2 0 0.2 M 6/10/2009 vomiting and diarrhea, dehydration.
348858 6/10/2009 IL 18 18 F 6/10/2009 Parent called clinic approximately 2
348859 6/10/2009 IL 32 32 M 6/10/2009 Client received
Y Twinrix vaccination o
348860 6/10/2009 GA 24 24 F 6/10/2009 Client was given an adolescent dos
348861 6/10/2009 MN 11 11 M 6/10/2009 Patient's mother reported patient ha
348862 6/10/2009 WI 1.6 1 0.6 F 6/10/2009 This child was given shots 05/06/09
348863 6/10/2009 GA 4 4 F 6/10/2009 10 to 12 red papules. Red base with
348864 6/10/2009 WA 830 83 F 6/11/2009 VACCINE GIVEN ON THURSDAY,
348865 6/10/2009 AZ 4 4 M 6/10/2009 EDEMA, ERYTHEMA 1"X 2" TO RI
348866 6/10/2009 NY 1.6 1 0.6 M 6/10/2009 Anaphylaxis (w/in 30 min, irritability,
348867 6/10/2009 IL 1.3 1 0.4 F 6/10/2009 After child received DTaP and Prevn
348869 6/10/2009 IL 1.6 1 0.6 F 6/5/2009 Vaccines given 5/20/09. Vomited st
348870 6/10/2009 TX 17 17 F 6/10/2009 Rash beginning on bilateral arms. O
348871 6/10/2009 OH 0.3 0 0.3 M 6/10/2009 Bloody stools 24 hours after admini
348872 6/10/2009 ND 59 59 F 6/9/2009 Pt had flu vaccine on 1-23-09. Since
348873 6/10/2009 CA 11 11 F 5/20/2009 Diagnose Juvenile Rheumatoid Arth
348874 6/10/2009 WI 1 0 1F 6/3/2009 7 days following inj - inj site slowly t
348875 6/10/2009 CA 2 2 0.5 M 6/10/2009 Approx. 30 minutes after receiving v
348876 6/10/2009 CA 4 4 M 6/10/2009 Inflammation, redness and tenderne
348877 6/10/2009 WA 11 11 F 6/10/2009 About 5 mins after rec'vg all imm. ap
348878 6/10/2009 MI 4 4 M 6/10/2009 Redness started (L) thigh increased
348879 6/10/2009 U No data given.
348880 6/10/2009 CA 0.8 0 0.8 M 6/2/2009 Gave PEDIARIX but didn't need a d
348882 6/10/2009 IN 8 8 F 6/10/2009 Redness -"Kiwi size"- approx. 3-4 in
348883 6/10/2009 CA 5 5 F 6/10/2009 Seen in clinic 1 week after vaccine 6
348885 6/10/2009 KY 60 60 F 6/10/2009 Arm sore next day with increased re
348898 6/10/2009 40 30 M 7/15/2005 Description: 11/10/98. Received ant
348899 6/10/2009 VA 30 30 M 6/23/2005 Multiple medical conditions diagnos
348900 6/10/2009 22 22 F 6/16/2005 Symptom: Dermatitis, focal Start: 0
348902 6/10/2009 NC 35 35 F 11/9/2006 Patient received FLUMIST and ADA
348903 6/10/2009 NC 36 36 F 11/7/2006 Patient received Tdap into the left s
348904 6/10/2009 NC 33 33 F 11/3/2006 Symptom: Fever start: 10/31/2006 -
348905 6/10/2009 NC 37 37 F 11/6/2006 Description: 37 y/o female develope
348906 6/10/2009 NC 1.9 1 0.9 F ### 22 month old female received DTaP
348907 6/11/2009 25 25 F 6/11/2009 NOTE: Reported
Y Adverse Event is d
348908 6/11/2009 AR 18 18 F 6/10/2009 None stated
348926 6/11/2009 NY 65 65 M 6/11/2009 rash, uticaria
348927 6/11/2009 TN 14 14 M 5/15/2009 Pt recd ADACEL and MENACTRA 0
348928 6/11/2009 MI 51 51 M ### Fever 103 degree and rigor 12 hour
348929 6/11/2009 NC 12 12 F 6/4/2009 Generalized Urticaria Patient treated
348930 6/11/2009 GA 41 41 M 6/5/2009 The shot was given to me months a
348931 6/11/2009 MS 4 4 F Red, warm to touch 2x2 circumferen
348932 6/11/2009 PA 17 17 M 6/5/2009 Varicella vaccine breakthrough. Dia
348933 6/11/2009 OR 77 77 F At 3d after vaccine. Severe local rea
348934 6/11/2009 MA 39 M 6/5/2009 Pt called on 6/5/09 c/o pain in (L) ar
348935 6/11/2009 MO 5 5 F 6/8/2009 Right upper arm area of induration a
348936 6/11/2009 PR 32 32 F 6/8/2009 See attached side effects which hav
348937 6/11/2009 51 F 6/9/2009 Patient received PNEUMOVAX 23 v
348938 6/11/2009 TN 2 2 0.6 M 5/20/2009 Pt came in the clinic on 5/20. Mom s
348939 6/11/2009 IN 12 12 M 5/29/2009 Local reaction with marked erythem
348940 6/11/2009 IN 52 52 F 6/11/2009 Had rash on neck after 1st shot (4-5
348942 6/11/2009 54 54 F 6/11/2009 About 2min after injection (s/s) Pt go
348943 6/11/2009 IL 5 5 F 6/11/2009 Redness, swelling from shoulder to
348944 6/11/2009 CA 60 60 F 6/10/2009 Right arm red, swollen, bruised, war
348945 6/11/2009 MT 4 4 M 6/11/2009 Patient given ADACEL instead of D
348946 6/11/2009 MA 0.3 0 0.3 F 6/11/2009 Forceful vomiting 24 degrees after v
348947 6/11/2009 IL 66 66 F 6/11/2009 Swollen, itchy, warm, sore, rash 6" l
348948 6/11/2009 26 26 M 6/11/2009 This case was reported via medical
348958 6/11/2009 MN 72 72 F 6/11/2009 Pt received Tdap vaccine in the ED
348959 6/11/2009 MN 82 82 F 6/11/2009 From physician note: "her right arm
348960 6/11/2009 39 39 M 6/11/2009 3day fever to 101F responded to NS
348961 6/11/2009 GA 28 28 F 6/11/2009 client received vaccines MMR, and
348962 6/11/2009 MO 10 10 F 6/11/2009 C/O pain, erythema, swelling 3-4" in
348963 6/11/2009 KY 1 1 0F 6/11/2009 Diffuse drug reaction of head chest
348964 6/11/2009 FL 15 15 F 6/11/2009 Immediately after vaccine was given
348965 6/11/2009 PR 17 17 F 6/11/2009 HEADACHE, DIZZINESS, PROBLE
348966 6/11/2009 MD 1.3 1 0.2 F 6/11/2009 maculopapular, red in color, blanchi
348967 6/11/2009 CA 11 M 6/11/2009 rash on trunk and forearms present
348968 6/11/2009 CA 42 42 M 6/11/2009 Rash to trunk and back with some it
348969 6/11/2009 MI 1.3 1 0.3 M 6/11/2009 2-3 minute long seizure associated
348970 6/11/2009 TX 1.8 1 0.8 F 6/11/2009 Rash: onset 6/7/09, duration of 3 da
348971 6/11/2009 FL 7 7 M 6/11/2009 patient experienced yesterday (6/10
348972 6/11/2009 NC 28 28 F 6/11/2009 55 X 60 mm area of induration, war
348973 6/11/2009 TX 26 26 M 6/11/2009 redness, induration, pain, itching, w
348974 6/11/2009 CA 14 14 F 6/11/2009 April 2009: Pt. had conjunctivitis in b
348975 6/11/2009 SD 17 17 M 6/11/2009 Second dose of Hepatitis A given by
348976 6/11/2009 AR 16 16 F 6/11/2009 Approx 90 seconds after the first inj
348978 6/11/2009 CA 47 42 U Not recently, but want to report now
348979 6/11/2009 CA 1 1 0F 6/11/2009 Varicella Molluscum after previous d
348980 6/11/2009 KY 11 11 F 6/11/2009 Woke up from a nap around 5pm on
348981 6/11/2009 KY 4 4 F 6/11/2009 Pt presents with red, raised area on
348982 6/11/2009 WI 11 11 M 6/11/2009 Fainted after Tdap, Menactra , Varic
348983 6/11/2009 CA 1 1 0F 6/11/2009 Urticarial rash within 6 H of adminis
348984 6/11/2009 AZ 4 4 M 6/11/2009 Localize reaction. Injection site, swe
348985 6/11/2009 AZ 5 5 M 6/11/2009 (L) arm 2x2 cm red, cellulitic area w
348986 6/11/2009 WA 5 5 F 6/11/2009 Shingles - dx 5/5/09.
348987 6/11/2009 AZ 65 65 M 6/11/2009 Red arm syndrome, headache + fev
348988 6/11/2009 CO 15 M 6/11/2009 Broke out with blisters on mouth.
348977 6/12/2009 WA 57 57 M 6/11/2009 Thickness of the eyelids, dizziness,
348989 6/12/2009 MI 0 0 0F 6/8/2009 Febrile (101) 24 hours after immuniz
348990 6/12/2009 CA 19 19 F Bilateral finger rash, erythematous n
348991 6/12/2009 VA 9 9 M 6/9/2009 1 1/2" diameter redness no induratio
348992 6/12/2009 MO 8 8 M 6/9/2009 6/9/09 Mother of the client reported
348993 6/12/2009 VA 5 5 F 6/9/2009 Marked by swollen upper left arm sh
348994 6/12/2009 TX 1 1 0M 6/8/2009 Child broke out in hives within 24 hr
348995 6/12/2009 CA 78 78 F 6/6/2009 Patient developed rash about 1 1/2"
348996 6/12/2009 SC 2 2 0.2 F 6/5/2009 Shortly after vaccine administration,
348997 6/12/2009 NC 5 5 F 6/8/2009 Pt developed redness, swelling & in
348998 6/12/2009 MD 1 1 0F 6/10/2009 Received MMR, varicella, PREVNA
348999 6/12/2009 NE 66 66 F 6/10/2009 Developed spots located on her sca
349000 6/12/2009 CT 63 63 F Difuse varicellaform rash on chest, b
349001 6/12/2009 OR 0.2 0 0.2 F 6/5/2009 very fussy
349002 6/12/2009 WI 16 16 F 6/8/2009 After administration of GARDASIL p
349010 6/12/2009 FL 1.9 1 0.9 F 6/12/2009 Patient had vaccines 6/10/09. Had H
349011 6/12/2009 GA 2 2 0.4 M 6/11/2009 Swelling and warmth at the site of in
349012 6/12/2009 OH 17 17 F 6/11/2009 Sore at injection site. Low grade fev
349013 6/12/2009 PA 65 65 F 6/11/2009 Site reaction- Red, itchy, warm 2 1/2
349014 6/12/2009 KY 0.5 0 0.5 M 6/12/2009 Stated after patient received shots c
349015 6/12/2009 TX 13 13 F 6/12/2009 Pt given VAQTA and MENACTRA.
349016 6/12/2009 KY 18 18 M 6/12/2009 Pt received vaccines approx. at 2:30
349017 6/12/2009 TX 25 25 F 6/12/2009 acute postvaccinial lymphadenitis b
349018 6/12/2009 PA 11 11 M 6/12/2009 on 5/23/09 developed headaches th
349019 6/12/2009 PA 5 5 F 6/12/2009 6/10/2009 Patients Mother called of
349020 6/12/2009 CT 67 67 F 6/12/2009 14:30 vaccine administered pt beca
349022 6/12/2009 WI 18 18 F 6/12/2009 Client fainted for a few seconds. I h
349023 6/12/2009 GA 58 58 F 6/12/2009 Exactly 24 hours from the vaccinatio
349024 6/12/2009 FL 24 24 F 6/12/2009 decreased sensation in left arm, left
349025 6/12/2009 VA 23 23 F 6/12/2009 Approximately 24 hrs after vaccinati
349026 6/12/2009 NM 36 36 M 6/10/2009 Pt was experiencing itchy palms and
349027 6/12/2009 OK 1.6 1 0.6 M 6/12/2009 area surrounding vaccine site was r
349028 6/12/2009 MO 27 M 6/12/2009 Patient is 28 year old male with com
349029 6/12/2009 GA 43 43 F 6/12/2009 Day after immunizations began hav
349030 6/12/2009 CA 28 28 M 6/12/2009 Individual developed a maculopapu
349031 6/12/2009 OR 17 17 F 6/12/2009 Reports rash and swelling noted in
349032 6/12/2009 CA 5 5 F 6/12/2009 Left Deltoid muscle red/swollen and
349033 6/12/2009 OH 8 8 M 6/12/2009 CHILD RECEIVED VACCINE ON 0
349045 6/12/2009 M 6/12/2009 This case was reported via a statem
349046 6/12/2009 WA 68 68 F 6/12/2009 Rash & pain at injection site (~ 3" in
349047 6/12/2009 WA 1.1 1 0.1 M 6/12/2009 Pt came in with what looked like bug
349048 6/12/2009 CA 4 4 M 6/12/2009 Redness with swelling to right arm.
349049 6/12/2009 TX 1.3 1 0.3 F 6/12/2009 Large erythematous rxn to both legs
349050 6/12/2009 TX 12 12 M 6/12/2009 Large, warm and tender indurated a
349051 6/12/2009 SC 15 15 M 6/12/2009 After MENACTRA injection. Child ha
349052 6/12/2009 AR 2 2 0.8 M 6/12/2009 Erythema confluent smooth area L d
349053 6/12/2009 NE 0.2 0 0.2 M 6/1/2009 On 05/26/09 after receiving immuniz
349054 6/12/2009 KY 29 29 F 6/12/2009 Patient complains of headache afte
349055 6/12/2009 KY 36 36 F 6/12/2009 Donor states she has muscle cramp
349056 6/12/2009 TX 10 10 M 6/12/2009 Red puffy reaction at site of VARIVA
349057 6/12/2009 NC 4 4 F 6/12/2009 Patient presented to office with redn
349058 6/12/2009 OH 66 66 F 6/12/2009 Pt received ZOSTAVAX vaccine on
349059 6/12/2009 CA 1.1 1 0.1 M 6/12/2009 Instant swelling and redness at injec
349060 6/12/2009 FL U Swelling and redness at injection sit
349061 6/12/2009 MN 25 25 F 6/11/2009 Right deltoid pain with radiating to n
349062 6/12/2009 MO 1.2 1 0.2 M 6/9/2009 6/7/09 Head to toe rash. Blisters m
349063 6/12/2009 OR 28 28 F 6/12/2009 Tightness, in chest, pale, warm, nau
349064 6/12/2009 ID 11 11 F 6/11/2009 Evening of 5/27. arm pain On 5/28.
349065 6/12/2009 WI 1.5 1 0.5 M 6/12/2009 Child was at daycare. He took a lon
349066 6/12/2009 NE 0.6 0 0.6 M 6/1/2009 Had immunization on 5/26/09, had e
349034 6/13/2009 NY 0.2 0 0.2 M 6/13/2009 Child developed Abnormal Seborrhe
349035 6/13/2009 CT 1 1 0F 6/13/2009 rash to MMR 10 days post vaccine
349036 6/14/2009 TX 34 34 F 6/14/2009 About two days after my 2nd vaccin
349037 6/14/2009 MI 50 50 M 6/14/2009 Pt received vaccine in the hospital.
349067 6/15/2009 64 M 6/12/2009 Report obtained
Y from literature case
349076 6/15/2009 PA 66 66 F 6/11/2009 Initial report was received 04 June 2
349080 6/15/2009 ME F 6/10/2009 Initial report received on 08 June 20
349083 6/15/2009 RI 86 86 F 6/12/2009 Information has been received from
349086 6/15/2009 DE F 6/12/2009 Information has been received from
349090 6/15/2009 NY 6 6 M 6/10/2009 Patient started sneezing approx. 20
349091 6/15/2009 OH 19 19 F 6/14/2009 Achy joints (not just in shoulders wit
349092 6/15/2009 KY 0.4 0 0.4 F 6/15/2009 THURSDAY, JUNE 4TH, RIGHT SI
349093 6/15/2009 MI 15 F 6/15/2009 syncope and briefly passed out a fe
349094 6/15/2009 TX 29 29 F 6/15/2009 CLIENT RECEIVED ALL THE VACC
349095 6/15/2009 WI 11 11 F 6/15/2009 Day of injection patient complained
349096 6/15/2009 KS 62 62 F 6/15/2009 3010/29 Itching under armpits 10/30
349097 6/15/2009 PA 40 40 F 6/15/2009 Following anthrax vaccination, mem
349098 6/15/2009 MI 69 69 M 6/15/2009 Pt developed zoster rash within 24h
349099 6/15/2009 MI 8 8 M 6/15/2009 Vaccination given at 9:20 a.m. Patie
349100 6/15/2009 WA 1.6 1 0.6 M 6/15/2009 4 days after receiving DTaP #4 and
349101 6/15/2009 WA 1.5 1 0.6 M 6/15/2009 Shots were given on 5/20/09. Shot s
349102 6/15/2009 CO 56 56 F 6/15/2009 HAD yellow fever INJECTION ON 6
349103 6/15/2009 NC 71 71 F 6/15/2009 Developed zoster pain 48 hours afte
349104 6/15/2009 WA 1.5 1 0.5 F 6/15/2009 Redness/extreme swelling to injectio
349105 6/15/2009 WA 4 4 M 6/15/2009 Pt received vaccinations on 6/9/09.
349106 6/15/2009 MN 13 13 F 6/15/2009 Fainting spells started in January 20
349107 6/15/2009 CO 61 61 F 6/15/2009 4x4 Swelling, redness, irritation at in
349108 6/15/2009 RI 66 66 F 6/15/2009 Varicella-like rash developed 3 days
349110 6/15/2009 OK 17 F 6/1/2009 Red swollen dots around injection s
349111 6/15/2009 OK 4 4 F 6/15/2009 At injection site approximately equa
349112 6/15/2009 FL 11 11 F 6/8/2009 Patient suddenly fell to the floor abo
349113 6/15/2009 MA 37 37 F 6/9/2009 Severe bilateral lower extremity ede
349114 6/15/2009 1 1 0F 6/10/2009 Developed erythema multiforme w/i
349116 6/15/2009 AK 0.7 0 0.7 M 5/28/2009 Mom reports she noticed hives on b
349120 6/15/2009 IL 19 F 6/10/2009 Pt. was seen on 6/9/09 for pap sme
349123 6/15/2009 CO 10.4 10 M 6/11/2009 Pt fainted in waiting area.
349125 6/15/2009 IL 69 69 F 6/10/2009 (No pain) 11/11/08 - 1st sore on out
349127 6/15/2009 MN 61 61 M 6/9/2009 Patient has red rash, left side of fore
349128 6/15/2009 VA 11 11 F 6/15/2009 5/27/09 S.T. Congestion; 6/2/09 Fev
349129 6/15/2009 CA 60 60 F 6/15/2009 Swelling, pain, erythema in (whole u
349130 6/15/2009 PA 4 4 M 6/9/2009 At bedtime on 6/5/09 mother noticed
349131 6/15/2009 NC 4 4 M 6/15/2009 Rt facial nerve palsy "Bell's palsy"
349132 6/15/2009 CA 1.4 1 0.4 M 6/9/2009 Given vaccines 6/3/09, started with
349133 6/15/2009 OH 54 54 F 6/13/2009 On 5-29-09-4AM started vomiting/di
349134 6/15/2009 NY 11 11 F 5/22/2009 Numbness in wrist, elbow and shou
349135 6/15/2009 KS 17 17 F 6/14/2009 Pt developed body aches, myalgias
349136 6/15/2009 MA 40 40 F 6/10/2009 Red, swelling R Deltoid
349137 6/15/2009 OH 18 18 M 6/15/2009 Red raised rash on hands, chin 6/12
349138 6/15/2009 MT 24 24 F 6/15/2009 Syncope in waiting room. Fell and h
349139 6/15/2009 TX 4 4 M 6/15/2009 Lt thigh with large area of erythema
349140 6/15/2009 FL 22 22 F 6/12/2009 R interior deltoid ~ 3 cm oval shape
349141 6/15/2009 NC 10 10 M 6/15/2009 Varicella vaccine adm. on 6/10/09. M
349142 6/15/2009 OH U Patient received her vaccine on 4/2
349143 6/15/2009 NY 64 64 F 6/9/2009 (1) Severe headache and swelling R
349144 6/15/2009 OR 66 66 M 6/11/2009 Pt states he had swelling and pain a
349145 6/15/2009 NJ 30 30 F 6/9/2009 On 5/21/09 Pt saw Doctor reports re
349146 6/15/2009 NH 30 29 F 6/15/2009 T to > 102 within 4 hours, cellulitis p
349147 6/15/2009 VA 13 11 M (Hep A and MENACTRA) Tdap 8/40
349148 6/15/2009 VA 12 12 M 5/13/2009 After HepA on 10/29/08 HA started
349149 6/15/2009 MD 72 72 M 5/29/2009 Administered 5/22/09; on Sunday, 5
349159 6/15/2009 AZ 21 20 F 6/12/2009 Information has been received throu
349166 6/15/2009 AK 2 1 1M 6/12/2009 5/28/09: Client received MMR and V
349167 6/15/2009 WA 43 F None stated
349168 6/15/2009 ME 16 16 F 6/12/2009 Information has been received from
349294 6/15/2009 CT 27 27 F 6/12/2009 Initial and follow up information has
349304 6/15/2009 CA 33 F 6/12/2009 Information has been received form
349328 6/15/2009 NV 20 19 F 6/12/2009 Information has been received from
349366 6/15/2009 RI 16 F 6/12/2009 Information has been received from
349378 6/15/2009 LA F 6/12/2009 Information has been received from
349391 6/15/2009 NY 25 F 6/12/2009 information has been received from
349109 6/16/2009 CA 22 22 F 6/15/2009 DURING A ROUTINE PHYSICAL, I
349174 6/16/2009 FL 0.6 F 6/15/2009 Information has been received from
349184 6/16/2009 18 18 F 6/11/2009 Developed Alopecia Areata Univers
349186 6/16/2009 65 65 M 6/6/2009 I received the vaccine and a month
349188 6/16/2009 CO 5 5 M 6/9/2009 Pt was seen 6/8/09 for 5 year WCC
349190 6/16/2009 OR 6 6 M 6/10/2009 6/3/09 office visit: Red, warm area
349192 6/16/2009 MA 16 16 F 6/11/2009 Light headedness, dizziness since v
349194 6/16/2009 TX 17 17 F 6/12/2009 Patient fainted
349196 6/16/2009 NY 22 22 F 6/12/2009 Tingling & numbness of the Rt finge
349197 6/16/2009 GA 18 18 F 6/11/2009 Immediately after receiving vaccine,
349198 6/16/2009 WV 52 F 6/11/2009 Severe pain at the injection, Limited
349199 6/16/2009 WV 59 59 F 6/11/2009 Severe tenderness and swelling at s
349202 6/16/2009 OR 4 4 M 6/10/2009 6/3/09 Came in for office visit - Urtic
349204 6/16/2009 OR 4 4 F 6/10/2009 6/10/09 office visit- firm, red, tender
349205 6/16/2009 SC 32 32 F 6/11/2009 Allergic reaction rash, swollen area
349214 6/16/2009 IN 0.5 0 0.5 F 6/16/2009 EXFOLIATIVE ERYTHRODERMA -
349215 6/16/2009 OH 5 5 M 6/8/2009 Mom described area on (R) leg is ap
349216 6/16/2009 NC 4 4 M 6/10/2009 Vaccine given on 6/5/09. On 6/7/09
349217 6/16/2009 IN 66 66 F 6/8/2009 Patient has a quarter-sized red area
349218 6/16/2009 OH 0.3 0 0.3 F 6/8/2009 Received PCV-7 in (R) thigh and PE
349219 6/16/2009 OK 5 5 F 6/5/2009 Child has a 6cm x 3cm erythematou
349220 6/16/2009 CT 45 45 M 6/10/2009 Member woke during night with chill
349221 6/16/2009 LA 37 37 F 6/9/2009 Redness 7cm x 5 1/2 cm warm to to
349222 6/16/2009 FL 25 25 F 5/4/2009 Spreading, redness, pain
349223 6/16/2009 OR 66 66 F 5/31/2009 Within 1/2 hr. - hives and swelling th
349224 6/16/2009 CA 4 4 F 6/5/2009 (L) leg red and swollen 35 mm X 35
349225 6/16/2009 NY 0.6 0 0.6 F 5/29/2009 Child received PENTACEL, PREVE
349226 6/16/2009 NE 12 12 M 6/10/2009 Right deltoid, red, warm to touch. S
349227 6/16/2009 FL 45 45 M 6/8/2009 Frontal headache "head pounding"
349228 6/16/2009 NC 4 4 F 6/8/2009 Pt received Immunisation and then
349229 6/16/2009 CA 14 14 F 6/4/2009 Pt was given MENACTRA - Vaccine
349230 6/16/2009 FL 60 60 M 6/15/2009 A developed shingles like rash in le
349231 6/16/2009 AZ 13 13 F 6/14/2009 Rash 10 days post vaccination seen
349232 6/16/2009 IN 39 39 F 6/12/2009 6-2-09 Rcvd MMR SubQ @ Health
349233 6/16/2009 NY 21 21 F 6/3/2009 Fever, chills, headache, sore throat
349234 6/16/2009 TX 14 14 F 6/9/2009 Fatigue X 2 days
349235 6/16/2009 AZ 0.1 0 0.1 M 6/8/2009 Increased irritability with green/muc
349236 6/16/2009 MN 16 16 F 6/9/2009 Woke up at 2 AM on 6/9/09 with tem
349237 6/16/2009 CA 58 58 F 6/6/2009 Hives occurred 5 to 7 days after shi
349238 6/16/2009 MI 17 18 M 4/23/2009 Received vaccines 4/21/09. That nig
349239 6/16/2009 AL 47 47 M 6/8/2009 None stated
349240 6/16/2009 ME 72 72 F 6/9/2009 Large 9 cm red area with 3x4 cm ra
349241 6/16/2009 WA 9 9 F 6/12/2009 Localized itching, erythema, and sw
349242 6/16/2009 WI 75 75 F 6/16/2009 Tenderness, swelling, erythema. No
349243 6/16/2009 PA 72 F 6/9/2009 Pain in arm neck back, chills fever s
349244 6/16/2009 LA 43 43 M 6/10/2009 None stated
349245 6/16/2009 CO 12 12 M 6/11/2009 Had IZs 6/9/09, on 6/11/09 MOC ca
349246 6/16/2009 38 38 F None stated
349247 6/16/2009 CO F 6/10/2009 No adverse reactions previously
349248 6/16/2009 GA 1.3 1 0.3 M 6/9/2009 Patient had fever and a seizure afte
349249 6/16/2009 SC 83 83 F 6/11/2009 Pt came in and stated that 2 months
349250 6/16/2009 WA 51 51 F 6/10/2009 Left arm edema, tenderness, fatigue
349251 6/16/2009 U UTD
349252 6/16/2009 IN 7 7 F 6/10/2009 Injection site is reddened and raised
349253 6/16/2009 MN 17 17 F 6/8/2009 Redness, tenderness, nausea
349254 6/16/2009 IL 37 M 6/5/2009 None stated
349255 6/16/2009 ME 1 1 0M 6/9/2009 Break through. Chicken pox 6-8-09
349256 6/16/2009 TX 16 16 F 6/16/2009 pt c/o itching at menactra injection s
349257 6/16/2009 NY 42 43 M 6/16/2009 member was given Typhoid at 0915
349260 6/16/2009 CA 62 U 6/16/2009 Subject in pneumococcal vaccine tr
349261 6/16/2009 WI 47 47 F 6/16/2009 On the 12th and 13th day after rece
349262 6/16/2009 MA 24 24 F 6/16/2009 One month after injection the patien
349263 6/16/2009 CO 15 15 M 6/16/2009 3/29/2009 Was hospitalized with me
349264 6/16/2009 CO 29 29 F 6/16/2009 After Tdap given, employee experie
349265 6/16/2009 WA 23 23 M 6/16/2009 Pt received smallpox vaccination on
349266 6/16/2009 MO 49 49 M 6/3/2009 6/03/09 1:10 p.m. - phone call from
349267 6/16/2009 MA 1.3 1 0.3 M 6/16/2009 Err:508
349269 6/16/2009 CA 18 18 F 6/16/2009 1 month following 1st gardasil inject
349270 6/16/2009 NM 67 67 F 6/16/2009 Red, swollen, Painful, warm to touch
349271 6/16/2009 GA 0.2 0 0.2 F 6/16/2009 Patient was given Hepatitis A vaccin
349272 6/16/2009 CO 56 56 F 6/16/2009 6/12/09 9am: Two days after vaccin
349273 6/16/2009 NC 2 2 0.5 M 6/16/2009 Patient fell asleep on the car ride ho
349274 6/16/2009 NE 1.9 1 0.9 M 6/16/2009 My son got his vaccinations on Thu
349275 6/16/2009 8 8 M 6/16/2009 Right Arm reddened, swollen and p
349277 6/16/2009 AR 1 1 0F 6/16/2009 Pt. had vaccines on 6-5-09, and on
349279 6/16/2009 CA 10 10 M 6/12/2009 MOC states child has been seizure
349281 6/16/2009 ID 0.2 0 0.2 F 6/16/2009 Shots given around 11am 6-12-09.
349282 6/16/2009 MO 5 5 M 6/15/2009 2" red area to injection site- Rt. leg (
349276 6/17/2009 8 8 F 6/11/2009 sWELLING AND REDNESS ON RIG
349358 6/17/2009 NC 1.3 1 0.3 F 6/12/2009 2 days after had a seizure with vom
349359 6/17/2009 IA 0.2 0 0.2 M 6/17/2009 Presented to Y ER -Died 6/26/09 Aut
349360 6/17/2009 IA 0.2 0 0.2 F 6/17/2009 Mom foundYbaby unresponsive 12-2
349361 6/17/2009 AZ 63 63 F 6/15/2009 GBS - numbness, tingling, burning o
349394 6/17/2009 IN 26 26 F 6/17/2009 i got the hep shot on 4-22-09. it was
349395 6/17/2009 NC 13 F 6/17/2009 since having gardasil shots my daug
349396 6/17/2009 MI 39 29 F 6/17/2009 Tremendous chills and pain in the le
349397 6/17/2009 NY 2 2 1F 6/17/2009 My son was sore for the remainder
349398 6/17/2009 SC 11 11 M 6/17/2009 Three hours after immunizations pa
349399 6/17/2009 OR 28 28 M 6/17/2009 Patient was administered vaccine. P
349400 6/17/2009 MO 0.3 0 0.4 M 6/17/2009 One day after vaccine was given, on
349401 6/17/2009 NY 64 64 M 6/17/2009 Inability to breath, extreme shortnes
349402 6/17/2009 TX 14 14 M 6/17/2009 varivax received approx 8 hrslater e
349403 6/17/2009 AR 68 68 M 6/17/2009 Fever (104) reduced with acetamino
349405 6/17/2009 NJ 24 24 F 6/17/2009 Dianosis: Left brachial neuritis after
349406 6/17/2009 NC 10 10 M 6/17/2009 CLIENT GIVEN VACCINES BECAM
349407 6/17/2009 WV 14 14 F 6/17/2009 Patient developed bacteremia witho
349408 6/17/2009 UT 49 49 F 6/17/2009 I received my Zostavax DS PWD #1
349409 6/17/2009 FL 1.1 1 0.1 M 6/17/2009 High fever, greater than 103F, axilla
349410 6/17/2009 VA 22 22 F 6/17/2009 Wasnt told to wait immediately after
349412 6/17/2009 28 28 M ### Description: Had febrile illness withi
349413 6/17/2009 34 34 M 2/10/2005 Description: diffuse puritic rash 2 da
349414 6/17/2009 35 35 U 6/14/2005 Description: Diffuse maculopapular
349415 6/17/2009 MD 25 25 F 6/17/2009 Rash- competent w/ past - MMR ras
349416 6/17/2009 18 18 M 2/8/2005 12/13/86 - received spv, yellow feve
349417 6/17/2009 NC 34 34 M 6/15/2009 Tdap given on 06-11-09. Began ha
349418 6/17/2009 WV 5 5 M 6/17/2009 No fever, redness and swelling from
349419 6/17/2009 NE 12 12 F 6/17/2009 Swelling and red reaction with indur
349420 6/17/2009 CT 27 F 6/9/2009 Received a phone call from patient
349421 6/17/2009 TX 63 63 F 6/16/2009 Developed rash on face and upper
349422 6/17/2009 LA 0.3 0 0.3 F 6/10/2009 On 6/10/09 grandmother presented
349423 6/17/2009 TN 0.5 0 0.5 M 6/17/2009 Seizure
349424 6/17/2009 22 22 M 12/7/2004 Anthrax vaccine #1, #2, #3- no prob
349425 6/17/2009 AL 1.6 1 0.6 M 6/17/2009 Apparent seizure that evening after
349426 6/17/2009 PA 4 4 F 6/15/2009 Received Kinrix on 6/11/09, IM/L ar
349427 6/17/2009 PA 4 4 M 6/15/2009 Received Kinrix on 6/10/09 IM/Larm
349428 6/17/2009 25 25 M 1/27/2005 2/17/04 - received ANTHRAX vaccin
349429 6/17/2009 CA 53 53 M 6/17/2009 Body ache, fever, right hand swellin
349430 6/17/2009 NC 39 39 M 2/22/2005 Description: 1/21/05- received prima
349431 6/17/2009 CA 19 19 U Rash, but not around injection site.
349432 6/17/2009 NC 33 U ### Vaccination site erythema, induratio
349433 6/17/2009 TX 0.2 0 0.2 M 6/17/2009 Vaccines administered 06/10/09 at
349434 6/17/2009 ND 1.1 1 0.1 F 6/17/2009 Patient broke out on forehead, face
349435 6/17/2009 NC 45 45 F ### Persistent, reproducible arthralgias
349436 6/17/2009 NC 28 28 M 3/15/2005 08/17/04 - received smallpox vaccin
349437 6/17/2009 VA 17 17 F 6/17/2009 Erythematous, non-fluctuant, indura
349438 6/17/2009 VA 15 15 F 6/17/2009 Mildly indurated, mildly erythematou
349439 6/17/2009 TX 11 11 M 6/17/2009 Local reaction to vaccine
349440 6/17/2009 CA 4 4 F 6/17/2009 (L) Deltoid - swollen, red AMOXICIL
349441 6/17/2009 WI 11 11 F 6/17/2009 7 by 2 cm area of erythema/swelling
349442 6/17/2009 MA 4 4 M 6/17/2009 Erythema, induration, swelling, itchi
349443 6/17/2009 AK 9 9 M 6/16/2009 9 cm roughly circular red/warm/itchi
349444 6/17/2009 NC 38 38 M ### 1/13/03 - received anthrax vaccine #
349445 6/17/2009 39 39 M 2/1/2005 DOD call received from patient on 1
349446 6/17/2009 30 30 M ### Progressive L arm / shoulder pain w
349447 6/17/2009 CT 24 21 F 4/15/2005 Description: 2/3/05- received SPV (3
349448 6/17/2009 NC 22 21 U 9/17/2007 Description: SM developed, N&V, H
349449 6/17/2009 NC 20 20 M 6/11/2009 20 y/o male, ADSM, presents as a r
349450 6/17/2009 NC 34 34 U ### Description : progressive fatigue, co
349451 6/17/2009 GA 40 40 U 6/17/2005 Description: This patient reports bac
349452 6/17/2009 42 42 U 2/18/2005 Description: Headache, arthralgias,
349453 6/17/2009 21 21 U ### Progressive, persistent bilateral sho
349454 6/17/2009 35 35 U ### Description: Headache, Myalgias, U
349753 6/17/2009 MD 0.1 0 0.1 U 5/28/2009 Information has been received from
349758 6/17/2009 SC 0.2 M 5/28/2009 Information has been received from
349766 6/17/2009 ME 0 0 0U 5/28/2009 Information has been received from
349776 6/17/2009 MA 1.3 F 5/29/2009 Information has been received from
349779 6/17/2009 MO M 5/29/2009 Information has been received from
349784 6/17/2009 NJ 34 33 F 5/29/2009 Initial information has been received
349789 6/17/2009 AR 5 M 5/29/2009 Information has been received from
349813 6/17/2009 NE 12 12 M 5/29/2009 Information has been received from
349932 6/17/2009 MD 9 M 5/29/2009 Information has been received from
349933 6/17/2009 MN 1.1 F 5/29/2009 Information has been received from
349943 6/17/2009 ME U 5/29/2009 Information has been received from
349946 6/17/2009 KS 1 1 0M 5/29/2009 Information has been received from
349947 6/17/2009 5 F 5/29/2009 A caller reported that her daughter e
349949 6/17/2009 KS 1.1 F 5/29/2009 Information has been received from
349950 6/17/2009 IL 1 1 0F 5/29/2009 Information has been received from
349954 6/17/2009 CO 1.5 M 5/29/2009 Information has been received from
349977 6/17/2009 CT 4 4 F 5/29/2009 Initial and follow-up information has
349992 6/17/2009 AZ 11 11 M 5/29/2009 Information has been received from
349996 6/17/2009 KY 1.5 1 0.5 M 5/29/2009 Initial and follow up information has
350050 6/17/2009 TX M 5/29/2009 Information has been received from
350055 6/17/2009 MS 1 1 0M 5/29/2009 Information has been received from
350064 6/17/2009 NE 1.3 M 5/29/2009 Information has been received from
350076 6/17/2009 MS 31 F 5/29/2009 Information has been received from
350084 6/17/2009 MO 2 2 0.7 F 5/29/2009 Information has been received from
350177 6/17/2009 WV F 5/29/2009 Information has been received from
350188 6/17/2009 NM 5 U 5/29/2009 Information has been received from
350195 6/17/2009 NM U 5/29/2009 Information has been received from
350197 6/17/2009 1.3 F 5/29/2009 Information has been viewed on the
350204 6/17/2009 MD 1.3 1 0.3 M 5/29/2009 Information has been receive from a
350205 6/17/2009 M 5/29/2009 The consumer reported that 10 yea
350210 6/17/2009 TX 1.2 1 0.2 F 5/29/2009 Information has been received from
350222 6/17/2009 5 F 5/29/2009 Information has been received form
350313 6/17/2009 FL 0.2 U 5/29/2009 Information has been received from
350317 6/17/2009 F 5/29/2009 Information has been received form
350325 6/17/2009 NE 1.1 1 0.1 M 5/29/2009 Information has been received from
349464 6/18/2009 M 6/16/2009 This case was received on 09-June
349465 6/18/2009 OK 35 F 6/15/2009 Initial report was received 11 June 2
349470 6/18/2009 VA 20 20 M 3/21/2009 PT PRESENTED TO MEDICAL C/O
349471 6/18/2009 PA 55 55 F 6/18/2009 Fever 102.1
349472 6/18/2009 TN 80 61 M 6/18/2009 patient broke out with shingles in his
349473 6/18/2009 PA 54 54 M 6/18/2009 Patient received pneumococcal vac
349474 6/18/2009 CO 13 13 F 6/18/2009 06-17-09 Fainting episodes x2 afte
349475 6/18/2009 1 1 0M 6/18/2009 rash
349476 6/18/2009 FL 18 18 F 6/18/2009 Patient had vaccine 9/11/08 and be
349477 6/18/2009 MI 1 1 0F 6/18/2009 Pt presented to our office on 6/18/0
349478 6/18/2009 OR 6 6 F 6/18/2009 24 hours after vaccine patient comp
349479 6/18/2009 NC 35 35 M 6/18/2009 Anthrax Vaccine exceeded the reco
349480 6/18/2009 FL 52 52 M 6/18/2009 Patient's throat 10 minutes after the
349481 6/18/2009 FL 60 60 F 6/18/2009 Difuse red papule rash and itching f
349484 6/18/2009 NC 35 M 6/18/2009 Anthrax Vaccine exceeded the reco
349485 6/18/2009 NY 35 35 M 6/18/2009 Complaining of continued pain and
349486 6/18/2009 CA 4 4 F 6/18/2009 2 large blisters on lt arm where varic
349487 6/18/2009 TX 33 33 F 6/18/2009 I began to have the following sympt
349488 6/18/2009 NY 38 38 M 6/18/2009 Member called stating that he was r
349489 6/18/2009 TN 0.2 0 0.2 M 6/18/2009 seen in emergency room twenty-fou
349491 6/18/2009 OH 11 11 M 6/18/2009 Patient was entered into the electro
349492 6/18/2009 U 6/18/2009 Fever, chills, muscle aches, sore joi
349494 6/18/2009 IN 41 41 F 6/18/2009 Fever 103, body aches, blotchy red
349495 6/18/2009 CA 1.3 1 0.3 M 6/18/2009 could not walk 5 hours after shot wa
349496 6/18/2009 TX 64 64 F 6/18/2009 Vaccine administered, vaccine 2 we
349497 6/18/2009 CA 4 4 F 6/18/2009 Dr. requested that these side-effect
349501 6/18/2009 CA 1.4 1 0.4 M 6/18/2009 L thigh swollen, red, + bump Dxper
349502 6/18/2009 TX 1.3 1 0.3 M 6/18/2009 L upper thigh with induration, red 4x
349503 6/18/2009 OH 18 18 M 6/18/2009 Sudden LOC onset about 10 minute
349504 6/18/2009 TX 11 11 M 6/18/2009 Pt. c/o left arm pain and swelling. N
349505 6/18/2009 KS 1.2 1 0.2 M 3/2/2009 See sheet
349506 6/18/2009 KS 5 5 M 2/26/2009 Redness and swelling onset 1 day a
349507 6/18/2009 KS 11 11 M 2/11/2009 Injection given left Deltoid on 2-7-09
349508 6/18/2009 KS 33 33 F 2/13/2009 Fever of 101 degrees, - fever at 5:0
349509 6/18/2009 KS 1 1 0F 1/21/2009 Patient was in her car seat, after gra
349511 6/18/2009 VA 27 27 F 6/18/2009 Started day of vaccine 17 hr HA and
349513 6/18/2009 CA 75 75 M 6/17/2009 Pt had Td and ZOSTAVAX on 5/4/0
349514 6/18/2009 CA 5 5 M 6/17/2009 Within minutes of injections, pt beca
349515 6/18/2009 FL 0.6 0 0.6 M 6/18/2009 Convulsions (seizures) approx. 1 da
349516 6/18/2009 AL 5 5 F Facial twitching and drooling
349517 6/18/2009 MA 19 19 F 6/16/2009 Fainted after injection. No adverse a
349519 6/18/2009 VA 12.5 12 F 6/18/2009 5 cm round, swollen red lesion on R
349520 6/18/2009 IL 0.4 0 0.4 F 2 days after 4 month shots, develop
349521 6/18/2009 MA 2 2 0.9 M 6/15/2009 VARICELLA complications: None -
349522 6/18/2009 HI 4 4 F 6/10/2009 Cold urticaria. ZYRTEC.
349523 6/18/2009 PA 56 56 F 6/16/2009 Pt received Tdap @ 9:30 am on 6/1
349524 6/18/2009 PA 34 34 M 6/9/2009 Right deltoid where Tdap administe
349525 6/18/2009 MA 2 2 0.6 F 6/12/2009 The patient received DTaP vaccine
349526 6/18/2009 OR 5 5 M 6/18/2009 Parent noticed the injection site was
349527 6/18/2009 NC 17 17 F 6/16/2009 Pt. had fainting episodes with 1st do
349528 6/18/2009 OH 0.1 0 0.1 M 6/3/2009 Diarrhea, vomiting
349530 6/18/2009 NJ 32 32 M 5/15/2009 Patient came to IMMs complaining o
349531 6/18/2009 NJ 25 25 M 5/15/2009 Patient came to IMMS complaining
349532 6/18/2009 VT 1 1 0F 6/18/2009 Pt father reported "it looked like hive
349533 6/18/2009 MI 69 69 F 4/23/2009 On March 7, 2009, I noticed a rash
349498 6/19/2009 35 35 M 6/19/2009 PT STATES EVERY TIME HE REC
349499 6/19/2009 WA 15 15 F 6/18/2009 Vaccines given at about 12:15 PM J
349536 6/19/2009 NE 31 31 M 6/18/2009 Information has been received from
349543 6/19/2009 F 6/18/2009 Information has been received throu
349550 6/19/2009 CO 0.2 0 0.2 M 6/18/2009 Information has been received from
349557 6/19/2009 OH 18 18 M 6/19/2009 Mother driving client home. Client c
349562 6/19/2009 IA 10 20 F 6/19/2009 Grandmother called clinic on 6/19/0
349563 6/19/2009 NY 86 86 F 6/19/2009 Cellulitis to upper right arm noted th
349564 6/19/2009 MD 4 4 M 6/19/2009 redness and swelling at site of vacc
349565 6/19/2009 WI 24 24 M 6/19/2009 Local redness and swelling on site.
349566 6/19/2009 OH 22 22 M 6/19/2009 fever, irritability, muscle/joint aches,
349567 6/19/2009 OK 10 10 F 6/19/2009 unknown
349568 6/19/2009 NY 12 12 F 6/19/2009 Left arm swelling and redness. No f
349570 6/19/2009 FL 4 4 F 6/19/2009 Swelling injection site, Left upper ar
349571 6/19/2009 NY 1.3 1 0.4 M 6/19/2009 Left arm swelling and redness. No f
349573 6/19/2009 NC 70 70 M 6/19/2009 Vaccine administered 6/16 @ 10am
349575 6/19/2009 CA 1.8 1 0.8 F 6/19/2009 LOCAL REACTION TO VACCINE
349576 6/19/2009 WI 70 70 F 6/19/2009 Patient developed Shingles on 1st b
349579 6/19/2009 NC 23 23 F 6/19/2009 Anthrax Vaccine exceeded the reco
349580 6/19/2009 GA 11 11 F 6/19/2009 Around 6-7 pm on 6/17/09, client ha
349581 6/19/2009 CA 65 65 F 6/19/2009 Patient received Pneumo vaccine ri
349584 6/19/2009 MI 1.2 1 0.2 M 6/19/2009 LYMPHNODE ENLARGED ON L IN
349585 6/19/2009 GA 64 64 M 6/19/2009 ON the site of the flu shot there is a
349586 6/19/2009 IL 18 18 F 6/19/2009 The day following administration of
349587 6/19/2009 IL 10 10 F 6/19/2009 Patient Received Havrix (Peds Hep
349588 6/19/2009 NY 2 1 1F 6/19/2009 pt recieved varivax on 11-21-1997,
349589 6/19/2009 MI 1 1 0F 6/19/2009 NONE
349590 6/19/2009 KS 60 60 F 6/19/2009 Ct obtained the prescription for the
349591 6/19/2009 AL 16 16 F 6/19/2009 Client reports back on 6-18-2009, o
349592 6/19/2009 NY 1.3 8 M 6/19/2009 PT RECEIVED VARIVAX ON 1-14-
349593 6/19/2009 TX 38 38 F 6/19/2009 rec'd MMR on 6/11/09. Kristin states
349594 6/19/2009 NJ 0.4 0 0.4 M 6/19/2009 Patient developed afebrile Seizures
349595 6/19/2009 WA 37 37 M 6/19/2009 Smallpox shot was uneventful. Afte
349596 6/19/2009 CA 20 20 F 6/19/2009 Patient became faint, diaphoretic an
349597 6/19/2009 MI 34 34 F 6/19/2009 Received vaccine 6/16/09, each day
349608 6/19/2009 CA 51 51 M 6/19/2009 Pt has persistent low grade pain sin
349609 6/19/2009 HI 2 2 0.9 M 6/19/2009 6.17.09 @ 2:30 pm immunization gi
349612 6/19/2009 OR 45 45 F 6/13/2009 On 6/10/09 patient felt generalized j
349614 6/19/2009 CA 58 58 F 6/20/2009 Redness, swelling at injection site (l
349615 6/19/2009 GU 53 53 M 6/22/2009 Soreness at site of injection - 6/17/0
349617 6/19/2009 FL 1.5 1 0.5 M 6/19/2009 Child had redness and edema arou
349618 6/19/2009 AL 0.4 0 0.4 M 6/19/2009 This case was reported by a physici
349619 6/19/2009 OH 1 0 1M 6/16/2009 Developed zoster PCR confirmed.
349620 6/19/2009 WI 7 7 M 6/5/2009 Pt had tightness in throat, pale, whe
349621 6/19/2009 MA 29 29 M 6/17/2009 04-20-09 - 04-24-09 = left arm, shou
349623 6/19/2009 PR 48 46 M 6/11/2009 None stated
349624 6/19/2009 IL 88 88 F 6/19/2009 Patient felt pain in her back on 6/10
349625 6/19/2009 TN 3 3 F 6/12/2009 Gave HAVRIX in prefilled syringe in
349626 6/19/2009 AK 9 9 M 6/19/2009 Right arm swelling at site of injection
349627 6/19/2009 PA 0.4 0 0.4 M 6/19/2009 Office visit 6.18.09 Acute URI 4 mo
349628 6/19/2009 MI 6 6 F 6/19/2009 Developed 1/2 dollar size hive arou
349629 6/19/2009 KS 5 5 U Pt developed localized redness and
349630 6/19/2009 DC 1.3 1 0.3 F 6/12/2009 Lethargy soon after immunization fo
349631 6/19/2009 WA 5 5 M 6/10/2009 Redness and swelling at injection si
349632 6/19/2009 U Mildly erythemic area approx 3cm d
349633 6/19/2009 GA 0.4 0 0.4 M 4/28/2009 Diagnosed with C. difficile on 2/27/0
349634 6/19/2009 FL 29 29 F 6/11/2009 None stated
349635 6/19/2009 CA 0.5 0 0.5 M 6/18/2009 fever 99.2, Redness around injectio
349636 6/19/2009 CT 7 7 M 6/11/2009 Child c/o cough.. mother brought ch
349637 6/19/2009 VA 5 5 M 6/19/2009 (L) arm swelling/redness, pain and b
349638 6/19/2009 IL 61 61 M 6/8/2009 Pt was given a DTaP rather than a T
349639 6/19/2009 IL 51 51 M 4/29/2009 None stated
349640 6/19/2009 NV 4 4 F 6/18/2009 Fever, lethargy began 24 hrs after s
349641 6/19/2009 MT 5 5 M 6/18/2009 3 inch circular raised red area at (R)
349642 6/19/2009 OH 15 15 M 6/18/2009 Near syncopal reaction minutes afte
349643 6/19/2009 MD 44 44 F 6/10/2009 Symptoms, started 11 hours after th
349644 6/19/2009 VA 14 14 F 6/15/2009 Facial edema (notable lips & (L) eye
349645 6/19/2009 NC 66 66 M 6/15/2009 1 hr after receiving Pneumovax & Z
349646 6/19/2009 MD 29 29 F 6/12/2009 Vaccine given 6/4/09. Pt developed
349647 6/19/2009 OH 45 45 F 6/16/2009 Vaccination LUE with YF Vax 2:30p
349648 6/19/2009 SC 41 41 M 6/15/2009 Swelling, redness at site one day af
349649 6/19/2009 GA 10 10 F 6/12/2009 (R) arm - swollen to shoulder & dow
349650 6/19/2009 MA 19 19 F 6/11/2009 Had PAP at Gyn which came back p
349651 6/19/2009 FL 18 18 F 6/9/2009 None stated.
349598 6/20/2009 CA 5 5 M 6/20/2009 Child became lethargic, flushed, dip
349599 6/20/2009 CA 70 70 M 6/20/2009 Twenty-four hours after the PPV va
349600 6/20/2009 NE 34 34 F 6/20/2009 Confusion; Severe and continuing h
349601 6/21/2009 U 6/21/2009 pain at site, chills, unwell, slightly sw
349602 6/21/2009 42 42 F 6/21/2009 I was administered the Anthrax Vac
349603 6/21/2009 PA 11 11 M 6/21/2009 Extreme tiredess within 1 hour of va
349604 6/21/2009 16 15 F 6/21/2009 endocraneal hipertension after 1.5
349605 6/21/2009 NV 5 5 M 6/21/2009 local exaggerated reaction at site of
349606 6/21/2009 TX 0.8 0 0.8 M 6/21/2009 DALLAS RECEIVED HEP B, POLIO
349607 6/21/2009 OH 1.6 1 0.6 M 6/21/2009 My son had his 4th dose of DTAP a
349653 6/22/2009 MI 82 82 F 6/19/2009 InformationYhas been received from
349660 6/22/2009 WV 49 M 6/18/2009 This case was received from a heal
349661 6/22/2009 WV F 6/18/2009 This case was received from a heal
349664 6/22/2009 VA 0.2 0 0.2 M 6/19/2009 Information has been received from
349666 6/22/2009 AL 14 14 F 6/19/2009 Information has been received throu
349670 6/22/2009 AR 28 28 F 6/22/2009 The morning after receiving the vac
349671 6/22/2009 GA 20 20 F 6/22/2009 Patient in for doctor's visit and was
349672 6/22/2009 MI 69 69 M 6/22/2009 Approximately 2 to 4 days after 2nd
349673 6/22/2009 VT 0.2 0 0.2 F 6/22/2009 Mother came in 6/22/09 stating that
349674 6/22/2009 NH 0.1 0 0.1 M 6/22/2009 THERE WERE Y NO ADVERSE EVE
349675 6/22/2009 CA 19 19 M 6/22/2009 Complaining of lesions on right wris
349676 6/22/2009 SD 70 70 F 6/22/2009 Patient presented with red, swollen,
349677 6/22/2009 NC 24 24 F 6/22/2009 Immediately after Pt received secon
349678 6/22/2009 GA 38 38 F 6/22/2009 patient examined - tender, urticarial
349679 6/22/2009 WA 33 33 F 6/22/2009 Within about 3-4 hours I had a tight
349680 6/22/2009 NC 40 40 F 6/22/2009 MMR given 4/07/09- she developed
349681 6/22/2009 OK 5 5 F 6/22/2009 Large area (from knee to buttock) o
349682 6/22/2009 NY 16 16 F 6/22/2009 child received HPV and had fingers
349683 6/22/2009 NC 4 5 F 6/22/2009 ON 6-17-2009, ONE DAY AFTER R
349684 6/22/2009 MI M 6/22/2009 Fever 103 & throbbing headache
349685 6/22/2009 SC 35 35 F 6/22/2009 Local tenderness and swelling over
349686 6/22/2009 NY 17 16 M 6/15/2009 Mother notified office approx 45 min
349688 6/22/2009 MI 27 27 F 6/22/2009 Pneumovax 23 was given 6/17/09. W
349689 6/22/2009 CA 10 10 M 6/22/2009 VACCINE WAS GIVEN ALONE IN D
349690 6/22/2009 MN 17 16 F 6/22/2009 Patient was given a HPV injection a
349691 6/22/2009 FL 70 70 M 6/22/2009 Reaction to Pneumovax with the sw
349692 6/22/2009 NJ 1.3 1 0.3 F 6/22/2009 ITP treated with Win. 9/29/09. Hosp
349693 6/22/2009 TX 60 61 F Pt mentioned she had warm facial c
349694 6/22/2009 MT 39 39 F 6/22/2009 6/19/09 MMR given Left arm. 2nd in
349695 6/22/2009 CA 13 13 F 6/17/2009 Pt. had syncopal event after admini
349696 6/22/2009 PA 70 70 F 6/22/2009 Since Zostavax was administered in
349698 6/22/2009 ND 1 1 0M 2/3/2009 Classic measles vaccination rash. R
349699 6/22/2009 CT 37 37 F 6/22/2009 Pain, swelling of from deltoid to just
349700 6/22/2009 OH 34 34 F 6/22/2009 Pt. States 2 days post injection. Lef
349701 6/22/2009 OR 1.2 1 0.2 M 6/22/2009 Began with rash (small red dots) in
349702 6/22/2009 NY 15 15 F 6/22/2009 Pt c/o. not feeling well. Generalized
349703 6/22/2009 NY 18 F 4/13/2009 Pt c/o feeling dizzy. V/S - HR 100/m
349704 6/22/2009 33 33 M 6/22/2009 Generalized pain and swelling of 3"
349705 6/22/2009 NM 15 15 F 6/16/2009 Patient became faint for about 15 se
349706 6/22/2009 CA 40 40 F No adverse events reported by patie
349707 6/22/2009 NY 1.6 1 0.6 M 6/15/2009 About 10 cm, overlying cellulitis.
349714 6/22/2009 VT 2 1 1F 6/15/2009 - Child received MMR and Hep A on
349716 6/22/2009 CA 0.6 0 0.6 F 6/11/2009 Fever (103.8) and febrile seizure 12
349718 6/22/2009 71 U 6/17/2009 Given adult diphtheria/tetanus vacc
349719 6/22/2009 CO 11 11 F 6/16/2009 Baseball-sized red area back of righ
349720 6/22/2009 CA 4 4 M 6/16/2009 Redness 13 1/2 cm x 17 1/2 cm, sw
349721 6/22/2009 CA 4 4 F 6/16/2009 Left arm deltoid 10 cm bruise. Warm
349722 6/22/2009 IL 0.6 0 0.6 F 6/16/2009 Mother of pt states she developed a
349724 6/22/2009 NC 53 53 F 6/15/2009 Employee's left deltoid was red + sw
349725 6/22/2009 OR 14 14 F 6/8/2009 Date: 5/28/09. Vaccines were admin
349726 6/22/2009 KS 5 5 M 6/17/2009 Imm. 2 days ago. No pain or fever.
349727 6/22/2009 CT 24 24 F 6/17/2009 First GARDASIL given 5/11/09. She
349728 6/22/2009 KY 15 16 F 6/18/2009 Woke up this am with shot area pain
349729 6/22/2009 GA 2 2 0.4 F 6/15/2009 MD ordered LPN to give Hep A and
349730 6/22/2009 IL 11 11 M 6/18/2009 Rec #2 VARICELLA left deltoid on 6
349731 6/22/2009 OH 0.2 0 0.2 F Diarrhea (5-8/day) for 2 weeks follow
349732 6/22/2009 AR 0.3 0 0.3 F 6/18/2009 Fever up to 103.3 within 24 hours o
349733 6/22/2009 OH 0.2 0 0.2 F 6/22/2009 Vomited the day of the vaccine, had
349734 6/22/2009 SC 35 35 F 6/22/2009 Swollen glands on left side of neck.
349735 6/22/2009 PA 18 18 F 6/19/2009 Patient at check-out area stating "i j
349736 6/22/2009 NJ 14 14 F 6/22/2009 Seconds after PPD placement and
349737 6/22/2009 IL 14 14 F 6/22/2009 Pt started with dizziness and SOB
349738 6/22/2009 30 30 F 6/14/2009 I work in a hospital. I was informed a
349739 6/22/2009 90 90 F 6/15/2009 Patient was given ZOSTAVAX on M
349740 6/22/2009 CA 4 4 F 6/22/2009 Rt Arm edema erythema hyperemia
349741 6/22/2009 PA 4 4 M 6/22/2009 Leg swollen; red and 3 in x 4 in area
349742 6/22/2009 TX 9 9 M 6/22/2009 Pt's mother called 6-19-09 reporting
349743 6/22/2009 GA 27 27 F 6/19/2009 Hepatitis B vaccine booster adminis
349744 6/22/2009 TX 1.5 1 0.5 M 6/12/2009 Right and left arm red and swollen.
349745 6/22/2009 FL 7 7 F 6/19/2009 Pt was checking out after check-up
349746 6/22/2009 CO 1 1 0F Developed rash c/w very mild VARI
349747 6/22/2009 ND 5 5 M 6/22/2009 3rd varicella given, supposed to be
349748 6/22/2009 AR 5 5 F 6/22/2009 9 1/2 x 7cm red area (L) Thigh. DTa
349749 6/22/2009 WI 78 78 M 6/17/2009 Left deltoid redness/swelling, fatigue
349750 6/22/2009 IL 43 43 M 6/18/2009 Donor reported a rash that develope
349751 6/22/2009 CA 15 15 F 6/19/2009 Given vaccine 6/3/09. Fever 101 de
349752 6/22/2009 NH 0.3 0 0.3 F 6/12/2009 Pain/redness starting 6/11/2009. R
349697 6/23/2009 32 32 F 6/23/2009 I took Gardasil 1st dose on Aug 23,
349791 6/23/2009 OH F 6/18/2009 Initial report was received 10 June 2
349793 6/23/2009 OH M 6/18/2009 Initial report was received 10 June 2
349821 6/23/2009 NY 0.2 0 0.2 M 6/21/2009 - Fever of 103 degrees - diarrhea - l
349822 6/23/2009 AR 63 63 M 6/2/2009 112408 - Pt c/o pain in feet; 112508
349823 6/23/2009 CO 60 60 F 5/28/2009 Patient received ZOSTAVAX vaccin
349824 6/23/2009 NE 5 5 M 6/17/2009 R-Deltoid (Dtap) whole arm swollen
349826 6/23/2009 WA 4 4 F 6/17/2009 Localized urticarial lesion w/o any s
349827 6/23/2009 MO 53 53 F 6/19/2009 Swollen, reddened, feverish knot wi
349828 6/23/2009 IN 67 67 F 6/19/2009 Vaccine administered 6/17. Arm turn
349829 6/23/2009 WA 9 8 F 6/5/2009 Vaccine given to early per manufac
349830 6/23/2009 NE 44 44 F 6/15/2009 Received TDAP on 6/9/09 noticed h
349831 6/23/2009 AZ 4 4 F 6/17/2009 Left shoulder swelling.
349832 6/23/2009 NY 4 4 M 6/17/2009 Left arm red and swollen.
349833 6/23/2009 FL 11 11 M 6/10/2009 (R) deltoid swollen, warm, red and h
349834 6/23/2009 NY 4 4 M 5/4/2009 5/4/09- Pt c/o L upper arm redness
349835 6/23/2009 NJ 4 4 M 6/23/2009 SEEN IN OUR OFFICE FOR 4 YEA
349836 6/23/2009 MI 46 46 M 6/23/2009 The patient is a 46-year-old man wh
349837 6/23/2009 FL 1.4 1 0.4 M 6/23/2009 Seizure 9 days after receiving MMR
349838 6/23/2009 TX 86 86 F 6/23/2009 Patient received the shingles vaccin
349839 6/23/2009 MO 0.2 0 0.2 F 6/23/2009 Child's mother reports 3 to 4 hours a
349840 6/23/2009 VT 19 19 F 6/23/2009 pt's mother called pt complained of
349841 6/23/2009 TX 9 9 F 6/23/2009 Called in by Father, stated school n
349842 6/23/2009 CA 60 60 M 6/23/2009 Received a Shingles vaccination at
349843 6/23/2009 FL 12 12 M 6/23/2009 Pt had the vaccine around 9:00 am,
349844 6/23/2009 FL 0.2 0 0.2 F 6/23/2009 Inconsolable crying, would not nurs
349845 6/23/2009 VA 18 18 F 6/23/2009 She had tdap immunization yesterd
349846 6/23/2009 NY 5 5 M 6/23/2009 COMPLAIN OF REDNESS, WARM
349847 6/23/2009 NH 0 0 0F 6/23/2009 UNKNOWNY6/29/09-autopsy report
349848 6/23/2009 IL 0.2 0 0.2 M 6/23/2009 Client developed a few small, raised
349849 6/23/2009 FL 0.9 0 0.8 M 6/23/2009 Per Mother and Grandmother after
349850 6/23/2009 CO 65 65 M 6/23/2009 Sudden Hearing Loss and balance
349851 6/23/2009 CO 23 23 M 6/23/2009 12 Jun 09/1:32pm-Anthrax vax rec'd
349852 6/23/2009 VA 0.2 0 0.2 M 6/23/2009 high grade fever, polymorphous ras
349853 6/23/2009 MA 18 18 F 6/23/2009 Swelling of both ankles, purple/red c
349854 6/23/2009 TX 49 49 F 6/23/2009 I attributed the initial left bicep musc
349857 6/23/2009 PA 65 65 M 6/23/2009 Patient had a headache shortly afte
349858 6/23/2009 MS 38 38 M 6/23/2009 Member complains of "severe itchin
349860 6/23/2009 MS 22 22 M Member complains of "severe itchin
349861 6/23/2009 MS 39 39 M 6/23/2009 Member complains of "severe" itchin
349862 6/23/2009 MS 22 22 M 6/23/2009 Member complains of "serve itching
349863 6/23/2009 MS 23 23 F 6/23/2009 Member complains of "severe itchin
349868 6/23/2009 AZ 11 11 M 6/23/2009 6/23/09 0935 Upon rising client stat
349871 6/23/2009 CA 54 54 F 6/23/2009 Pt returned c/o pain + swelling (LD)
349873 6/23/2009 CA 22 22 F 6/22/2009 Seizure 3 hours post administration
349874 6/23/2009 TX 18 18 M 6/23/2009 Expired lot- MENACTRA
349875 6/23/2009 TX 11 11 F 6/23/2009 Expired Lot- MENACTRA
349877 6/23/2009 22 22 M 6/23/2009 Received the typhoid vaccine on 26
349878 6/23/2009 TX U Expired Lot-MENACTRA
349879 6/23/2009 NJ 18 18 M 6/23/2009 Patient was shaking violently for les
349880 6/23/2009 NC 1.3 1 0.3 F 6/12/2009 Approximately equal to 2 hours afte
349881 6/23/2009 CA F 6/23/2009 Pt had 2 doses of varicella on 2-17-
349882 6/23/2009 VA 39 39 U 6/23/2009 The pt states that after the receipt o
349883 6/23/2009 SC 8 8 F 6/19/2009 Significant induration, redness, tend
349884 6/23/2009 TX F 6/18/2009 Received vaccinations 6/8/2009, de
349885 6/23/2009 NE 18 18 F 6/23/2009 Adacel given at the site of redness a
349886 6/23/2009 VA 50 F 6/19/2009 Arm where she received Tdap is red
349887 6/23/2009 NC 81 81 F 6/23/2009 Patient reports an itching bump at s
349888 6/23/2009 TX 11 11 M 6/23/2009 Fri Jun 19, 2009 12:04 PM After pt
349889 6/23/2009 NC 19 19 F 6/15/2009 As per mother, patient c/o headache
349890 6/23/2009 TX 0.6 0 0.6 M 6/22/2009 Inadvertently gave PEDIARIX at sam
349891 6/23/2009 TX 0.4 0 0.4 F 6/22/2009 PEDIARIX given inadvertently @ sa
349892 6/23/2009 KY 35 35 M Minor + progressive body aches. T
349893 6/23/2009 CA 4 4 M 6/18/2009 Significant swelling involving the wh
349894 6/23/2009 VA 20 20 M 6/23/2009 Fever, headaches - Given medicatio
349895 6/23/2009 NC 19 19 F 6/22/2009 Syncopal episode after MMR vaccin
349896 6/23/2009 OK 11 11 M 4/3/2009 1 day of local erythema of skin appr
349897 6/23/2009 TX 12 11 F 6/23/2009 R arm swelling from elbow to neck.
349898 6/23/2009 IL 0.4 0 0.4 F 6/22/2009 4 mo shot, given & explanation of p
349899 6/23/2009 NJ 63 63 F 6/12/2009 R arm rash ~ 2" diameter with corre
349900 6/23/2009 MI 17 17 F 6/23/2009 The day following vaccine pt - had s
349902 6/23/2009 IL 9 9 F 6/17/2009 Right arm, deltoid region : 4x6 cm in
349903 6/23/2009 IL 1.6 1 0.6 F 6/18/2009 Client woke up screaming @ 2am. P
349904 6/23/2009 CA 0.6 0 0.6 F 6/18/2009 3 to 5 minutes after intramuscular; in
349905 6/23/2009 NY 1 1 0F 6/18/2009 Patient received VARIVAX 5/21/09
349906 6/23/2009 CA 0.2 0 0.2 F 6/23/2009 Urticaria seconds after vaccines giv
349907 6/23/2009 CA 9 9 F 6/17/2009 Erythematous circular area around s
349987 6/23/2009 WI 32 32 F 5/21/2009 Reddened lump at injection site.
350304 6/23/2009 TX 1.3 1 0.3 M 6/26/2009 Scattered macular rash trunk, limbs
349855 6/24/2009 VA 20 20 M 6/23/2009 Injection site pain after 20 mins. 2 w
349856 6/24/2009 TX 4 1 0M 6/24/2009 My son have two knot very swollen
349966 6/24/2009 IL 14 F 6/22/2009 This case was received from a phys
349988 6/24/2009 SC 50 50 M 6/22/2009 Pt states he felt sinus congruent wit
349989 6/24/2009 PA 14 14 F ### Shakiness legs + arms heaviness a
349990 6/24/2009 LA 4 4 M 6/12/2009 Swelling to injection site 3x3 round
350006 6/24/2009 GA 14 14 F 6/24/2009 Client became pale and lightheaded
350007 6/24/2009 IN 12 12 M 6/24/2009 Redness, warmth and swelling at ad
350008 6/24/2009 GA 39 39 F 6/24/2009 Vaccinated with ACAM 2000 (lot VV
350009 6/24/2009 NE 0.5 0 0.5 M 6/24/2009 Patient screamed inconsolably for 3
350010 6/24/2009 OR 0.3 0 0.2 F 6/24/2009 The patient inadvertantly received a
350011 6/24/2009 TN 0.2 0 0.2 M 6/24/2009 Patient received 4 immunizations in
350012 6/24/2009 PA 1.1 1 0.1 F 6/24/2009 pt was given 1st varicella on 06/12/2
350013 6/24/2009 NY 51 51 M 6/24/2009 Patient received Rabies Post Expos
350014 6/24/2009 MA 27 27 F 6/24/2009 swollen right parotid gland without f
350015 6/24/2009 WI 59 59 F 6/24/2009 2nd day after administration of zosta
350016 6/24/2009 CA 4 4 M 6/24/2009 Left arm redness and swelling appro
350017 6/24/2009 VT 23 23 F 6/24/2009 Right after i recieved the vaccination
350018 6/24/2009 OK 1.3 0 0.2 M 6/24/2009 The evening of immunizations he th
350019 6/24/2009 NC 65 65 F 6/24/2009 Itching at site the day after immuniz
350020 6/24/2009 NC 5 5 M 6/24/2009 Received immunizations on 06.16.0
350021 6/24/2009 TX 12 12 F 6/24/2009 Mom stated Pt developed hearing lo
350022 6/24/2009 TX 34 34 M 6/24/2009 On 6/16/2009 center was notified by
350023 6/24/2009 PA 19 19 F 6/24/2009 Pt. received Tdap and then GARDA
350025 6/24/2009 VI 1.2 1 0.2 F 6/22/2009 Mother states "bumpy rash" to both
350026 6/24/2009 WA 28 28 F 6/24/2009 28 y/o female who presented as wa
350027 6/24/2009 AZ 11 11 M 6/24/2009 Mild fever. Soreness at site (L arm).
350029 6/24/2009 KY 1.3 1 0.3 F 6/24/2009 6/19/09 at 3PM increased fussiness
350030 6/24/2009 FL 0.5 0 0.5 M 6/24/2009 Mom reports that approximately 7 h
350031 6/24/2009 CA 11 11 F 6/22/2009 Pt came in upper arm swelling, warm
350032 6/24/2009 MA 65 65 F 6/24/2009 Pt given PNEUMOVAX (L) deltoid 6
350033 6/24/2009 TX 1.4 1 0.4 M 6/24/2009 Urticaria rash involving mainly the a
350034 6/24/2009 WI 38 38 F 6/22/2009 11:45 am: RN at Dr's office called s
350037 6/24/2009 MA 38 38 F 6/22/2009 Hot, reddened skin from elbow to sh
350038 6/24/2009 MN 26 26 M 6/24/2009 Pt. reported "low grade fever" the ev
350039 6/24/2009 CA 8 8 F 6/24/2009 R arm warmth eryth and 1 vesicle ju
350040 6/24/2009 ME 62 62 F 6/24/2009 Late evening of day she received va
350041 6/24/2009 ME 53 53 F 6/24/2009 Received vaccine at 830 AM and by
350042 6/24/2009 NY 68 68 F 6/24/2009 Pt. with erythematous plaque to L d
350043 6/24/2009 CA 76 76 F 6/24/2009 6-11-09 approx 2 pm ZOSTAVAX g
350092 6/25/2009 NC 23 23 F 6/24/2009 Information has been received throu
350104 6/25/2009 PA 19 19 M 6/20/2009 Pt had stroke-like symptoms such a
350106 6/25/2009 PA 26 26 M 6/20/2009 Pt was given a flu shot on Monday.
350107 6/25/2009 NY 21 21 F 6/16/2009 Received PNEUMOVAX 0.5 ml IM 6
350108 6/25/2009 NJ 14 14 F 6/19/2009 Pt came to hospital for routine medi
350109 6/25/2009 MN 65 65 F 6/11/2009 ADACEL given in high left shoulder
350110 6/25/2009 MA 1.1 1 0.1 F 6/22/2009 6/21 fussy, cranky, clingy, sl. decrea
350111 6/25/2009 PA 39 39 F 6/18/2009 redness, swelling, warm to touch at
350112 6/25/2009 MD 14 14 F 6/22/2009 45 to 60 seconds after injection, pat
350113 6/25/2009 MD 4 4 F 6/22/2009 L thigh with erythema, swelling, war
350114 6/25/2009 IL 4 4 F 5/12/2009 Swelling and redness, tenderness in
350115 6/25/2009 AR 12 12 F 6/2/2009 Mother and patient reports that patie
350117 6/25/2009 CO 5 5 M 6/20/2009 Had bilat. leg pain and refusal to wa
350118 6/25/2009 AL 29 29 F 6/19/2009 Tired, weakness, SOB on exertion (
350119 6/25/2009 MO 1.3 1 0.3 M 5/27/2009 Mom called on 5-27 and stated child
350120 6/25/2009 OR 14 14 M 6/16/2009 T 00:30 on 6-10-09 c/o headache th
350121 6/25/2009 16 16 F 6/19/2009 pt sits on exam table - gave MENAC
350122 6/25/2009 57 F 6/21/2009 I received the shingles vaccine hopi
350123 6/25/2009 TX 12 12 M 6/25/2009 None Stated
350124 6/25/2009 TX 14 14 F 6/25/2009 None stated.
350125 6/25/2009 TX 11 11 M 6/25/2009 None given
350126 6/25/2009 TN 14 14 F 6/25/2009 Patient presented with Bell's Palsy o
350127 6/25/2009 MD 37 37 F 6/25/2009 Pt Rcd Pneumococcal vaccine in th
350128 6/25/2009 TX 17 17 F 6/25/2009 None Stated
350129 6/25/2009 TX 5 5 M 6/25/2009 None stated.
350131 6/25/2009 NY 12 12 M 6/22/2009 Patient had temp 100.3, unable to w
350132 6/25/2009 NH 0.1 0 0.1 F 6/25/2009 None known. Y 7/2/09 Medical Exami
350133 6/25/2009 OR 49 49 F 6/25/2009 Lump at injection site, feels tender a
350134 6/25/2009 MA 22 22 F 6/25/2009 6/19/09 patient felt some pain in her
350135 6/25/2009 VA 25 25 F 6/25/2009 On June 3, 2009, client returned to
350136 6/25/2009 TX 11 11 F 6/25/2009 SWOLLEN RED PATCH ON RIGHT
350137 6/25/2009 IA 61 61 M 6/25/2009 Patient is a 61 year old MALE who p
350138 6/25/2009 OH 21 21 F 6/25/2009 6/15/09 Fever of 102, vomiting, and
350139 6/25/2009 MI 15 15 F 6/25/2009 Patient given VFC DTAP. No adver
350140 6/25/2009 TX 24 24 F 6/25/2009 Employee recieved 4 vaccines, Hep
350141 6/25/2009 IN 0.2 0 0.2 F 6/25/2009 Administered 2 doses of hepatitis B
350142 6/25/2009 CA 22 22 F 6/25/2009 Patient received Hep A and Tdap va
350145 6/25/2009 50 50 M 6/29/2009 Immediate myalgias after injection.
350146 6/25/2009 NY 0.1 0 0.1 F 6/25/2009 All vaccines listed given at 29 days
350150 6/25/2009 IL 4 4 F 6/25/2009 Received KINRIX on 6.22.09. Per m
350152 6/25/2009 PA 20 11 F 6/24/2009 Mother called @ 10 am 6/24/09 to s
350153 6/25/2009 FL 17 17 F 6/23/2009 Pt had a vasovagal reaction abut 5
350156 6/25/2009 11 11 F 6/25/2009 Cellulitis to R arm.
350157 6/25/2009 MA 0.2 0 0.2 F 6/25/2009 Fussy baby T-99. Red, swollen at si
350158 6/25/2009 AL 5 5 M 5/11/2009 Patient would present himself off &
350159 6/25/2009 AZ 0.5 0 0.5 M 6/19/2009 Swelling of right thigh and bruising.
350160 6/25/2009 ME 21 21 M 6/11/2009 Itching, redness, heat, tender, firm a
350161 6/25/2009 NH 6 M 6/19/2009 Extensive macular rash started 2 da
350162 6/25/2009 IA 0.6 0 0.6 M 6/18/2009 progressive decreased motor skills
350163 6/25/2009 WA 19 19 F 6/25/2009 VHC re-contacted by pt mid-Jun 200
350164 6/25/2009 NY 7 7 M 6/22/2009 One day after administration of vacc
350165 6/25/2009 OR 63 63 M 6/15/2009 Evening of injection: Chills, Nausea
350166 6/25/2009 TX 3 3 M 6/25/2009 None stated.
350167 6/25/2009 TX 2 2 0.1 M 6/25/2009 None stated.
350168 6/25/2009 TX 3 3 F 6/25/2009 None stated
350169 6/25/2009 AZ 1 1 0F 6/25/2009 Red papular rash at injection site - (
350170 6/25/2009 NY 4 4 M 6/25/2009 Developed AM of 6/25/09 L upper a
350837 6/25/2009 M 6/19/2009 Report received from a physician on
350841 6/25/2009 IL 59 59 F 6/22/2009 Migraine. Migraine with loss of centr
350842 6/25/2009 MT 80 M 6/22/2009 Report received from a nurse on 03
350843 6/25/2009 WA U 6/22/2009 Report received from a paramedic/f
350847 6/25/2009 79 79 F 6/22/2009 Injection site pain lasting 3 months
350241 6/26/2009 MI 1 1 0F 6/25/2009 Follow-up information received from
350245 6/26/2009 TN 1 1 0M 6/19/2009 Vaccines given MMR and Varicella.
350246 6/26/2009 OR 0.2 0 0.2 M 6/22/2009 Extreme crying baby in severe pain-
350247 6/26/2009 VA 14 14 F 6/22/2009 Mother came to health dept today a
350248 6/26/2009 MI 1.4 1 0.4 F 6/25/2009 None stated
350249 6/26/2009 TN 0.5 0 0.5 M 5/19/2009 Mo states child spiked temp of 101.
350250 6/26/2009 PA 0.2 0 0.2 F 4/1/2009 Symptom: Bright red blood in stool -
350251 6/26/2009 GA 17 17 M 6/18/2009 Tongue and throat swelling, chest p
350252 6/26/2009 WI 0.5 M Hives- Diphenhydramine
350253 6/26/2009 MD 1.5 1 0.5 M 6/24/2009 5/26/09 Fever, went to ED -> Dx wit
350254 6/26/2009 ME 66 66 F 5/21/2009 Developed elbow and knee burning
350255 6/26/2009 RI 49 49 F 6/22/2009 Persistent pain in left arm after rece
350256 6/26/2009 LA 57 57 M 6/17/2009 6/17/09 Dr reported to me that 3 da
350257 6/26/2009 MD 4 4 F 6/24/2009 Fever, runny nose, coughing Dx 6/1
350258 6/26/2009 OR 0.2 0 0.2 F 6/22/2009 Extremely fussy, screaming, incons
350259 6/26/2009 AZ 11 11 F 6/19/2009 Erythema @ injection site
350260 6/26/2009 AZ 15 15 F 6/23/2009 Immediately after varicella vaccine,
350261 6/26/2009 FL F 6/24/2009 Post immunization client developed
350264 6/26/2009 OR 71 71 U 6-11-09 After shot, arm swell up, tur
350265 6/26/2009 DC 27 27 F On 6/1/09, pt. called & left a messag
350266 6/26/2009 GA 0.3 0 0.3 F 6/26/2009 Fever started about 6 to 8 hours aft
350267 6/26/2009 IA 59 59 U 6/26/2009 Achey on 6-3-09. Severe pain in arm
350268 6/26/2009 PA 20 20 M 6/26/2009 Patient had symptoms of dizziness
350269 6/26/2009 PA 20 20 M 6/26/2009 About eight hours after vaccine adm
350270 6/26/2009 WI 24 24 F 6/26/2009 Developed nausea and vomiting, in
350271 6/26/2009 AZ 25 25 F 6/26/2009 Patient presents to clinic at approxim
350272 6/26/2009 IL 5 5 M 6/26/2009 Client was given a Dtap/Polio IM inj
350273 6/26/2009 TX 4 4 M 6/26/2009 PATIENT HAD KINRIX ON 06-23-2
350274 6/26/2009 PA 63 63 F 6/26/2009 itchy red welt, larger then usual
350275 6/26/2009 OK 2 2 0.1 M 6/26/2009 Large area of erythema with a sligh
350276 6/26/2009 NV 4 4 M 6/26/2009 red, blotchy, hard, swollen around th
350277 6/26/2009 MO 72 F 6/26/2009 red, raised swollen area approx 4x4
350278 6/26/2009 NC 0.2 0 0.2 M 6/26/2009 Several hours after receiving Oral R
350279 6/26/2009 OR 61 61 F 6/26/2009 A couple hours after the vaccination
350280 6/26/2009 VA 64 64 F 6/26/2009 Her arm was swollen all the way do
350281 6/26/2009 MN 32 32 F 6/26/2009 Expired vaccine administered inadv
350282 6/26/2009 MN 1.1 1 0.1 M 6/26/2009 Expired vaccine administered inadv
350283 6/26/2009 WI 13 13 F 6/26/2009 Patient received Menactra and variv
350284 6/26/2009 CA 13 13 F 6/26/2009 Immediately following vaccine, patie
350297 6/26/2009 MO 19 19 M 6/28/2009 Pt given TWINRIX 1ml, Tdap 0.5 ml
350298 6/26/2009 IA 37 37 F 6/26/2009 Patient was given an MMR by agen
350299 6/26/2009 OK U Temp 102 sweats, dizziness.
350300 6/26/2009 ME 1.3 1 0.3 U Diffuse urticaria that started about 1
350301 6/26/2009 CA 4 F 6/25/2009 Arm swelling - 1 1/2 cm circumferen
350302 6/26/2009 CA 1.2 1 0.2 F 6/26/2009 Per mother of child: See attachmen
350303 6/26/2009 MA 5 5 F 6/26/2009 DTaP given 6/24/09. 6/26/09 woke
350305 6/26/2009 NJ 16 16 F 6/26/2009 30 minutes after receiving GARDAS
350306 6/26/2009 CA 1 0 1F 6/25/2009 After few minutes of MMR + Varicel
350307 6/26/2009 UT 0.2 0 0.2 M 6/26/2009 Child with 3hr prolonged crying epis
350308 6/26/2009 CO M 6/26/2009 Received imms. 6/9/09. On 6/10/09
350309 6/26/2009 PA 11 11 F 6/26/2009 R arm red with warmth ~ 6-7 cm dia
350285 6/27/2009 MI 66 66 M 6/27/2009 On March 24,2009 received injectio
350286 6/28/2009 GA 2 2 0.1 M 6/28/2009 fussy, loss of appetite, fever as high
350288 6/28/2009 PA 68 68 M 6/28/2009 severe asthma attack, no fever, sinu
350289 6/28/2009 RI 1.1 1 0.1 F 6/28/2009 PATIENT STARTED WITH A FEVE
350351 6/29/2009 NY 72 72 F 6/22/2009 Patient experienced two episodes o
350352 6/29/2009 IL 13 13 F 6/29/2009 For 2 days, pt experience moderate
350353 6/29/2009 MI 74 74 M 6/29/2009 Pt contacted Merck first to report ad
350354 6/29/2009 GA 15 15 F 6/29/2009 Chronic Hives...They were first notic
350355 6/29/2009 MA 36 36 F 6/29/2009 Next day, pt called to report GI sxs:
350356 6/29/2009 MI 0.3 0 0.3 M 6/29/2009 TEMP 99.7 TO 100.8 FOR 2 DAYS
350357 6/29/2009 TX F 6/29/2009 right arm started getting red over 24
350358 6/29/2009 MD 1.1 1 0.1 F 6/29/2009 rash at injection site, R leg "hundred
350359 6/29/2009 MA 21 21 F 6/29/2009 First event 4 days after vaccine (2nd
350360 6/29/2009 CA 4 4 F 6/29/2009 Received DTaP, MMR, IPV, Varivax
350361 6/29/2009 PA 17 17 F 6/29/2009 Patiet received Menactra, Gardisil, A
350362 6/29/2009 TX 64 64 F 6/29/2009 ON 6/27/2009 CLIENT NOTICED T
350363 6/29/2009 MO 45 45 F 6/29/2009 Severe aches in joints, especially in
350364 6/29/2009 OH 0.9 0 1M 6/29/2009 Uncontrollable crying, arching back
350365 6/29/2009 NY 23 23 F 6/29/2009 Client stated that she developed hiv
350366 6/29/2009 AZ 1 0 0M 6/29/2009 RED ITCHY BUMPS ON BADY NO
350367 6/29/2009 CA 63 63 F 6/29/2009 Patient received Zostavax vaccine o
350372 6/29/2009 WA 43 43 F 2 days after vaccination temp. - sore
350374 6/29/2009 WA 62 62 F 6/22/2009 05-27-09 Right hand swollen, numb
350382 6/29/2009 CA 5 5 M 6/24/2009 Reported by mother: 5/8 Right arm
350388 6/29/2009 U 6/30/2009 We received the following literature
350389 6/29/2009 CO 17 17 M 6/23/2009 After taking 2 doses of VIVOTIF, de
350390 6/29/2009 IN 10 10 F 6/26/2009 Client immediately suffered syncope
350391 6/29/2009 NE 0.6 0 0.6 M 6/15/2009 1st set (PENTACEL, HVB, PCV7, R
350395 6/29/2009 LA 12 12 M 6/9/2009 Approx. 5 minutes after receiving va
350400 6/29/2009 LA 32 32 M 6/4/2009 Pt reported swollen lymph nodes to
350402 6/29/2009 MA 65 65 M 6/18/2009 Pt experienced arm pain and should
350405 6/29/2009 PR U Headaches, irritation, lack of sweat
350409 6/29/2009 AZ 21 21 M 6/8/2009 Fevers, rash/pustules, RX with NSA
350411 6/29/2009 SD 1.8 1 0.8 M 6/23/2009 Tdap given instead of DTaP, no rea
350412 6/29/2009 PA 0.4 0 0.4 M 6/29/2009 Sudden Death.
Y 8/12/09 Autopsy re
350413 6/29/2009 68 F 6/1/2009 Erythema, swelling, tenderness (all
350414 6/29/2009 CA 19 19 F 6/29/2009 Pt c/o headache, the began c/o sen
350415 6/29/2009 SC 18 18 F 6/25/2009 Severe HA, myalgias, back pain, LE
350416 6/29/2009 IL 19 F 6/26/2009 Fainted about 2 - 3min after receivin
350417 6/29/2009 ID 14 14 M 6/25/2009 Child was accidently given PCV-7 in
350418 6/29/2009 CA 4 4 F 6/25/2009 Left arm with 4/3" reddened area. W
350419 6/29/2009 IN 0.2 0 0.2 F 6/29/2009 Diarrhea since day after vaccine up
350420 6/29/2009 CO 14 14 F 6/29/2009 Pt was given dose of TDAP, MENAC
350421 6/29/2009 CO 12 12 M 6/29/2009 Pt was given 2 doses of TDAP and
350422 6/29/2009 25 25 M 6/29/2009 Consultation with the Vaccine Healt
350423 6/29/2009 NJ 17 17 F 4/9/2009 Hives seen @ ER 3/6/09
350424 6/29/2009 MN 18 18 M 6/24/2009 Spiked temp > 103 degrees F @ 2A
350425 6/29/2009 ND 49 49 F 6/26/2009 Redness & swelling size - began 50
350426 6/29/2009 AZ 21 21 F 6/28/2009 Severe abdominal cramping & pain
350427 6/29/2009 CA 60 60 F Injection site swollen, red, itchy - Pt
350428 6/29/2009 WI 15 15 M 6/2/2009 Redness, swelling localized to injec
350429 6/29/2009 NV 1.3 1 0.3 M 6/29/2009 Father of pt called office 6/25/09 sts
350430 6/29/2009 CA 43 43 F 6/29/2009 06/29/09 Pt came in today c/o redn
350431 6/29/2009 CA 32 32 F 6/16/2009 See attached notes.
350432 6/29/2009 OH 80 80 F Edema, redness of entire circumfere
350433 6/29/2009 CA 72 72 M 6/23/2009 L Deltoid persistent pain and mild te
350434 6/29/2009 WA 1 1 0M 6/22/2009 Patient developed 10 vesicular rash
350436 6/29/2009 54 F 6/22/2009 Redness, swelling, and a hard lump
350459 6/30/2009 GA 0.5 0 0.5 F 6/26/2009 This case was received from a heal
350460 6/30/2009 IL 17 17 F 6/26/2009 Initial report received 19 June 2009
350461 6/30/2009 CA 11 U 6/25/2009 This case was retrieved from a new
350464 6/30/2009 PA 33 33 M 6/24/2009 Pt. developed onset of paresthesias
350465 6/30/2009 IL 11 11 M 6/25/2009 Pt was seen for annual physical 5/1
350466 6/30/2009 MI 1 1 0M 6/24/2009 1 yr old w/ h/o recurrent cough w/ w
350467 6/30/2009 NY 4 4 M 6/25/2009 1. 6/15/09 called arm red & swollen
350468 6/30/2009 CT 4 4 F 6/26/2009 C/o cellulitis of the left arm at the sit
350469 6/30/2009 VA 38 38 F 6/26/2009 Pt received vaccine on 06/18/2009,
350470 6/30/2009 0.5 0 0.5 M 6/24/2007 Low grade fever w/ knot in left thigh
350471 6/30/2009 PA 15 15 F 6/23/2009 (LT) upper arm weak & numb x 6 da
350472 6/30/2009 KY 16 16 F 6/23/2009 PNEUMOVAX given @ 0900 on 6/2
350473 6/30/2009 TN 52 52 F 6/24/2009 6/11/09 - Vaccine given. 6/12/ - 6/1
350474 6/30/2009 OR 1 1 0M 6/21/2009 Approximately 24 hours after vaccin
350475 6/30/2009 OR 15 15 M 6/22/2009 Unwitnessed syncope vs possible s
350486 6/30/2009 PA 10 10 F 6/29/2009 Generalized red papular rash every
350488 6/30/2009 LA 0.5 0 0.5 M Hematoma to right thigh. Size smal
350490 6/30/2009 MI 82 82 F 5- 27 - 28 - Hot flush - 5-28 - red rai
350492 6/30/2009 CO 6 6 F 6/24/2009 Developed 20cm X 25cm area of re
350495 6/30/2009 CO 5 5 F 6/24/2009 Developed 105 cm x 70 cm area of
350497 6/30/2009 MO 56 56 F 6/24/2009 Tdap given Lt deltoid 6/20/09 - no p
350498 6/30/2009 NC 10 10 F 6/24/2009 Pt given adacel - recommended for
350499 6/30/2009 VA 75 75 M 6/25/2009 Redness in area of injection site. La
350500 6/30/2009 VA 18 18 M 6/12/2009 FLUVIRIN was in box labeled PPD
350501 6/30/2009 OK 18 M 6/23/2009 About 1 hr after immunization (10:3
350502 6/30/2009 CA 54 54 F 6/23/2009 Pt returned c/o pain and swelling (L
350503 6/30/2009 OH 14 14 F 6/24/2009 On 6-23-09 received Hep A and MC
350504 6/30/2009 CO 52 52 F 6/25/2009 Area of Lt arm, red tender and hot.
350505 6/30/2009 CA 4 F 5/24/2009 Swollen arm, redness, hardness pa
350506 6/30/2009 MA 0.6 0 0.6 F 6/25/2009 Mom reported fever 103 + irritability
350507 6/30/2009 NY 4 4 M 6/24/2009 Significant local reaction on L arm, r
350508 6/30/2009 PA 5 5 F 6/25/2009 Red rash local to inject - fussy and f
350509 6/30/2009 PR 46 46 M 6/24/2009 Hand pain, joint pain, diarrhea, high
350510 6/30/2009 CO 77 77 F 6/25/2009 Redness, tender, sore, red, warm to
350511 6/30/2009 WI 43 43 F 6/25/2009 2 inch lump, itching, hot to the touch
350512 6/30/2009 21 21 M 6/18/2009 Right shoulder pain for a couple of w
350513 6/30/2009 WA 22 22 F 6/29/2009 Pt. turned white and became sick/fe
350514 6/30/2009 TX 16 16 M 6/30/2009 Headache, nausea, fatigue
350515 6/30/2009 AR 4 4 M 6/25/2009 Significant local reaction. - *see atta
350522 6/30/2009 NY M 6/30/2009 This case was reported by a physici
350543 6/30/2009 CA 14 14 F 6/28/2009 Faints - blacks out - low blood press
350544 6/30/2009 MI 0.5 0 0.5 M 6/30/2009 No reaction
350545 6/30/2009 MI 1.5 1 0.5 M 6/30/2009 Pt came in w/ rash all over body on
350547 6/30/2009 KS 2 2 0.4 F 6/30/2009 Pain in left leg, high fever, refused t
350548 6/30/2009 MD 14 14 M 6/30/2009 starting having bloody noses at app
350550 6/30/2009 OK 12 12 F 6/30/2009 Pt left clinic with mom approx 5 min
350551 6/30/2009 TN 20 20 F 6/30/2009 Pt called office to report approx 12 h
350552 6/30/2009 TN 51 51 M 6/30/2009 Vaccine administered 6-22-09, 2nd
350553 6/30/2009 OR 19 F 6/30/2009 Erythema, edema, hives, lymphade
350554 6/30/2009 PA 1 1 0M 6/30/2009 pt with c/o rash onset 6/28/2009 and
350555 6/30/2009 MI 14 14 F 6/30/2009 fainted immediatley with slight jerkin
350556 6/30/2009 TX 27 27 M 6/30/2009 Pt received vaccines ~ 1230 pm. Pt
350557 6/30/2009 NC 49 49 F 6/30/2009 Patient states that Right arm becam
350558 6/30/2009 IN 11 11 M 6/30/2009 Patient passed out in the hallway ab
350559 6/30/2009 CO 63 63 F 6/30/2009 The patient experienced hives 1 we
350560 6/30/2009 TN 0.6 0 0.6 M 6/30/2009 Patient received Rotateq 6-12-09, o
350561 6/30/2009 NJ 1 1 0M 6/30/2009 Temperature elevation 104 degrees
350562 6/30/2009 TX 18 18 M 6/30/2009 No adverse reaction noted. Verified
350563 6/30/2009 IL 11 11 F 6/30/2009 Shot was administered around 4:15
350564 6/30/2009 HI 16 16 F 6/30/2009 Pt c/o "dizziness", stomach pain wit
350565 6/30/2009 WA 13 13 F 6/30/2009 Inability to close right eye, facial num
350566 6/30/2009 NY 14 14 F 6/30/2009 Patient received Varivax, Gardasil, a
350567 6/30/2009 MO 0.2 0 0.2 M 6/30/2009 Rotateq given on 6-18-09 & patient
350568 6/30/2009 UT 5 5 F 6/30/2009 Patient had swelling of the eye's, lip
350569 6/30/2009 LA 3 3 M 6/30/2009 My son received two vaccinations, H
350570 6/30/2009 NV 4 4 M 6/30/2009 Child was evaluated on 6/30/09 and
350571 6/30/2009 NY 11 11 M 6/30/2009 Matthew developed bright red macu
350572 6/30/2009 WA 66 66 M 6/30/2009 About 2 hours after vaccine adminis
350573 6/30/2009 VT 2 2 0.3 M 6/30/2009 High fever,lethargic,shakes,chills,no
350574 6/30/2009 NJ 15 15 M 6/30/2009 chest pain, myocarditis treated with
350576 6/30/2009 CA 20 20 M 6/30/2009 Pt was in excellent health prior to se
350577 6/30/2009 IA 4 4 F 6/26/2009 24 hrs after shot 2 areas of large bli
350578 6/30/2009 KY 49 49 F 6/30/2009 Swelling and redness of right arm.
350579 6/30/2009 VA 19 19 M 6/30/2009 Corneal abrasion/ shield ulcer follow
350580 6/30/2009 CO 4 4 F 6/29/2009 About 10 minutes after vaccination
350581 6/30/2009 AL 1 0 1F 6/30/2009 06/25/09 - Started with multiple sma
350582 6/30/2009 CA 59 59 F 6/30/2009 Within a few hours of receiving TDA
350583 6/30/2009 WI 29 29 F 6/30/2009 Hard lump in arm swelling & pain
350720 6/30/2009 MN 5 5 M 6/25/2009 This case was reported by a physici
350575 7/1/2009 WV 18 16 F 7/1/2009 felt very weak/ shakey. Chest was t
350584 7/1/2009 TX 11 11 M 6/24/2009 Wheeze, stridor, cough and shortne
350585 7/1/2009 NC 0.2 0 0.2 M 6/26/2009 6 days following ROTATEQ vaccine
350586 7/1/2009 ND 13 13 F 6/29/2009 Depression, mood swings, change i
350587 7/1/2009 HI 48 48 F 6/24/2009 Swelling, Redness, Soreness 6cm X
350588 7/1/2009 FL 12 12 M 6/27/2009 Fever, chills, cold hands, pain in leg
350602 7/1/2009 NJ F 6/29/2009 Initial report was received 25 June 2
350604 7/1/2009 WA F 6/29/2009 Initial report received 25 June 2009
350625 7/1/2009 MO 2 2 0.1 F 7/1/2009 After patient's Hepatitis A immuniza
350626 7/1/2009 OK 36 36 F 7/1/2009 Patient was given inital dose of Tda
350627 7/1/2009 WV 18 18 M 7/1/2009 Developed syncope immediately fol
350628 7/1/2009 PA 1.3 1 0.3 M 7/1/2009 Varicella vaccine breakthrough. Dia
350629 7/1/2009 OH 52 52 F 7/1/2009 6/12/09 - Pt presented to the emerg
350630 7/1/2009 NV 20 20 F 7/1/2009 Pt stopped breathing and had a car
350631 7/1/2009 MI 53 53 F 7/1/2009 On 06/19/09 pt received Tdap.That
350632 7/1/2009 NC 4 4 F 7/1/2009 06/30/09 MT REPORTS CHILD FEL
350633 7/1/2009 CA 5 5 M 7/1/2009 LOCAL REACTION TO L UPPER A
350634 7/1/2009 OH 0 0 0F 7/1/2009 FIRST DOSE OF HEPATITIS B WA
350635 7/1/2009 DE 11 11 M 7/1/2009 With in 10 min after Varivax vaccine
350636 7/1/2009 IL 25 25 F 7/1/2009 PERSISTENT PAIN IN LEFT DELT
350637 7/1/2009 TX 45 45 F 7/1/2009 Rcvd Varivax on 5/29/09. Reports s
350638 7/1/2009 VA 12 12 M 7/1/2009 Circular area (1 3/4"x1 1/4") of mild
350640 7/1/2009 WA 11 11 F 7/1/2009 After giving last injection (which was
350641 7/1/2009 NC 12 12 F 7/1/2009 4 cm area of swelling/induration aro
350642 7/1/2009 AZ 60 60 F 6/30/2009 Extreme watery diarrhea, nausea, s
350643 7/1/2009 CA 38 38 M 6/16/2009 Visual changes after AVA 1 and 2.
350644 7/1/2009 IL 5 5 F 6/30/2009 Child recd #2 dose of VARICELLA o
350645 7/1/2009 WA 0.5 0 0.5 F 7/1/2009 Received immunizations 6/29/2009
350647 7/1/2009 IL 43 43 M 7/1/2009 Localized skin reaction. Red raised
350648 7/1/2009 OH 13 13 F 6-30-09 4:45 pm pt. c/o tingling in a
350649 7/1/2009 GA 0.2 0 0.2 M 6/26/2009 Hypotensive episode - pallor & unre
350650 7/1/2009 MI 0.5 0 0.5 F 7/1/2009 None
350651 7/1/2009 MN 12 M 7/1/2009 R arm pain, redness and swelling.
350652 7/1/2009 NH 1 1 0F 7/1/2009 Mom reported to -us on 6-30-09 tha
350653 7/1/2009 TX 33 33 F 7/1/2009 It happened around March 12 and t
350654 7/1/2009 TX 0.7 0 0.7 M 6/29/2009 I did not mix the DTaP IPV solution
350639 7/2/2009 GU 12 12 F 7/2/2009 SHE WAS GIVEN GARDASIL 1 ST
350646 7/2/2009 MI 15 15 F 7/1/2009 Pt was also given T-DAP- MENACT
350655 7/2/2009 20 20 F 6/30/2009 I am unsure if the lateral neuropathy
350656 7/2/2009 NM 0.1 0 0.1 F Right deltoid area of redness, heat,
350657 7/2/2009 PA 1 1 0F 6/28/2009 None stated
350658 7/2/2009 VA 77 77 F 6/30/2009 Cluster of blisters on hand. Tender
350659 7/2/2009 OH 4 4 M 6/25/2009 Erythema around site and down me
350660 7/2/2009 IL 14 14 F 6/30/2009 Immediately following immunization
350661 7/2/2009 VA 17 17 F 7/7/2009 Tetanus has been hurting since inje
350662 7/2/2009 SC 16 16 U Vaccines prior to 11:30 AM 7/1/200
350663 7/2/2009 NY 20 20 F 7/12/2009 Dizziness, light headed, fever, naus
350664 7/2/2009 IL 5 5 F 6/29/2009 Red, swollen. Hard lump at injection
350665 7/2/2009 IL 14 14 F 7/2/2009 Developed pain, swelling and decre
350679 7/2/2009 KS 5 5 M 7/2/2009 This case was reported by a healthc
350686 7/2/2009 IL 17 17 M 7/2/2009 4/20/09 Later in the day, respiratory
350687 7/2/2009 GA 0.2 0 0.2 M 7/2/2009 Patient was given Immunizations on
350688 7/2/2009 KY 69 69 M 7/2/2009 I am experiencing itchiness--Thumb
350689 7/2/2009 LA 0.2 0 0.2 F 7/2/2009 Persistent (more than 3 weeks) muc
350690 7/2/2009 WI 4 4 M 7/2/2009 Mother reported temperature of 104
350691 7/2/2009 WI 5 5 M 7/2/2009 Fever began 6-4-09 with small red a
350692 7/2/2009 GA 0.2 0 0.2 M 7/2/2009 Fussy, crying, hard to console, on a
350694 7/2/2009 AK 35 45 F 7/2/2009 Severe pain in upper arm at site of i
350695 7/2/2009 CA 71 71 F 7/2/2009 generalize rash - chicken pox lesion
350705 7/2/2009 VA 64 64 F 7/2/2009 Bump and rash at injection site deve
350706 7/2/2009 PA 20 20 F 7/2/2009 Pt came for Adagio visit, HPV # 3 d
350707 7/2/2009 CA 4 4 M None stated.
350708 7/2/2009 CA 21 21 F 7/2/2009 6/15/09 Pt. to clinic to receive HPV
350710 7/2/2009 NJ 4 4 M 7/2/2009 RA swollen the whole length of the
350711 7/2/2009 33 33 F 7/2/2009 Same day as received last AVA, no
350714 7/2/2009 NH 11 11 M 7/2/2009 (L) arm where he received MENACT
350715 7/2/2009 LA 16 16 F 7/2/2009 TDAP administered, then MCV - 4 g
350716 7/2/2009 MS 4 4 M 7/1/2009 Pt. received vaccines Monday 6/29/
350717 7/2/2009 MI 1.8 1 0.8 M 7/1/2009 Patient had bumps- Red on arm and
350718 7/2/2009 PA 49 49 F 7/1/2009 Erythema, edema, tenderness at inj
350719 7/2/2009 CA 12 12 F 6/25/2009 Swelling & redness left arm @ site o
350696 7/3/2009 OH 10 10 F 7/3/2009 After administration of albuterol neb
350697 7/3/2009 PA 5 5 F 7/3/2009 child recieved dtap on 7\2\2009 was
350698 7/3/2009 PA 2 2 0.2 F 7/3/2009 Approximately 45 minutes after the
350709 7/3/2009 IL 14 14 F 6/19/2009 Pt. received HPV vaccine for 1st tim
350713 7/3/2009 TX 0.5 0 0.5 U Swelling and redness at injection sit
350699 7/4/2009 MN 1 1 0F 7/3/2009 Herpes Zoster involving the left side
350700 7/4/2009 NY 29 29 F 7/4/2009 received tetanus shot and was diag
350701 7/4/2009 PA 0.4 0 0.4 F 7/4/2009 Patient was unusually sleepy the da
350702 7/4/2009 AR 1 1 0F 7/4/2009 Mild rash of varicella
350703 7/5/2009 MD 60 60 M 7/5/2009 My left upper arm, where the injectio
350704 7/5/2009 MD 17 17 F 7/5/2009 The patient received gardisil #1, Td
350774 7/6/2009 DC 17 17 M 7/6/2009 Patient developed fevers about 2-3
350775 7/6/2009 NJ 16 16 M 7/6/2009 SEEN ON 6/30/09 FOR 16 YEAR O
350776 7/6/2009 OH 75 75 F 7/6/2009 Client reports on Sat., July 4, 09, sh
350777 7/6/2009 NY 5 4 M 7/6/2009 redness, diaphoresis, early analphy
350778 7/6/2009 IL 14 14 F 7/6/2009 Fainted after recieving immunization
350779 7/6/2009 MO 14 14 M 6/29/2009 Felt ill day after infection, by 7:00 p.
350780 7/6/2009 IL 14 14 F 7/6/2009 Patient recieved shots, walked out o
350781 7/6/2009 WA 69 69 M 7/6/2009 PATIENT DEVELOPED ATRIAL FL
350782 7/6/2009 OH 52 52 F 7/6/2009 After receiving both vaccines, patien
350783 7/6/2009 CA 5 5 U 7/6/2009 reddness and swelling at injection s
350784 7/6/2009 NE 0.2 0 0.2 M 7/6/2009 Edema at site approx 3 hours post i
350785 7/6/2009 CA 52 52 F 7/6/2009 severe rash developed by 7/1/09. ra
350786 7/6/2009 NC 48 48 F 7/6/2009 PATIENT COMPLAINS OF SWELL
350787 7/6/2009 MI 76 76 M 7/6/2009 Hives Tx 50 mg prednisone x 3 day
350788 7/6/2009 FL 1.3 1 0.3 F 7/6/2009 Temp to 103 degrees started at 6pm
350789 7/6/2009 WA 25 25 M 7/6/2009 Pt presents to the clinic with 3 day h
350790 7/6/2009 NJ 70 70 F 6/25/2009 OV made to inform PHN that approx
350791 7/6/2009 TN 4 4 F 7/1/2009 Redness, warmth, tenderness to lef
350792 7/6/2009 MI 1.4 1 0.4 F 7/6/2009 Wheal and flared urticaria scattered
350793 7/6/2009 KY 14 14 F 6/30/2009 14 yr old fe here today with Aunt (w
350794 7/6/2009 UT 10 10 F 1/6/2009 Arm swelled up after it was given. R
350797 7/6/2009 NC 0 0 0F 6/26/2009 1 X 3 cm area of erythema but no in
350798 7/6/2009 MS 1.8 1 0.8 M 6/29/2009 Mom called office 9:10 am 6/29/09 r
350799 7/6/2009 FL 1.7 1 0.7 F 6/24/2009 On 6/11/09, we have this 20-month
350800 7/6/2009 FL 0 0 0M 7/6/2009 Infant accidentally received RUBEL
350801 7/6/2009 FL 0 0 0F 7/6/2009 Infant accidentally received Rubella
350804 7/6/2009 OR 54 54 F 7/6/2009 Low grade fever, nausea, headache
350805 7/6/2009 CA 4 4 M 7/3/2009 Pt had DTAP vaccine 6/29/09 @ Lt
350807 7/6/2009 NJ 4 4 M 7/6/2009 Area red, swollen, warm to touch at
350808 7/6/2009 IA 80 80 F 7/6/2009 1 day lump X 2 days 1 1/2 dollar siz
350810 7/6/2009 AR 16 16 F 7/6/2009 Red, raised area to right upper arm.
350814 7/6/2009 NC 15 15 F 7/6/2009 This case was reported by a physici
350815 7/6/2009 AZ 0.3 0 0.3 M 7/2/2009 On 6/21/09 mother put infant to slee
350816 7/6/2009 WI 2 2 0.1 F 6/30/2009 Unable to bear full weight. Fever, R
350817 7/6/2009 NJ 12 12 F 6/23/2009 GARDASIL. Redness, swelling area
350818 7/6/2009 MI 68 68 F 6/23/2009 Less than one week later sleepines
350858 7/7/2009 PA 15 15 F 7/6/2009 Initial information has been received
350862 7/7/2009 18 F 7/6/2009 It was reported in a newspaper artic
350864 7/7/2009 KY 11 11 M 7/2/2009 Initial report received on 24 June 20
350868 7/7/2009 AR 0.4 0 0.4 F 6/15/2009 Mom states infant started having dia
350869 7/7/2009 TX 0.5 0 0.5 F 6/26/2009 Pt was admitted to hospital on 4/13/
350870 7/7/2009 WI 17 17 F 7/2/2009 Pt had 3rd GARDASIL Injection and
350872 7/7/2009 CA 61 61 F 7/6/2009 2 cm raised red wheal
350873 7/7/2009 TX 0.3 0 0.3 M 7/2/2009 Patient became very fussy and deve
350874 7/7/2009 LA 1.1 1 0.1 M 6/25/2009 Local tissue reaction Left arm and R
350875 7/7/2009 NY 17 17 F Day after injection had raised, red, h
350876 7/7/2009 27 27 M 6/23/2009 Onset of whole body maculopapula
350877 7/7/2009 VA 14 14 F 6/29/2009 Pt. Was given 1st GARDASIL shot t
350878 7/7/2009 CA 1.6 1 0.6 M 6/27/2009 Large induration over entire left oute
350879 7/7/2009 NY 1 1 0M 6/29/2009 While administering vaccines MMR
350880 7/7/2009 TX 61 61 F 6/30/2009 Pt. stated that the next day. After th
350881 7/7/2009 VA 1.3 1 0.3 M 7/1/2009 Erythematous blanchable rash on tr
350882 7/7/2009 PA 52 52 F 6/30/2009 Pt 1st noticed pain in (L) hip on 6/23
350883 7/7/2009 OH 22 22 F 4/25/2009 4/21/09 Headache, itching, rash, ch
350884 7/7/2009 MA 63 63 F 6/30/2009 3 days after administration of vaccin
350885 7/7/2009 PA 1 1 0M 6/30/2009 Evening of 6/23 pt whole body turne
350886 7/7/2009 PA 13.5 13 F 6/26/2009 6/24/09 redness, swelling, warmth,
350887 7/7/2009 IL 62 62 M 6/25/2009 Patient developed bruising at injecti
350888 7/7/2009 NY 1.1 1 0.1 F 7/1/2009 Fever + rash typical of rubella.
350889 7/7/2009 NY 12 12 F 7/1/2009 At 12:15 pm pt. felt dizzy (6/30/09) a
350890 7/7/2009 TN 1 1 0M 6/25/2009 Patient had a area - 10 cm- area of
350891 7/7/2009 NY 4 4 M 6/25/2009 Area of erythema and induration at
350892 7/7/2009 AZ 30 30 M 6/29/2009 14 days after vaccination postular ra
350893 7/7/2009 NE 1.7 1 0.7 M 7/2/2009 8.5 cm X 3 cm area of tan/lt. brown
350894 7/7/2009 1 1 0U Pt had eruption of pustules on eryth
350895 7/7/2009 NE 70 70 U Red swollen, painful, hard felling (so
350896 7/7/2009 CA 4 4 F 7/3/2009 Erythema and induration
350897 7/7/2009 NY 16 16 F 7/1/2009 Patient received HPV #2 @ 4 pm 6/
350898 7/7/2009 MN 67 67 F 6/25/2009 Patient developed a red raised area
350899 7/7/2009 IN 0.2 0 0.2 F 6/25/2009 Dad stated that immediately after th
350900 7/7/2009 AL 47 47 F 7/1/2009 Pt had fever 102-103, body aches, s
350901 7/7/2009 CA 4 4 F 9 x 7,5 cm erythematous induration
350902 7/7/2009 TN 6 6 M 6/29/2009 Erythematous, swelling at site of inje
350903 7/7/2009 NH 9 9 M 6/29/2009 Patient received the varicella vaccin
350904 7/7/2009 CO 24 24 M 6/20/2009 Patient fainted, went white, no treat
350905 7/7/2009 NC 14 14 M 7/2/2009 Pt had severe HA, myalgias followe
350906 7/7/2009 IN 5 5 F 7/7/2009 Half dollar sized area of redness ov
350907 7/7/2009 TX 4 4 M Left thigh swollen & hot to touch 7/3
350908 7/7/2009 MA 23 23 F 6/30/2009 ER x2 6/22/09, Redness, fever, nau
350909 7/7/2009 CA 9 9 F 6/28/2009 Within a few hours of vaccination th
350910 7/7/2009 CT 1.3 1 0.3 M 6/30/2009 None.
350911 7/7/2009 NY 0.1 0 0.1 M 7/1/2009 Admin IM Hep B dose # 2 of 3 at ap
350912 7/7/2009 PA 7 7 F 6/29/2009 Rash started at site of injection with
350913 7/7/2009 AZ 30 30 F Pt received ACAM2000 on 6/25/09.
350914 7/7/2009 MN 55 55 F 5/26/2009 No inflammation at deltoid but very
350915 7/7/2009 OR 76 76 F 7/6/2009 Patient had ZOSTAVAX vaccine ad
350916 7/7/2009 TX 0.6 0 0.6 M 7/7/2009 10 minutes after receiving DTaP, de
350917 7/7/2009 AL 46 46 F 7/7/2009 Pt received vaccine on 6/26/09. On
350918 7/7/2009 TN 6 6 M 6/29/2009 Erythematous swelling at site of inje
350919 7/7/2009 MA 3 3 F 7/1/2009 Received DTaP on 6/30/09. c/o pain
350920 7/7/2009 VT 30 30 F 7/7/2009 Three days after receiving started w
350921 7/7/2009 NY 66 66 M 7/1/2009 Redness and swelling of arm.
350922 7/7/2009 IN 1.7 1 0.7 F 6/29/2009 0 / parent notified of dose given out
350923 7/7/2009 PA 61 61 F 6/19/2009 5/14/09 - Vaccination (itch, no fever
350924 7/7/2009 VT 71 71 F 7/7/2009 Small bump, reddened ongoing afte
350925 7/7/2009 TX 12 12 M 7/7/2009 Patient became extremely pale, ligh
350926 7/7/2009 KS 18 18 F 7/7/2009 Site at varicella injection site becam
350927 7/7/2009 WI 50 50 F 7/7/2009 On 7-3-09 came to work at 7am with
350928 7/7/2009 OH 5 5 F 7/7/2009 Mother states has red spots with a w
350929 7/7/2009 TX 4 4 F 7/7/2009 As per phone conversation w/ grand
350930 7/7/2009 PA 8 8 M 7/7/2009 Varicella vaccine breakthrough. Ha
350931 7/7/2009 IA 18 18 F 7/7/2009 7/01/2009 Dr. reported that patient h
350932 7/7/2009 MI 0.4 0 0.4 F 7/7/2009 Mother states at 7 pm infant began
350933 7/7/2009 MN 0.3 0 0.4 M 7/7/2009 About 30 minutes after vaccines we
350934 7/7/2009 OR 4 4 M 7/7/2009 Left lower extremity swelling from th
350935 7/7/2009 VT 77 77 F 7/7/2009 pt experienced swelling and rednes
350936 7/7/2009 AZ 4 4 F 7/7/2009 Redness and swelling of left arm tw
350937 7/7/2009 MI 15 15 F 7/7/2009 Fever, Headache, Syncope
350938 7/7/2009 CT 20 20 F 7/7/2009 The injection was given on May 1, 2
350939 7/7/2009 PA 9.5 9 F 7/1/2009 Varicella vaccine break through. Ha
350940 7/7/2009 NV 0.2 0 0.2 F 7/7/2009 Right tonic-clonic seizure with left fa
350941 7/7/2009 AZ 11 11 M 7/7/2009 Pt. came in with headache, pain in l
350942 7/7/2009 CO 71 71 F 7/7/2009 Developed 2 chickenpox like rashes
350943 7/7/2009 CA 1.3 1 0.3 M 7/7/2009 Dtap and MMR where given on 06/2
350944 7/7/2009 CA 1.1 1 0.1 M 7/7/2009 infant had shots app 11 days ago no
350946 7/7/2009 NY 66 66 F 7/1/2009 Arm swelling at injection site - red fr
350945 7/8/2009 CA 12 12 F 7/8/2009 Nausea and weakness days before
350952 7/8/2009 25 M 7/2/2009 After taking required doses of the A
350953 7/8/2009 19 F 7/4/2009 My daughter was encouraged to ha
350954 7/8/2009 M 6/17/2009 Narrative: The patient had a mild fe
350955 7/8/2009 63 M 6/8/2009 Per clinic note on 5/11/09- Patient h
350965 7/8/2009 OH 47 47 F 7/6/2009 Initial report received on 30 June 20
350967 7/8/2009 U 7/7/2009 It was reported
Y from an article publis
350968 7/8/2009 U 7/7/2009 It was reported
Y from an article publis
350978 7/8/2009 GA 19 19 F 7/8/2009 No adverse events or treatment nee
350979 7/8/2009 NE 61 61 F 7/8/2009 Received S Zostavax and within an
350980 7/8/2009 IN 19 19 F 7/8/2009 Pt received Hepatitis A & typhoid @
350981 7/8/2009 GA 0.3 0 0.3 F 7/8/2009 BLOOD IN STOOL
350982 7/8/2009 SC 0.5 0 0.6 F 7/8/2009 Patient developed jerking movemen
350983 7/8/2009 CA 20 20 F 7/8/2009 lower body paralysis. 7/9/09 Hospita
350984 7/8/2009 WA 24 24 F 7/8/2009 after receiving inj. pt sat down and p
350985 7/8/2009 NY 62 62 F 7/8/2009 Patient received TDaP injection to le
350986 7/8/2009 MN 50 50 F 7/8/2009 Expired vaccine given inadvertantly
350987 7/8/2009 VA 70 70 F 7/8/2009 area right outer and anterior upper a
350989 7/8/2009 NC 4 5 F 7/8/2009 Patient was given Boostrix instead o
350990 7/8/2009 KY 4 4 M 7/8/2009 Patient recieved vaccinations at the
350991 7/8/2009 IL U 7/8/2009 well he was looking at wheni was ca
350992 7/8/2009 MN 28 28 F 7/8/2009 She is a 28-year-old intern in biosta
350993 7/8/2009 AZ 4 4 F 7/8/2009 Client's Mother called stating that sh
350994 7/8/2009 PA 1 1 0M 7/8/2009 Child screamed and cried for two fu
350995 7/8/2009 CA 29 F 7/8/2009 Allergic Reaction five days after inje
350996 7/8/2009 MA 4 4 F 7/8/2009 07/07/2008 PM (Less than 24 hours
350997 7/8/2009 MI 1 1 0M 7/7/2009 MMR vaccination given IM route.
350998 7/8/2009 CA 0.6 0 0.6 M 7/7/2009 Fever/Seizure. Febrile seizure- eval
350999 7/8/2009 CA 65 65 F 7/8/2009 Patient received ZOSTAVAX vaccin
351000 7/8/2009 SD 43 43 M 7/7/2009 Severe pain at injection site.
351001 7/8/2009 TX F 6/29/2009 None Stated
351002 7/8/2009 MA 1.2 1 0.2 M 7/8/2009 Received Varicella 7/1/09, 7/6/09 no
351003 7/8/2009 NC 1 1 0F 5/14/2009 Rash on chest, back and legs.
351004 7/8/2009 GA 54 54 M 6/26/2009 1. Chin numbness. TX: CT of head.
351005 7/8/2009 OH 1.1 1 0.1 F 7/8/2009 Multiple blisters at various stages of
351006 7/8/2009 MI 51 51 F 7/8/2009 Pt presented to office one day after
351007 7/8/2009 MO 5 5 M 7/8/2009 Right upper arm, redness, swollen,
351097 7/8/2009 MN 5 5 M 6/25/2009 This case was reported by a physici
351039 7/9/2009 VA 14 14 F 7/7/2009 Initial report was received 01 July 20
351040 7/9/2009 ID 63 63 F 7/8/2009 Initial report received on 02 July 200
351049 7/9/2009 FL 24 24 F 7/9/2009 It has been over 2 weeks since my
351050 7/9/2009 PA 7 7 F 7/9/2009 Near syncope event.
351051 7/9/2009 NY 50 50 F 7/9/2009 PINKISH DISCHARGE AT INJECTI
351052 7/9/2009 MI 15 15 M 7/9/2009 After administration of vaccines. Clie
351053 7/9/2009 OR 1 1 0F 7/9/2009 Rash x1 week, develops water filled
351054 7/9/2009 CA 20 20 F 7/9/2009 Client fainted after receiving immuiz
351055 7/9/2009 OH 65 65 F 7/9/2009 Aproximately 15 minutes after vacci
351056 7/9/2009 MN 2 2 0M 7/9/2009 Within 12 hours of immuniation Chil
351057 7/9/2009 MD 11 11 F 7/9/2009 Swelling, redness and warmth at inj
351058 7/9/2009 AR 42 42 F 7/9/2009 Pt received Tdap 0.5ml Im in left de
351059 7/9/2009 NC 24 24 F 7/9/2009 Pt received HPV vaccine on 14 Apr
351060 7/9/2009 OK 73 73 M 7/9/2009 Received a call from son-in-law of p
351061 7/9/2009 MA 75 75 F 7/9/2009 Shingles vaccine given at 1:35PM. A
351062 7/9/2009 OR 5 5 M 7/9/2009 Vaccine given in Right deltoid. Nex
351063 7/9/2009 CA 50 50 F 7/9/2009 Pt report onset of pain in joints on in
351064 7/9/2009 CA 9 9 F 7/9/2009 Measures 10cm x 10cm Flat with ra
351065 7/9/2009 CA 1.5 1 0.4 M 7/9/2009 Duplicate doses of DTap and IPV w
351066 7/9/2009 OR 14 14 F 7/9/2009 Extreme fatigue (sleeping 20-22 hou
351067 7/9/2009 NJ 13 13 F 7/9/2009 Coughing, trouble breathing, loss of
351068 7/9/2009 CA 6 6 U 7/9/2009 Severe swelling, induration, pain an
351070 7/9/2009 NJ 18 18 M 7/7/2009 Approx. less than a minute after vac
351071 7/9/2009 WI 5 5 M 6/30/2009 Redness around injection site "hard
351072 7/9/2009 MD 69 69 F 7/6/2009 1. Shot administered on Wed. 2. Th
351073 7/9/2009 IL 4 4 F 7/1/2009 Right thigh (injection site) with 4 in x
351074 7/9/2009 CO 10 10 F 6/26/2009 ZOSTAVAX was administered on 6/
351075 7/9/2009 CA 11 11 M 7/3/2009 Induration and erythema.
351076 7/9/2009 CA 67 67 F 6/15/2009 Back pain, nausea and vomiting - p
351077 7/9/2009 PA 10 10 F 7/3/2009 Patient received GARDASIL and DT
351078 7/9/2009 AZ 1.2 1 0.2 F 6/26/2009 Pt developed Varicella infection; < 5
351079 7/9/2009 NJ 17 17 F 7/8/2009 5cm by 4cm swollen right upper arm
351080 7/9/2009 NJ 49 49 F 7/9/2009 Received yellow fever vaccine on 7/
351081 7/9/2009 TX 4 4 M 7/9/2009 Redness, swelling R arm deltoid.
351082 7/9/2009 CA 4 4 M 7/9/2009 Swelling, redness and pruritus. Mar
351083 7/9/2009 NJ 63 63 F 7/9/2009 Herpetic vesical 2" X 1" surrounded
351084 7/9/2009 IL 11 11 M 7/9/2009 Child received vaccination 7-7-09; c
351085 7/9/2009 KS 5 5 F 7/7/2009 Pt. received MMR and VARIVAX su
351086 7/9/2009 AZ 5 5 M 7/9/2009 Large area of erythema at deltoid ar
351087 7/9/2009 IN 1.3 1 0.3 M 7/9/2009 L thigh sterile abscess with 5 X 3 cm
351088 7/9/2009 NY 11 11 M 7/6/2009 Pt noticed erythema ~2 1/2 inches o
351089 7/9/2009 KY 36 36 M 7/6/2009 7-2-09 - Leg, knee pain. 7-3-09 - Nu
351090 7/9/2009 CA 1.3 1 0.3 M 7/2/2009 Received 15 mos vaccines. Develop
351091 7/9/2009 DE 1.5 1 0.5 F 6/26/2009 Pt with sl swelling at site of injection
351092 7/9/2009 IN 19 19 M 7/9/2009 Palpitations.
351093 7/9/2009 CA 71 71 F 7/9/2009 (L) arm - red, swollen, tender to touc
351094 7/9/2009 MN 5 5 F 6/18/2009 L upper arm swelling, temp and pain
351095 7/9/2009 MN 13 13 M 7/9/2009 Approximately 12 hours after admin
351069 7/10/2009 CA 1 1 0M 7/10/2009 The varicella vaccination administer
351098 7/10/2009 NY 1.4 1 0.4 M 7/1/2009 Febrile seizure 3:38 am after vaccin
351101 7/10/2009 AR 12 F 7/9/2009 Information has been received from
351108 7/10/2009 CT 10 10 F 7/9/2009 Anaphylaxis - Vaccine given @ 1:45
351109 7/10/2009 TX 0.7 0 0.7 F 7/9/2009 Immunizations followed about 4-5 h
351110 7/10/2009 NC 74 74 F 7/10/2009 patient developed approx 12 raised
351111 7/10/2009 AL 5 5 F 7/10/2009 Immunization given on 6/30/09. Par
351112 7/10/2009 MI 17 17 M 7/10/2009 Patient feeling nausea and dry heav
351113 7/10/2009 TX 15 15 F 7/10/2009 Patient developed a bright red, irreg
351114 7/10/2009 CA 74 74 F 7/10/2009 extreme burning & itching, extensive
351115 7/10/2009 MA 60 60 F 7/10/2009 soreness, redness and swelling left
351116 7/10/2009 MA 76 76 F 7/10/2009 SORENESS AND SWELLING, SLIG
351117 7/10/2009 PA 11 11 M 7/10/2009 after vaccine administration the pt w
351118 7/10/2009 IA 0.2 0 0.2 F 7/10/2009 Patient rec'd vaccines 7/8/09 and on
351119 7/10/2009 AZ 26 26 M 7/8/2009 Diffuse Musculostreleted pain and w
351120 7/10/2009 GA 18 18 M 7/10/2009 2:53 P.M. 18 y.o w/m administered
351121 7/10/2009 MI 1 1 0M 7/10/2009 Spoke with Mother who has noticed
351122 7/10/2009 CA 22 22 F 7/10/2009 Inflamation around the smallpox site
351123 7/10/2009 CA 0.3 0 0.2 M 7/10/2009 Diarrhea 4 days after Rotateq (6/26
351124 7/10/2009 WI 56 56 F 7/10/2009 Patient presented with redness, war
351125 7/10/2009 TX 12 12 M 7/10/2009 The second evening after patient re
351145 7/10/2009 VA 37 37 M 7/6/2009 Received AVA #3 and Tdap on 6/29
351146 7/10/2009 NC 19 19 F 7/10/2009 No adverse event/pregnancy outcom
351147 7/10/2009 GA 0.2 0 0.2 M 7/9/2009 Received 2m vaccination with oral R
351148 7/10/2009 NY 20 20 F 7/10/2009 4 hours after receiving vaccine pt c/
351150 7/10/2009 NY 16 16 F 7/10/2009 1 day after GARDASIL developed fe
351151 7/10/2009 CA 8 8 M 7/12/2009 About 24h after vaccination, child de
351152 7/10/2009 PA 66 66 M 7/11/2009 Swollen (slight), looks reddish (as if
351153 7/10/2009 CA 4 4 F 7/9/2009 1 cm raised patch ~ 1cm above MM
351154 7/10/2009 WA 18 18 F 7/9/2009 Pt A and O x3. HPV given L deltoid.
351155 7/10/2009 CA 11 11 F 7/7/2009 Local redness and swelling 4 days a
351156 7/10/2009 CA 4 4 F 7/10/2009 Swelling: blistering of arm.
351157 7/10/2009 CA 1.2 1 0.2 F 7/9/2009 1- Vaccine and Anaphylactic reactio
351158 7/10/2009 DE 75 75 M 7/10/2009 Pt given PNEUMOVAX in left deltoid
351159 7/10/2009 DC 4 4 M 6/19/2009 Vaccine Administration error HIB va
351160 7/10/2009 NC 8 8 F 7/10/2009 Patient developed a 3cm erythemat
351161 7/10/2009 IA 85 85 F 6/23/2009 Pt states started burning itchy area
351162 7/10/2009 FL 38 38 M 7/11/2009 Left arm soreness, tenderness, kno
351163 7/10/2009 UT 53 53 M 7/10/2009 30 min- after given, sudden onset h
351164 7/10/2009 CA 3 3 M 7/10/2009 Left upper arm is red, swollen from
351165 7/10/2009 AR 52 52 F 7/10/2009 Redness at injection site, left deltoid
351126 7/11/2009 NJ 27 27 M 7/11/2009 ANTHRAX WAS GIVEN AS PPD. 0
351127 7/11/2009 NJ 31 31 F 7/11/2009 SERVICE MEMBER GIVEN ATHRA
351128 7/11/2009 NC 60 60 M 7/11/2009 Arm and head have hurt enough to
351129 7/11/2009 NY 15 15 F 7/11/2009 Seizure 7:30PM on 7/10/09 and at 8
351130 7/11/2009 GA 37 37 M 7/11/2009 Multiple pustules at site of inoculatio
351131 7/11/2009 PR 18 18 M 7/11/2009 FACIAL PALSY(RIGHT SIDE) DAY
351132 7/11/2009 TX 0.1 0 0.1 F 7/11/2009 On Tues.7th my 5 week old daught
351133 7/12/2009 TX 24 24 F 7/12/2009 after the third vaccine of GARDISIL
351134 7/12/2009 NY 24 24 M 7/12/2009 Woke up at 0200 with pounding hea
351135 7/12/2009 NY 38 38 F 7/12/2009 CHills, myalgias, headache all starte
351136 7/12/2009 DC 58 58 F 7/12/2009 3 weeks after Tdap vaccine, awake
351181 7/13/2009 WA 57 57 F 7/9/2009 Initial report received on 06 July 200
351191 7/13/2009 WI 14 14 F 7/13/2009 Immun. given Mon., 7/6/09 at 3:30 p
351192 7/13/2009 PA 4 4 F 7/13/2009 Varicella Vaccine breakthrough. Ha
351193 7/13/2009 OH 42 42 F 7/13/2009 Patient complaining of dizziness an
351194 7/13/2009 NY 24 24 F 7/13/2009 PATIENT COMPLAINED OF AN ITC
351195 7/13/2009 CA 12 12 F 7/13/2009 Patient with fever >102.0 less than 1
351197 7/13/2009 MO 52 52 M 7/13/2009 Fever, nights sweats, weight loss, a
351198 7/13/2009 KY 83 83 F 7/13/2009 PT PHONED ON MONDAY (7/13/0
351199 7/13/2009 KY 28 28 F 7/13/2009 c/o soreness of R arm, mild swelling
351200 7/13/2009 MA 75 75 M 7/13/2009 Developed red, hot, raised, itchy blo
351201 7/13/2009 FL 4 4 F 7/13/2009 REDNESS WITH EDEMA AROUND
351203 7/13/2009 CA 69 69 F 7/13/2009 This 69-year-old female was brough
351204 7/13/2009 TX 38 38 F 7/13/2009 Fever of 101, redness, raised bump
351205 7/13/2009 NY 28 F 7/13/2009 Patient reports having an MMR vacc
351206 7/13/2009 FL 34 34 F 7/13/2009 Rec'd one dose Varicella, 48hrs late
351207 7/13/2009 FL 63 63 F 7/13/2009 broke out with a rash on buttovk, sid
351208 7/13/2009 WI 14 14 M 7/13/2009 Recieved vaccine without incident a
351211 7/13/2009 CA 4 F 7/1/2009 L deltoid induration (+) erythema, w
351212 7/13/2009 HI 56 56 F 7/13/2009 Vaccination site indurated, erythem
351213 7/13/2009 WA 63 63 F 7/13/2009 Patient woke up this morning (7-13-
351214 7/13/2009 CA 14 14 F 7/13/2009 Scared before injection. Syncopal e
351215 7/13/2009 PA 4 4 M 7/13/2009 Woke up 07/11/09 Swelling & cellul
351216 7/13/2009 MA 69 69 F 7/13/2009 Headaches Fevers- per pt. None w
351217 7/13/2009 CT 4 4 M 7/10/2009 Blistering irregular rash on upper L a
351218 7/13/2009 VA 21 21 M 7/13/2009 This 31 year old male reported rece
351219 7/13/2009 CT 63 63 F 7/13/2009 Flu-like malaise, weakness, low gra
351220 7/13/2009 DC 45 45 M 7/6/2009 Extended rash - additional sores. Pt
351221 7/13/2009 FL 12 12 M Had TDAP/Menactra in (L) Deltoid o
351222 7/13/2009 HI 1 1 0F 7/8/2009 After receiving MMR shot at age 1,
351223 7/13/2009 CA 61 61 F 6/22/2009 Redness. pain, swelling localized to
351224 7/13/2009 GA 50 50 M 5/29/2009 Broke out with rash 5/26/09. Mild fe
351225 7/13/2009 GA 18 18 F 6/5/2009 Received 5 immunizations. After re
351226 7/13/2009 GA 18 18 F 6/19/2009 See attached Notes. See back. Cli
351227 7/13/2009 GA 51 51 F 6/22/2009 Pt. called 6-19-09 spoke with RN c/o
351228 7/13/2009 ME 39 39 F 7/10/2009 7-8-09 receive injection - next day b
351229 7/13/2009 IL 17 17 M 7/13/2009 Immediately after the 2 vaccines we
351230 7/13/2009 GA 1.1 1 0.1 F Hives Rash over abdomen and extr
351231 7/13/2009 2 2 0.9 M 7/13/2009 Parents report change of affect of p
351232 7/13/2009 MS 10 10 M 7/13/2009 Severe swelling/induration of deltoid
351233 7/13/2009 CA 21 21 M 7/6/2009 21 y.o. c/o rash on arms torso ches
351234 7/13/2009 NC 1.4 1 0.4 M 7/9/2009 Low grade fever since immunization
351235 7/13/2009 UT 4 4 M 7/9/2009 Night after vaccines, right thigh gros
351236 7/13/2009 CA 65 65 U None stated
351239 7/13/2009 FL 79 79 F 6/19/2009 Onset pulsating pain in shoulder rad
351245 7/13/2009 WA 85 85 M 6/24/2009 Information has been received from
351252 7/13/2009 WY 73 F 6/24/2009 Information has been received from
351271 7/13/2009 OR 71 71 M 6/24/2009 Information has been received from
351272 7/13/2009 MT 73 F 6/24/2009 Information has been received from
351373 7/13/2009 IA 56 F 7/7/2009 This case was reported by a healthc
351392 7/13/2009 IL M 6/24/2009 Information has been received from
351493 7/13/2009 AZ M 6/24/2009 Information has been received from
351511 7/13/2009 AL 38 M 6/24/2009 Information has been received from
351527 7/13/2009 NM 63 63 M 6/24/2009 Information has been received from
351562 7/13/2009 68 68 U 6/24/2009 Information has been received from
351568 7/13/2009 CA 16 U 6/24/2009 Information has been received from
351643 7/13/2009 HI U 6/24/2009 Information has been received from
351649 7/13/2009 PA 79 79 F 6/24/2009 Information has with allergies to PE
351652 7/13/2009 SD 76 F 6/24/2009 Information has been received from
351656 7/13/2009 AZ 71 71 U 6/24/2009 Information has been received from
351684 7/13/2009 KS 63 M 6/24/2009 Information has been received from
351696 7/13/2009 NV 61 61 M 6/24/2009 Information has been received from
351699 7/13/2009 ME 57 57 U 6/24/2009 Information has been received from
351761 7/13/2009 WV 55 M 6/24/2009 Information has been received from
351813 7/13/2009 OK 79 79 M 6/24/2009 Information has been received from
351828 7/13/2009 IN 1.2 U 6/24/2009 Information has been received from
351838 7/13/2009 WY 58 F 6/24/2009 Information has been received from
326259 7/14/2009 CO 18 18 M 10/7/2008 Initial information received from a he
351238 7/14/2009 NY 18 18 F 7/13/2009 Coughing, shortness of breath edem
351296 7/14/2009 LA 0.6 0 0.6 M 6/22/2009 Imun given Thursday - 6/18/09 appr
351299 7/14/2009 SC 0.6 0 0.6 F 7/7/2009 Intussusception requiring surgical re
351300 7/14/2009 12 F 7/12/2009 Daughter has adverse reaction to G
351303 7/14/2009 0.2 F 7/10/2009 At 2 mo, child was given her 1st dos
351307 7/14/2009 NV 28 28 F 6/25/2009 Shot Saturday, swollen knot on righ
351309 7/14/2009 KS 0.4 0 0.4 F At 2 mo. well child visit, pt. was give
351310 7/14/2009 OH 5 5 M 7/10/2009 13x8 cm region of erythema and ed
351312 7/14/2009 AZ 1 1 0F 7/8/2009 On 6/12/2009 MMR, Varicella, PCV
351313 7/14/2009 SD 1 1 0M 7/9/2009 None stated
351314 7/14/2009 NC 4 4 F 6/29/2009 MMR + Varicella given in (L) upper/
351315 7/14/2009 CO 18 18 F 7/6/2009 Per client, 30 minutes after vaccine,
351316 7/14/2009 FL 0.4 0 0.4 M 7/6/2009 After last immunization pt had fever
351317 7/14/2009 VT 61 61 F 5/29/2009 Vaccine given 5-26- AM. Symptom
351318 7/14/2009 CT 13 13 F 7/6/2009 Painful arms at inj. site - warm to tou
351319 7/14/2009 TX 10 10 F 7/3/2009 The child had an episode of dizzine
351322 7/14/2009 NJ 0.3 0 0.3 F 7/14/2009 6/22/09 - ER Hospital for elevated te
351323 7/14/2009 16 16 F 7/7/2009 Pt became light headed. Blood pres
351324 7/14/2009 MI 44 44 F 7/14/2009 Patient presented today to emergen
351325 7/14/2009 IL 17 17 F 7/14/2009 90 minutes after receiving vaccine c
351326 7/14/2009 CA 46 46 F 7/14/2009 Soreness at injection site and sever
351328 7/14/2009 CA 72 70 F 7/14/2009 4 inch redness, bumpy, warm, itchin
351329 7/14/2009 FL 23 23 F 7/14/2009 Client stated that she experienced c
351330 7/14/2009 CA 1 1 0F 7/14/2009 On 7/8/09 patient received Prevnar,
351331 7/14/2009 TX 1 1 0M 7/14/2009 STARTED WITH A RASH ALL OVE
351332 7/14/2009 NC 2 2 0.6 M 7/14/2009 SEVERE GENERALIZED RASH AN
351333 7/14/2009 TX 2 2 0F 7/14/2009 Urticaria Mom noticed rash upon aw
351334 7/14/2009 AZ 4 4 F 7/14/2009 Flat, red rash and spots on chest; in
351335 7/14/2009 WA 65 65 F 7/14/2009 Shingles vaccination 7/1/09; 7/2/09
351336 7/14/2009 CA 0.5 0 0.5 F 7/14/2009 VACCINE WAS ADMINISTERED A
351337 7/14/2009 CA 0.5 0 0.5 F 7/14/2009 6month term previously healthy fem
351338 7/14/2009 AZ 11 11 F 7/14/2009 severe headache,soreness in arms
351340 7/14/2009 VA 1 0 1M 7/6/2009 Within 5 min of vaccines being given
351341 7/14/2009 FL 11 11 M 6/26/2009 Edema, Tenderness (L) Deltoid, wa
351342 7/14/2009 WA 1 M 6/30/2009 Hard, warm to touch, red area state
351343 7/14/2009 CA 20 20 F 7/7/2009 Developed headache p.m. of 7/2/09
351345 7/14/2009 26 26 F 7/14/2009 Vaccine administered 7-10-09, pt re
351346 7/14/2009 AR 33 33 F Vaccine administered 9/10/08 and n
351347 7/14/2009 AR 5 5 F 6/16/2009 Mom stated that she took client to P
351348 7/14/2009 AR 18 18 M 6/5/2009 Pt was given MMR II, RECOMBIVA
351349 7/14/2009 CA 0.4 0 0.4 U None stated
351350 7/14/2009 WA 1 1 0M 7/14/2009 Fever 103, crying, fussy, red rash o
351351 7/14/2009 WI 4 4 F 7/14/2009 Redness, swelling, tenderness on le
351352 7/14/2009 FL 0.2 0 0.2 F 7/14/2009 (B) legs - 5-10 min after vax bright r
351353 7/14/2009 CA 11 11 F 7/13/2009 Per Grandma- patient got a "pimple
351354 7/14/2009 FL 12 12 F 7/14/2009 About 20 seconds after administerin
351355 7/14/2009 NC 5 5 F 7/2/2009 Mom noted red knot on arm and leg
351356 7/14/2009 NC 57 57 F 7/6/2009 Injection site was red, tender, itchy.
351357 7/14/2009 MN 12 12 M 7/14/2009 7/10/09 Pt. presented to doctor with
351358 7/14/2009 CA 12 12 F 7/14/2009 12 year old child, new to area, no va
351359 7/14/2009 CA 14 14 F 7/13/2009 1600 pt passed out, in the lobby on
351360 7/14/2009 CA 57 57 F 7/13/2009 Severe pain and inability to lift arm h
351361 7/14/2009 AZ 42 42 F 7/6/2009 Painful, swollen, red right arm.
351362 7/14/2009 OH 46 46 F 7/7/2009 Started feeling sluggish on 6/27/09,
351363 7/14/2009 WA 1.3 1 0.3 M 7/7/2009 Received DTAP, HIB and PREVNA
351364 7/14/2009 NY 0.9 0 0.9 M 7/6/2009 High fever up to 104.8 (R) for 3 day
351365 7/14/2009 CA 9 9 M 7/2/2009 4 cm round reddish area at site of in
351366 7/14/2009 CA 3 3 M 7/3/2009 Erythema and induration.
351367 7/14/2009 TX 3 3 M 7/7/2009 12 X 13 cm red mildly tender area a
351368 7/14/2009 WA F 7/7/2009 Injection site red, itchy, hot to touch
351369 7/14/2009 WA 10 M 7/7/2009 Swollen, irritated, itchy Injection site
351370 7/14/2009 WA 14 14 M 7/7/2009 7 cm swelling with 5cm induration/s
351371 7/14/2009 MI 1.8 1 0.8 M 7/13/2009 Fever, vomiting, fussiness/irritability
351372 7/14/2009 IA 18 18 M 7/2/2009 Transient vision loss.
351407 7/14/2009 NC U 6/24/2009 Information has been received from
351844 7/14/2009 CA 42 42 F 9/9/2008 A 42-year-old female patient had re
351845 7/14/2009 SC 73 73 F 8/5/2008 Initial report was received 29 May 2
351846 7/14/2009 TX 29 28 F 9/9/2008 This non-serious case was received
351847 7/14/2009 NC 20 20 F 5/6/2009 Initial report received on 24 June 20
351848 7/14/2009 KY 57 57 F 8/26/2008 Initial report received on 07 July 200
351849 7/14/2009 CO 58 58 F ### Initial non-serious case received fro
351850 7/14/2009 PA 43 43 F ### Initial report received from a health
351851 7/14/2009 NJ 60 60 M ### This non-serious case was received
351852 7/14/2009 TN F 2/13/2009 Initial report received from a healthc
351854 7/14/2009 TN 56 56 F 2/13/2009 Initial report received from a healthc
351856 7/14/2009 UT 38 38 F 2/9/2009 Initial information was received on 1
351857 7/14/2009 OR U 4/27/2009 Initial report received on 05 Februar
351858 7/14/2009 CA 31 31 F 4/28/2009 Initial report received 19 February 2
351859 7/14/2009 58 F 3/4/2009 This non serious case was received
351860 7/14/2009 42 F 3/4/2009 This case was extracted from the VA
351861 7/14/2009 34 F 3/4/2009 This non serious case was received
351862 7/14/2009 26 F 3/3/2009 This case was extracted from the VA
351877 7/14/2009 MD 74 74 F 3/5/2009 This non serious case was received
351878 7/14/2009 CA 34 34 F 3/26/2009 A cluster of 3 patients who received
351879 7/14/2009 NC 42 42 F 4/30/2009 Initial report received on 20 March 2
351880 7/14/2009 PA 40 40 F 4/8/2009 This non serious case was received
351881 7/14/2009 PA 28 28 F 4/23/2009 This non serious case was received
351882 7/14/2009 AZ 47 47 F 5/13/2009 A 47 year old female patient with a
351883 7/14/2009 NJ 58 58 F 6/17/2008 This case was received from a cons
351884 7/14/2009 LA 54 54 F 10/9/2008 Initial report received on 22 Septem
351885 7/14/2009 MA 49 49 F 3/21/2009 This non serious case was received
351886 7/14/2009 OH 47 47 F 3/11/2009 This report was received from a con
351961 7/14/2009 NY 11 11 F 9/8/2008 Initial information was received from
351963 7/14/2009 28 28 M 9/29/2008 A 28 year old male patient, with no
351964 7/14/2009 TN F 2/13/2009 Case received from a healthcare pro
351965 7/14/2009 CA 41 41 F 9/30/2008 A cluster of 2 adult patients who rec
351966 7/14/2009 ID 37 37 F 3/31/2009 A 37-year-old female patient who w
351967 7/14/2009 CA 61 61 F ### Initial non-serious case received fro
351968 7/14/2009 NC 54 54 F ### Initial information was received on 2
351969 7/14/2009 GA 37 37 F 2/20/2009 Initial report received from a health
351339 7/15/2009 2 0 0.6 M 7/15/2009 SWELLING, REDNESS AND WARM
351415 7/15/2009 NE 16 16 M 7/7/2009 Severe nausea; weight loss over 20
351416 7/15/2009 FL 0.5 0 0.5 M 7/10/2009 Information was extracted from his d
351417 7/15/2009 CO 0.9 0 0.9 F 7/7/2009 Patient developed small lump at site
351418 7/15/2009 VA 28 28 M 7/6/2009 Chills x 3 days ago. Cellulitis 6.5 cm
351419 7/15/2009 WI 25 25 M 7/9/2009 Cellulitis secondary to smallpox vac
351420 7/15/2009 NC 0.2 0 0.2 F 7/9/2009 Redness & swelling at site. Mostly
351422 7/15/2009 VA 11 11 M 7/8/2009 Pt. received 2 vaccines @ approxim
351424 7/15/2009 PA 5 5 F 7/9/2009 Swelling, redness, warmth of right u
351425 7/15/2009 AZ 48 48 F 7/9/2009 Chills, cramps, severe weakness, d
351427 7/15/2009 NH 12 12 F 7/9/2009 This child developed hives within 48
351430 7/15/2009 MN 39 39 M 6/29/2009 None stated
351434 7/15/2009 MN 40 40 F 6/29/2009 None
351436 7/15/2009 NY 0.4 0 0.4 F 7/8/2009 Fever up to 106 degrees and irritab
351438 7/15/2009 OR 4 4 M 7/9/2009 R arm swelling > 2 in width & length
351443 7/15/2009 NY 51 51 M 7/15/2009 Typical Arthur reaction at right delto
351444 7/15/2009 WI 4 4 M 7/9/2009 Local vaccine reaction. Left arm ext
351445 7/15/2009 MN 61 61 F 7/8/2009 2cm swelling at injection site. No sig
351446 7/15/2009 MN 20 20 M 7/2/2009 No adverse reaction. MMR II given
351447 7/15/2009 SC 70 70 F 7/6/2009 Denied any symptoms-soreness, fe
351448 7/15/2009 OH 40 40 M Inflammation of optical, nerves + mu
351449 7/15/2009 OK 54 54 F 7/17/2009 Redness, Swelling at site of injectio
351450 7/15/2009 PA 73 M 7/7/2009 Shortly after admin of ZOSTAVAX p
351451 7/15/2009 CA 32 32 F 6/17/2009 Pt. reports "severe pain" in muscles
351452 7/15/2009 AZ 27 27 M 6/29/2009 Found vomiting x 2 in waiting room-
351453 7/15/2009 OH 26 26 M 7/8/2009 Pt called 7/2/09 stating he became
351454 7/15/2009 MI 0.2 0 0.2 F 7/7/2009 Unconsolable crying/screaming x 3-
351455 7/15/2009 ME 3 3 M 7/9/2009 1 -1/2 hrs after receiving vaccine pa
351456 7/15/2009 CA 8 8 F 6/26/2009 Raised, red, round- approx. 2 inche
351457 7/15/2009 RI 65 65 M 7/7/2009 Generalized pruritus. Fatigue. Myalg
351458 7/15/2009 OH 6 6 M 7/15/2009 Mild erythema 4cm X 6cm at injectio
351459 7/15/2009 NC 55 55 F 7/15/2009 approximately 42 hours post Zostav
351460 7/15/2009 NH 3 3 M 7/15/2009 3 year old male brought in by his mo
351461 7/15/2009 TX 37 37 F 7/15/2009 Within 1 hour of administration patie
351462 7/15/2009 NC 46 46 M 7/15/2009 He had a varivax booster on Monda
351463 7/15/2009 NC 21 21 F 7/15/2009 She has developed generalized vac
351464 7/15/2009 IN 34 34 M 7/15/2009 Patient developed a burning sensat
351465 7/15/2009 NY 62 62 F 7/15/2009 1-2 days later: dizziness, malaise fo
351466 7/15/2009 NM 37 37 F 7/15/2009 Hour after immunization, experience
351467 7/15/2009 IN 5 5 M 7/15/2009 Child was given a double dose of V
351468 7/15/2009 CA 1.2 1 0.2 M 7/15/2009 12 1/2 x 10cm Circular, swollen leas
351469 7/15/2009 CA 25 25 F 7/15/2009 Nausea, chest pain, asthsma, diarrh
351470 7/15/2009 VA 62 62 F 7/15/2009 arm became swollen down to elbow
351471 7/15/2009 MD 22 22 F 7/15/2009 Rabavert (Rabies vaccine)#1 given
351472 7/15/2009 CA 5 5 F 7/15/2009 REDNESS AND SWELLING AROU
351473 7/15/2009 OH 1.5 1 0.5 F 7/15/2009 Legs were tender to touch where va
351474 7/15/2009 AZ 1 1 0.1 F 7/15/2009 On 7-5-09, child developed raised p
351475 7/15/2009 CA 4 4 M 7/15/2009 pt developed local reaction to vaccin
351476 7/15/2009 NC 18 18 F 7/15/2009 Shortly after receiving her Gardasil,
351477 7/15/2009 UT 66 66 M 7/15/2009 Woke up with head ache, slight nau
351478 7/15/2009 OR 47 M 7/15/2009 c/o that he felt poorly last night. He
351480 7/15/2009 CO 0.5 0 0.5 F 7/15/2009 Given 6 month vaccines including P
351481 7/15/2009 PA 1.3 1 0.2 M 7/15/2009 104.2 fever taken at 2:15 a.m. on 4/
351483 7/15/2009 IA 0.4 0 0.4 F 7/14/2009 On 7-2-09 at 10pm father noticed ey
351484 7/15/2009 IL 45 45 F 7/14/2009 Symptoms of Bells Palsy returned. T
351485 7/15/2009 NM 10 10 M 7/15/2009 Raised papule, erythema at site of V
351486 7/15/2009 NC 23 23 M 7/15/2009 SM woke up with chest pain that go
351487 7/15/2009 NC 21 21 M 7/15/2009 Sm developed chest pain that lasted
351488 7/15/2009 OH 4 4 M 7/15/2009 Sneezing, coughing, wheezing, leth
351489 7/15/2009 CA 0.1 0 0.1 M 7/15/2009 L thigh area red and swollen, hot to
351491 7/15/2009 CA 54 54 F 7/15/2009 Redness, tender swelling at site of i
351533 7/16/2009 CA 5 5 M 6/5/2009 R Leg - Varicella red + swollen + itc
351534 7/16/2009 CA 5 5 F 7/7/2009 Redness and induration in right thig
351535 7/16/2009 PA 4 4 M 7/7/2009 On 6-20-9, child complained of rt ch
351536 7/16/2009 AZ 20 20 F 7/6/2009 Fever, nausea, diarrhea, itchy Skin/
351537 7/16/2009 MI 67 67 F 7/10/2009 ZOSTAVAX administered 7/7/09. P
351538 7/16/2009 KY 5 5 M 7/9/2009 In less than 24 hours after vaccinati
351539 7/16/2009 PA 1.3 1 0.3 M 7/4/2009 Pt's family called on 6/2/09 to let us
351540 7/16/2009 MD 0.2 0 0.2 F 7/14/2009 Intermittent cyclical crying/ screamin
351541 7/16/2009 NY 0.2 0 0.2 F 7/10/2009 Outstretching of arms & legs for a fe
351542 7/16/2009 OH 1.5 1 0.5 M 7/10/2009 Complex partial seizure, head nodd
351543 7/16/2009 MA 53 53 F 7/13/2009 Approximately 10-15 min after vacc
351544 7/16/2009 GA 1.6 1 0.6 F 7/6/2009 Child loss the use of her muscles, b
351546 7/16/2009 CO 0.4 0 0.4 F 7/1/2009 Whole body tremor/spasmed (seizu
351547 7/16/2009 HI 23 23 M 7/7/2009 Patient had moderate swelling R de
351548 7/16/2009 PA 72 72 F 7/9/2009 Neck pain began on LFT side (wher
351549 7/16/2009 AZ 27 27 M 7/7/2009 Pt presented 10 d. after vaccines w
351550 7/16/2009 CO 0.4 0 0.4 F 7/9/2009 Infant vomited at home x 3 and had
351551 7/16/2009 CO 10.5 10 F 7/9/2009 Patient rec'd Hep A and VZV #2 on
351552 7/16/2009 TX 1.4 1 0.4 F 7/2/2009 7/2/09 1500. Received call from pts
351553 7/16/2009 FL 11.9 11 F 7/9/2009 Child almost bumped in the door as
351554 7/16/2009 NY 24 24 M 7/8/2009 Pt reports temp of 104.3 degrees F,
351555 7/16/2009 MA 14 14 F 7/13/2009 Pt received varivax vaccine sc in lef
351556 7/16/2009 GA 0.4 0 0.4 F 7/13/2009 Mom stated child had a rash to both
351557 7/16/2009 PA 12 12 F 7/7/2009 Redness, slight elevation.
351558 7/16/2009 49 49 F 6/30/2009 Migratory skin rash, diarrhea, soren
351580 7/16/2009 CO 30 30 M 7/16/2009 This case was reported by a pharma
351581 7/16/2009 CO 30 30 M 7/16/2009 This case was reported by a pharma
351582 7/16/2009 18 M 7/16/2009 This case was reported by a physici
351593 7/16/2009 MI 18 18 F 7/16/2009 Fever onset of 9:00pm on 7/14/09, b
351594 7/16/2009 VA 27 M 7/16/2009 localized swelling, redness and itchi
351595 7/16/2009 GA 5 5 M 7/16/2009 4 hours after receiving IPV vaccine,
351596 7/16/2009 OH 15 15 F 7/16/2009 This 15 year old received the follow
351597 7/16/2009 OR 62 62 F 7/16/2009 Client presented to clinic 2 days afte
351598 7/16/2009 MI 12 12 F 7/16/2009 Mom states that pt had a nose blee
351599 7/16/2009 FL 12 12 F 7/16/2009 My daughter received the HPV Vac
351600 7/16/2009 FL 8 8 F 7/16/2009 Per mother, patient experienced an
351601 7/16/2009 IL 18 18 F 7/16/2009 07-08-2009 Patient came home with
351602 7/16/2009 CT 4 14 M 7/16/2009 Arm swelling, redness, pain, itching
351603 7/16/2009 WI 12 12 F 7/16/2009 2 X 3 inch reddened area on left arm
351604 7/16/2009 TX 12 12 M 7/16/2009 Right arm swollen at sight of injectio
351605 7/16/2009 OH 59 59 F 7/16/2009 EXTENSIVE REEDNESS AND PAI
351606 7/16/2009 TN 10 10 F 7/16/2009 Received Varivax and had a local re
351607 7/16/2009 TX 4 4 M 7/16/2009 redness streaks from scratching irrit
351608 7/16/2009 ID 5 5 M 7/16/2009 On 7/8/09 patient received following
351609 7/16/2009 TN 10 9 M 7/16/2009 Received Varivax on 7/13/09 on 7/1
351610 7/16/2009 OK 1.3 1 0.3 F 7/16/2009 Mother called office at 8:30 am on 7
351611 7/16/2009 TX 11 11 F 7/16/2009 Patient was vaccinated on July 14,
351612 7/16/2009 IN 46 46 F 7/16/2009 Mumps titer came back too low on 5
351613 7/16/2009 NM 48 48 F 7/16/2009 Approx 2 minutes after pneumococc
351614 7/16/2009 MI 36 36 F 7/16/2009 fever, chills, shakiness, nausea, join
351619 7/16/2009 NM 64 F 7/17/2009 Dizziness and profuse sweating for
351620 7/16/2009 IL 67 67 F 7/16/2009 Pt received vaccine on Mon 7/13/09
351621 7/16/2009 MO 25 25 F 7/16/2009 Pt received GARDASIL #2 on 7/10/
351622 7/16/2009 MD 2 2 0F 7/16/2009 June 16th onset of fever and child c
351623 7/16/2009 NM 60 60 F Area surrounding injection site redd
351624 7/16/2009 MI 0.1 0 0.1 M 7/14/2009 None Known
351625 7/16/2009 TX 0.2 0 0.2 M 7/15/2009 Increased "startle reflex" every few
351626 7/16/2009 NJ 1.2 1 0.2 F 6/17/2009 MOC brought child to clinic 7 days a
351627 7/16/2009 NC 28 28 M 7/15/2009 28 y/o male ADSM is referred from
351628 7/16/2009 GA 1.1 1 0.1 M 7/14/2009 Pt with macular rash on trunk - antih
351629 7/16/2009 68 F 7/13/2009 I was given the shingles vaccination
351630 7/16/2009 30 30 F 7/13/2009 Pt was given TDAP and VARIVAX v
351631 7/16/2009 NJ 9 9 M 7/15/2009 Immediately after giving vaccines - V
351632 7/16/2009 LA 12 12 M 7/16/2009 24 hrs after injection outer aspect o
351633 7/16/2009 MN 4 4 M 7/8/2009 Red & swollen at injection site. Ice
351634 7/16/2009 FL 11 11 M 7/16/2009 Mom states hot, red and painful ind
351635 7/16/2009 TX 64 64 F 7/16/2009 Pt. called on 7/16/09 self reported e
351636 7/16/2009 GA 9 9 M 7/16/2009 '15min episode of nausea then vom
351637 7/16/2009 AK 17 17 F 7/16/2009 Swelling around injection sight, eryt
351638 7/16/2009 NJ 74 74 F 7/16/2009 Swelling and redness of left upper a
351639 7/16/2009 OH 23 23 F 7/16/2009 Friday after injection arm became e
352073 7/16/2009 WA 46 46 M 9/2/2008 A 46-year-old male, with no illness a
352074 7/16/2009 PA 22 22 M 1/23/2009 Initial information was received on 0
352075 7/16/2009 CA 56 56 M 3/27/2009 Initial report was received 03 Decem
352076 7/16/2009 CA 29 29 F 3/10/2009 This case was received from a heal
352077 7/16/2009 KS 21 M 4/3/2009 This non serious case was received
352078 7/16/2009 NY 22 22 F 5/21/2009 This non serious case was received
351615 7/17/2009 KY 1.8 1 0.8 F 7/17/2009 Fever that lasted 2 days straight. Ev
351700 7/17/2009 WA 24 24 M 7/17/2009 June 24th - Reported to the ER with
351703 7/17/2009 WA 11 11 M Redness and swelling up to 5" in pla
351704 7/17/2009 GA 4 4 M 7/13/2009 Rash on abdominal, face, legs, and
351706 7/17/2009 NY 26 26 F 7/13/2009 After 2nd HPV vaccine 5 days later
351707 7/17/2009 28 M 7/13/2009 A 28-year-old male patient received
351708 7/17/2009 MN 12 12 M 7/10/2009 Patient felt clinic was reported by m
351710 7/17/2009 NY 4 4 M 7/13/2009 7/11 - arm (upper) was reported as
351711 7/17/2009 NE 13 13 F 7/11/2009 Pain 24 hours after shot - swelling r
351712 7/17/2009 WA F 7/7/2009 4-5 inch raised, red, hot area aroun
351713 7/17/2009 MA 35 35 F 7/15/2009 Initial report was received 14 July 20
351714 7/17/2009 MI 4 4 M 7/16/2009 7-13-09 child received 4 immunizati
351715 7/17/2009 MD 26 26 F 7/16/2009 Information has been received for th
351716 7/17/2009 TX 12 M 7/16/2009 Left upper arm below injection site i
351717 7/17/2009 TX 10 10 M 7/15/2009 Left deltoid at injection site red\swol
351719 7/17/2009 IL 4 4 M 7/17/2009 Right upper arm swollen, warm to to
351721 7/17/2009 WI 29 29 F 7/9/2009 Pediatric dose of Hep B given to ad
351722 7/17/2009 OH 46 46 F 7/13/2009 Pain. Pressure both lower legs (calf
351723 7/17/2009 MN 25 M 7/13/2009 Tetanus booster given on: DECAVA
351724 7/17/2009 WA 1.2 1 0.2 M 7/14/2009 Local Rxn. 2 Red papules L thigh, s
351725 7/17/2009 NY 56 56 M 6/29/2009 High fever, chills, diarrhea, weaknes
351726 7/17/2009 MT 55 55 F 7/14/2009 Patient described dizziness, vision d
351727 7/17/2009 TX 42 42 M 7/17/2009 Pt c/o pain and swelling to R arm se
351758 7/17/2009 OH F 7/17/2009 This case was reported by a healthc
351766 7/17/2009 AL 28 27 M 7/16/2009 Pt recieved four shots right arm (Me
351767 7/17/2009 MO 14 14 F 7/9/2009 6-24-09 Fever 103 and nausea 6-2
351768 7/17/2009 MI 47 47 F 7/17/2009 severe joint pain, headache, nausea
351769 7/17/2009 GA 11 11 M 7/17/2009 Had swelling and redness at the inje
351770 7/17/2009 OH 18 18 F 7/17/2009 PATIENT CAME TO HEALTH DEPA
351771 7/17/2009 WI 4 4 F 7/17/2009 Local reaction, red, swollen, hurts, n
351772 7/17/2009 WI 11 11 M 7/17/2009 Local reaction, red, swollen, hurts, n
351773 7/17/2009 IN 5 5 F 7/17/2009 The patient received a Dtap in the le
351774 7/17/2009 WI 24 24 F 7/17/2009 Calls to say is declining 3rd Gardas
351775 7/17/2009 WA 12 12 F 7/17/2009 Red, warm, raised area at vaccine s
351776 7/17/2009 NY 24 24 F 7/17/2009 SEVERAL HOURS AFTER RECEIV
351777 7/17/2009 NJ 1.8 1 0.9 F 7/17/2009 Painfull swelling of joints(knees and
351778 7/17/2009 TX 38 38 F 7/17/2009 Less than 24 hours after vaccination
351779 7/17/2009 WI 1.2 1 0.2 M 7/17/2009 Fever began on 7/16/2009, 8 days a
351780 7/17/2009 TX 27 27 F 7/17/2009 Localized erythema, warmth to touc
351781 7/17/2009 NC 21 21 F 7/17/2009 PT'S MOM CALLED TODAY TO RE
351782 7/17/2009 PA 17 17 F 7/17/2009 Client had vaccines 7/16/2009. Rep
351783 7/17/2009 OR 12 12 F 7/17/2009 4in by 4in redness surrounding vacc
351784 7/17/2009 CA 16 16 F 7/10/2009 Pt. developed acute arm pain at the
351785 7/17/2009 WA 67 67 M 7/17/2009 Shingles vaccine resulted in a case
351786 7/17/2009 MN 42 42 F 7/17/2009 Woke am after injection with chills, m
351788 7/17/2009 KY 4 4 M 7/17/2009 7 mm brawny edema area on right u
351789 7/17/2009 AR 4 4 F 7/17/2009 7-16-09 pm noticed swelling adn red
351790 7/17/2009 TX 60 60 F 7/17/2009 Approx. 24 hours after vaccination,
351791 7/17/2009 FL 80 80 F 7/17/2009 Patient received Zostavax vaccine f
351792 7/17/2009 AK 12 12 F 7/17/2009 Moderate fever, hoarseness, palene
351797 7/17/2009 MD 1 1 0M 7/17/2009 13 mth old male received MMR #1,
351798 7/17/2009 MO 13 13 F 7/17/2009 6"X4" area on back of left arm. Red
351799 7/17/2009 CA F 7/17/2009 (L) side Deltoid swollen noticed 7.16
351800 7/17/2009 IL 0.2 0 0.2 F 7/17/2009 Urticana @ vaccine sites 0 anaphyl
351801 7/17/2009 CO 16 16 F 7/17/2009 L deltoid injection, 2 hours later L ar
351802 7/17/2009 TN 4 M 7/17/2009 DPT and IPV given in lower mid Lt t
351804 7/17/2009 NY 0.2 0 0.2 F 7/17/2009 Persistent crying with loss of appetit
351805 7/17/2009 GA 0.3 0 0.3 M 7/16/2009 Developed stools with bloody mucu
351806 7/17/2009 TX 17 17 F Client given 6 shots on 7-14-09. Re
351987 7/17/2009 TX 20 20 F 7/15/2009 Information has been received throu
352084 7/17/2009 WV 11 F 7/15/2009 Information has been received from
352147 7/17/2009 17 17 F 7/15/2009 Initial information has been received
352179 7/17/2009 23 23 F 7/15/2009 Information has been received conc
352205 7/17/2009 F 7/15/2009 Information has been sent from a co
352206 7/17/2009 CA F 7/15/2009 Information has bee received from a
352246 7/17/2009 F 7/15/2009 It was reported in an internet article
352279 7/17/2009 KY F 7/15/2009 Information has been received from
352283 7/17/2009 F 7/15/2009 Information has bee received from a
352350 7/17/2009 F 7/15/2009 It was reported in an internet article
352353 7/17/2009 U 7/15/2009 It was reported from an article, publ
351787 7/18/2009 65 65 U Left arm redness swollen and tende
351793 7/18/2009 FL 26 26 F 7/18/2009 at 9:00 am I had the 3rd gardasil sh
351794 7/18/2009 WA 54 54 F 7/18/2009 Had the injection 7-6-09 at 5 pm. B
351795 7/18/2009 AR 14 14 F 7/18/2009 2nd dose of gardasil administered in
351796 7/18/2009 FL 40 40 F 7/18/2009 7/11/09: Abdominal pain, nausea, v
351874 7/20/2009 NJ 29 29 M 7/16/2009 Initial report received on 08 July 200
351887 7/20/2009 NV 1 0 1M 6/30/2008 Loss of eye contact, words, repetitiv
351888 7/20/2009 NC 21 21 M 7/15/2009 Developed GUILLAIN BARRE Synd
351889 7/20/2009 70 70 M 7/20/2009 This case wasY reported by a consum
351892 7/20/2009 FL 4 4 F 7/17/2009 Red swollen area measuring 4 1/4 "
351893 7/20/2009 MS 10 10 F Child began to have emesis around
351894 7/20/2009 LA 0.2 0 0.2 M 7/8/2009 Mom reported blister at injection site
351899 7/20/2009 NC 6 6 M 7/14/2009 3 x 3 cm area of redness at vaccina
351900 7/20/2009 NC 29 29 F 7/20/2009 This case was reported by a healthc
351902 7/20/2009 AZ 79 F 7/15/2009 Dermatologist - gave Valtrex 16m +
351903 7/20/2009 NC 12 12 F 7/16/2009 Developed severe headache on 7/1
351904 7/20/2009 NE 13 13 F 7/14/2009 Myalgias, nausea, episode of faintin
351905 7/20/2009 VA 51 51 F 7/14/2009 Administration site became red & sw
351906 7/20/2009 GA 4 4 F 7/14/2009 Eyes swollen, clear runny nose. Sw
351907 7/20/2009 NJ 1.2 1 0.2 F 7/13/2009 10 AM 7/13/2009- Seizure activity- f
351908 7/20/2009 FL 0.2 0 0.2 M 7/14/2009 Pt start crying inconsolable the day
351909 7/20/2009 MI 1.3 1 0.3 F 7/20/2009 C/O LEFT LEG RED AND SWOLLE
351910 7/20/2009 MN 65 65 F 7/20/2009 Received vaccine July 10, 2009 with
351911 7/20/2009 MI 25 25 F 7/20/2009 Rec'd Boostrix on 7/17/09; reports v
351912 7/20/2009 CO 3 3 F 7/20/2009 Shingles
351913 7/20/2009 NY 1.4 1 0.5 M 7/20/2009 the next day his leg was blistered, r
351914 7/20/2009 IN 8 8 M 7/20/2009 On 7/19/09 noted lethargy, headach
351915 7/20/2009 TN 1 1 0F 7/20/2009 Pt developed marked thrombocytop
351916 7/20/2009 WA 20 20 M 7/20/2009 rash on hands, elbows, and chest. c
351917 7/20/2009 NY 0.2 0 0.2 F 7/20/2009 Patient received Pentacel, Prevnar,
351918 7/20/2009 IN 17 17 F 7/20/2009 none
351919 7/20/2009 IN 4 4 F 7/20/2009 none
351920 7/20/2009 PA 66 66 F 7/20/2009 Outbreak of vessicular rash in L5/S1
351921 7/20/2009 MA 32 32 F 7/20/2009 Patient describes receiving Tetanus
351922 7/20/2009 NC 22 22 F 7/20/2009 Employee reported that approximat
351923 7/20/2009 TN 1 1 0F 7/20/2009 Received her 1st Varivax 7/6/09 in h
351924 7/20/2009 VA 72 72 F 7/20/2009 temp 100, rash, itching, left upper u
351925 7/20/2009 OH 17 17 F 7/20/2009 Client received a Menactra on 7/20/
351926 7/20/2009 TN 18 18 M 7/20/2009 Varicella virus vaccine was ordered
351927 7/20/2009 WI 17 F 7/20/2009 The injection site began to itch, turn
351929 7/20/2009 IL 14 14 F 7/20/2009 6 cm wide tender erythmatous area
351930 7/20/2009 KS 59 59 M 7/20/2009 I gave a pediatric dose of Hep B ins
351931 7/20/2009 CA 1 1 0F 7/20/2009 Low Platlet Count
351932 7/20/2009 MA 70 70 M 7/20/2009 Vaccine administered Friday afterno
351933 7/20/2009 WA 38 38 F 7/20/2009 Employee who works in Dental scho
351934 7/20/2009 CA 49 49 M 7/15/2009 Per translator
Y client died 2 to 3 hrs.
351937 7/20/2009 TX 18 18 M 7/20/2009 Within 1-2 days c/o headache, naus
351938 7/20/2009 FL 1.3 1 0.3 M 7/20/2009 Increased temperature 105 degrees
351939 7/20/2009 AZ 11 11 M 7/20/2009 Left arm - noted severe redness, er
351940 7/20/2009 CA 13 13 M 7/20/2009 Patient received VARIVAX IM instea
351941 7/20/2009 WA 67 67 M 7/20/2009 Pt reports insect bite like sensations
351942 7/20/2009 IL 13 13 F 7/10/2009 Patient here for physical with foster
351943 7/20/2009 NC 17 17 F 7/14/2009 7-14-09 8:35 AM - Patient received
351944 7/20/2009 AZ 4 4 M 7/13/2009 Redness and swelling on the left arm
351945 7/20/2009 ME M "Fever, chills, body aches began 2 h
351946 7/20/2009 NV 75 75 F 7/14/2009 Redness, swelling, warmth & streak
351947 7/20/2009 WV 10 10 M 7/17/2009 Redness at injection site, knot in arm
351948 7/20/2009 MA 1 1 0F Less than 24 hrs, acute onset, on b
351950 7/20/2009 WI 10 10 M 7/20/2009 Within 1 min after vaccines adminis
351951 7/20/2009 MI 2 2 0.6 F 7/20/2009 Pt was given Adult dose of Hep A -
351952 7/20/2009 MS 11 11 F Child began to have emesis around
351953 7/20/2009 TN 18 18 F 7/18/2009 Patient complained of pain in injecti
351954 7/20/2009 GA 1.4 1 0.4 F 7/10/2009 Hives started on shoulders and then
351955 7/20/2009 AZ 2 2 0.2 F 7/14/2009 Swelling, erythematous, hot, 3/12 cm
351956 7/20/2009 CA 6 6 F 7/2/2009 All of patient's upper arm, where va
351957 7/20/2009 OR 1.3 1 0.3 M 7/15/2009 Lump & pustule on right thigh.
351958 7/20/2009 ID 5 5 M 7/11/2009 Red - indurated - pruritic 12 X 6 cm
351959 7/20/2009 TX 10 10 F 7/14/2009 None Stated
351960 7/20/2009 MN 30 30 F 7/1/2009 Received vaccine 6/29 - developed
351962 7/21/2009 VT 31 31 F 10/3/2008 Initial report received on 16 Septem
351970 7/21/2009 37 37 F 7/20/2009 InformationYhas been received from
351984 7/21/2009 NC 0.3 0 0.3 M 7/20/2009 Information has been received from
351989 7/21/2009 RI M 7/20/2009 Information has been received from
351998 7/21/2009 MS 20 20 F 3/26/2009 Fatigue for the first few weeks, pani
351999 7/21/2009 50 M 7/8/2009 50yo male received pneumococcal
352000 7/21/2009 NV 4 4 M 7/15/2009 After 15 minutes of giving KINRIX, V
352001 7/21/2009 MD 0.2 0 0.2 F 7/20/2009 G. mom - Reports crying x 2/2 hrs a
352002 7/21/2009 NH 18 18 M 7/14/2009 Raised erythematous somewhat con
352003 7/21/2009 OH 1 1 0F 7/16/2009 On 7/3/09 patient started running a
352004 7/21/2009 ID 19 19 M 7/16/2009 N/A
352005 7/21/2009 OH 5 5 M 7/17/2009 Swelling, redness, pain and itching
352006 7/21/2009 MS 4 4 F 7/17/2009 7/16/09 pm - Received care from M
352007 7/21/2009 TX 2 2 0.2 F 7/16/2009 X 1 Hive at the site of injection. Mea
352008 7/21/2009 NC 63 63 F 7/21/2009 Patient received Zostavax vaccine o
352010 7/21/2009 GA 18 18 F 7/21/2009 Administered adult dose of Hep B v
352011 7/21/2009 MD 48 48 M 7/21/2009 Received two doses of Tdap. First
352012 7/21/2009 MA 23 F 7/21/2009 Patient complained of right swollen
352013 7/21/2009 TX 8 8 F 7/21/2009 Varicella vaccine given 7-18-09 in L
352014 7/21/2009 OK 17 17 M 7/21/2009 Starting the night of immunization h
352015 7/21/2009 VA 0.2 0 0.2 M 7/21/2009 Approximately seven hours after rec
352016 7/21/2009 PA 90 F 7/21/2009 BURNING REDNESS AND EXTRE
352017 7/21/2009 LA 32 32 F 7/21/2009 Pain right deltoid starting the day af
352018 7/21/2009 MD 40 40 F 7/21/2009 Tdap received IM on 7/16/09. Emplo
352019 7/21/2009 ME 43 43 F 7/21/2009 Patient reports fever last evening. M
352020 7/21/2009 NV 24 24 F 7/21/2009 Patient with history of cluster heada
352021 7/21/2009 IL 56 56 F 7/21/2009 fever, rash at site, swelling at site, d
352022 7/21/2009 TX 48 48 F 7/21/2009 Localized inflammatory irritation with
352023 7/21/2009 CA 11 11 M 7/21/2009 VARICELLA 3
352024 7/21/2009 CA 15 15 F 7/21/2009 Immediately after administration of H
352025 7/21/2009 WA 65 65 F 7/17/2009 Left upper arm rash/pain starting 1 d
352026 7/21/2009 VA 15 15 F 7/21/2009 LEFT SIDED FACIAL SWELLING, T
352027 7/21/2009 NC 12 12 M 7/21/2009 Beginning at 6:00 pt c/o soreness.
352028 7/21/2009 CA 1 1 0M 7/21/2009 VACCINE GIVEN ON THE 10 OF J
352030 7/21/2009 IL 0.3 0 0.3 F 7/4/2009 Received vaccines at 2:30 pm office
352031 7/21/2009 NC 62 62 F 7/16/2009 Monday administration, dizziness fo
352032 7/21/2009 IL 14 14 M 7/21/2009 Pt developed chills Monday evening
352033 7/21/2009 GA 14 14 M 7/22/2009 2 d. after immunization began havin
352034 7/21/2009 OR 0.2 0 0.2 F 7/14/2009 The day after child received rotaviru
352035 7/21/2009 WV 1.2 1 0.2 M 7/16/2009 Inconsolable crying last evening (7-
352036 7/21/2009 OR 0.2 0 0.2 F 7/14/2009 After child received rotavirus vaccin
352037 7/21/2009 PA 36 36 F 7/16/2009 Temp. 1004, body aches, nausea.
352038 7/21/2009 MN 12 12 M 7/16/2009 Dizziness, weakness, had to stop u
352039 7/21/2009 MT 15 15 F 7/16/2009 Client experienced dizziness, faintin
352040 7/21/2009 IL 18 18 F 7/16/2009 Immediately after shots were given
352041 7/21/2009 ND 23 23 F 7/17/2009 Rt arm-area red-warm-swollen-tend
352042 7/21/2009 LA 6 6 F 7/16/2009 Developed hives after KINRIX immu
352043 7/21/2009 NC 48 48 F 7/11/2009 Zostavax vaccine given subcutaneo
352044 7/21/2009 27 27 M 7/7/2009 Pruritis, painful, papular rash of han
352046 7/21/2009 KY 4 4 M 7/14/2009 Anaphylaxis: Child presented with h
352047 7/21/2009 VA 11 11 M 7/16/2009 11 yo with large amount of swelling
352048 7/21/2009 WI 4 4 F 7/14/2009 Shots given on 7/10/09 Pt in to U.C
352049 7/21/2009 CA 0.2 0 0.2 F 7/13/2009 Tonic-clonic seizures, 3 hours after
352050 7/21/2009 PA 2 2 0.2 F 7/15/2009 Pts father stated that pt developed f
352051 7/21/2009 MN 70 70 F 7/10/2009 Patient was given Tdap immunizatio
352052 7/21/2009 CA 18 18 F 7/14/2009 Pt was given GARDASIL vaccine up
352053 7/21/2009 AR 32 32 F 7/14/2009 Patient called 7-6-09 c/o (L) arm stif
352054 7/21/2009 OH 10 10 M 7/21/2009 - Acting delirious - severe headache
352055 7/21/2009 AL 12 12 M 7/21/2009 Pt had redness & swelling to injectio
352056 7/21/2009 OH 1 1 0F 7/20/2009 Morbilliform rash - generalized - Rx
352057 7/21/2009 IL 68 68 F 7/21/2009 Redness + itching at site, has persis
352058 7/21/2009 MO 4 4 M 7/21/2009 Developed urticaria, angio edema, t
352059 7/21/2009 CA 1.4 1 0.4 F 7/21/2009 Right arm (erythematous & edemato
352060 7/21/2009 IL 80 80 F 7/21/2009 Swelling, redness, severe itching at
352061 7/21/2009 ID 10 10 M 7/21/2009 N/A given TDAP before age 11 yrs.
352062 7/21/2009 CA 17 17 F 7/21/2009 Dizziness with Pt blurring of vision a
352063 7/21/2009 CA 13 13 F 7/21/2009 Fainted briefly after immunization: in
352064 7/21/2009 WI 18 18 F 7/21/2009 Patient was given GARDASIL on 7/
352065 7/21/2009 NY 9 9 M 7/21/2009 Became lightheaded and nauseous
352066 7/21/2009 PA 58 58 F 7/20/2009 7-17-09 - Sleep & H/A 7-19-09 - H/
352067 7/21/2009 MA 44 44 M 7/16/2009 Client states about 4o after shot his
352068 7/21/2009 OH 6 6 F 7/20/2009 L lump at injection site - egg size, re
352069 7/21/2009 IL 45 45 F 7/21/2009 Pt. has persistent left arm pain since
352070 7/21/2009 NV 66 F Arm swelled, red rash, itchy, ice 15
352071 7/21/2009 TN 5 5 F 7/16/2009 16 cm + 11cm red area surrounding
352072 7/21/2009 CA 4 4 M Spiked a fever, began vomiting, & s
352029 7/22/2009 CA 0.5 0 0.5 F 7/21/2009 The patient had what were describe
352093 7/22/2009 MD 0.2 0 0.2 M 7/17/2009 25 wker now 11 wks old received 2
352094 7/22/2009 CA 59 59 F 7/17/2009 Blister like spots to back, arms,ches
352095 7/22/2009 63 63 F 7/20/2009 I have received the ZOSTAVAX vac
352096 7/22/2009 VA 62 62 F 7/16/2009 Bright red rash 3 x 7 cm at injection
352100 7/22/2009 AZ 26 26 F 7/22/2009 This case was reported by a pharma
352152 7/22/2009 IL 21 21 F 7/22/2009 Seizures, Slurred speech, Dizziness
352153 7/22/2009 OH 17 17 M 7/22/2009 Acute disseminated encephalomyel
352154 7/22/2009 TX 10 10 F 7/22/2009 Small, bumpy, itchy rash at injection
352155 7/22/2009 UT 60 60 F 7/22/2009 PT REPORTS WAKING WITH HEA
352156 7/22/2009 KS 12 12 F 7/22/2009 Parent states child c/o right arm pai
352157 7/22/2009 WA 66 66 M 7/22/2009 Per patient secure message (email)
352158 7/22/2009 CO 43 43 M 7/22/2009 Patient experienced change in sens
352159 7/22/2009 PA 22 22 F 7/22/2009 Patient received a gardasil vaccine
352160 7/22/2009 SC 77 77 M 7/22/2009 Patient presents with redness and w
352161 7/22/2009 TX 4 4 F 7/22/2009 Site of injection red, swollen, with pa
352162 7/22/2009 NV 0.2 0 0.2 F 7/22/2009 The baby diedY under suspicious con
352163 7/22/2009 TX 4 4 F 7/22/2009 Left upper arm wheal measured at 5
352164 7/22/2009 PA 8 8 F 7/22/2009 5/20/09 received telephone call from
352165 7/22/2009 ND 1.5 1 0.5 M 7/22/2009 SEIZURE LASTED 10-30 SECOND
352166 7/22/2009 AR 5 5 F 7/22/2009 localized swelling, redness, and war
352167 7/22/2009 CO 60 60 F 7/22/2009 patient reports vaccination site with
352168 7/22/2009 NC 10 10 F 7/22/2009 On 7-14-09 pt received varicella and
352184 7/22/2009 NJ 26 26 M 7/22/2009 Pt went to ER on 6/26/09. Pt states
352185 7/22/2009 NM 1.1 1 0.1 F 7/22/2009 Petechial Rash entire body. Fever t
352186 7/22/2009 KS 4 4 M 7/22/2009 Mother reported erythema swelling
352187 7/22/2009 NY 17.8 17 F 7/22/2009 Evening of vaccines, pt developed r
352188 7/22/2009 OR 2 2 0.2 M 7/22/2009 None Stated.
352189 7/22/2009 MI 58 58 F 7/22/2009 Onset of swelling, erythema <48 ho
352190 7/22/2009 MI 53 U 7/22/2009 Approximately 4 days after vaccinat
352191 7/22/2009 CA 23 23 F 7/22/2009 Fever, sweats, nausea, vomiting & s
352192 7/22/2009 AK 8 8 M 7/22/2009 Pt came in on 20 Jul 09 to receive V
352193 7/22/2009 12 12 F 7/10/2009 Left upper arm over Tricep with 3x4
352194 7/22/2009 MN 0 0 0M 7/21/2009 7-10 days post injection, site of VAR
352196 7/22/2009 MN 1.1 1 0.1 F 7/21/2009 7-10 days after injection, at site of V
352197 7/22/2009 FL 11 11 F 7/22/2009 Headache, dizziness AP 89 reg R-2
352199 7/22/2009 AK 23 23 F Pt came back to clinic after 15 min c
352202 7/22/2009 MD 4 4 F 6/24/2009 Vaccine administered on 6/22/2009
352214 7/22/2009 MD F 7/15/2009 Information has been received from
352169 7/23/2009 CA 11 11 F 7/23/2009 Complained of feeling faint, lighthea
352224 7/23/2009 WA M 7/22/2009 Information has been received from
352240 7/23/2009 TX 15 15 F 7/22/2009 This case was received from a heal
352248 7/23/2009 MI 17 17 M 7/21/2009 Pt complained of thirst after receivin
352249 7/23/2009 MN 15 15 M 7/22/2009 3 hours after injections-pt became m
352250 7/23/2009 NH 12 12 F 7/22/2009 Mom called said she wanted it docu
352251 7/23/2009 MO 16 16 F 7/23/2009 HPV #1 lot# 0171U, exp 6/29/09 wa
352252 7/23/2009 MO 16 16 F 7/23/2009 Received HPV # 3 on 7/15/2009. T
352255 7/23/2009 MO 15 15 F 7/23/2009 Received HPV #3 on 7/15/09. This
352256 7/23/2009 MO 12 12 F 7/23/2009 Received HPV #2 7/21/09. This vac
352257 7/23/2009 OH 60 60 F 7/20/2009 7 X 9 cm. area of redness and edem
352258 7/23/2009 NY 5 5 M 7/20/2009 Patients arm swelled up and appea
352260 7/23/2009 NY 21 21 F 7/17/2009 Pt fell to floor post GARDASIL vacc
352261 7/23/2009 ME 66 66 F 7/20/2009 Broke out in severe rash left side ne
352262 7/23/2009 PA 10 10 F 7/17/2009 Mother reports child began having r
352263 7/23/2009 CT 5 5 M 7/17/2009 Upper left deltoid area reddened, sw
352264 7/23/2009 GA 1.3 1 0.3 F 7/8/2009 -Skin redness over body, -Rash, -Itc
352265 7/23/2009 NY 8 8 M 7/16/2009 Red, warm, swollen "2x2 " tender co
352266 7/23/2009 NC 67 67 F 7/17/2009 Redness, itching, and induration aro
352267 7/23/2009 NC 65 65 F 7/17/2009 Redness, swelling, and pain surroun
352268 7/23/2009 GA 11 11 M 9/23/2009 After MENACTRA, TDAP, vaccinati
352269 7/23/2009 TX 18 18 F 7/23/2009 Reported 7/23/09 - came to clinic to
352270 7/23/2009 NE 17 17 F 7/23/2009 Seizure - like activity noted on 7-22-
352286 7/23/2009 ME 6 6 F 7/23/2009 Patient arrived at ED 17 Jul 2009 @
352287 7/23/2009 CA 1.1 1 0.1 F 7/23/2009 Macular - papular rash 1 day after v
352288 7/23/2009 AZ 4 4 M 7/25/2009 Local erythema, induration, warmth,
352289 7/23/2009 NY 72 71 F 7/23/2009 chicken pox like rash/hive like, occu
352290 7/23/2009 IN 11 11 F 7/23/2009 large, red welt at site of vaccine. Pa
352291 7/23/2009 NY 19 19 F 7/23/2009 erythema to left tricep area started d
352292 7/23/2009 MO 57 57 M 7/23/2009 3 days after shots, had joint aches a
352293 7/23/2009 OK 0.3 0 0.3 F 7/23/2009 She was born Y August 22nd, 2008, p
352294 7/23/2009 OK 11 11 F 7/23/2009 Right upper arm with large red, indu
352295 7/23/2009 NY 73 72 F 7/23/2009 off balance with nausea and vomitin
352296 7/23/2009 AK 66 66 F 7/23/2009 Shingles vacccine: first and second
352297 7/23/2009 58 M 7/23/2009 PT REPORTED FEVER AND PAIN
352298 7/23/2009 TN 9 9 F 7/23/2009 Patient received 2nd Varivax on 7/2
352299 7/23/2009 IA 0.2 0 0.1 M 7/23/2009 Unconsolable crying for 3 and 1/2 h
352300 7/23/2009 OR 4 4 F 7/23/2009 10 cm x 11 cm red, warm, localized
352301 7/23/2009 IN 8 8 F 7/23/2009 Patient returned to District Health O
352302 7/23/2009 IN 22 22 M 7/23/2009 CLIENT RETURNED TO CLINIC FO
352303 7/23/2009 TX 57 57 F 7/23/2009 Severe rash to arms and legs, seen
352304 7/23/2009 WA 72 72 F 7/23/2009 Patient reported experiencing wide-
352305 7/23/2009 CA 39 39 F 7/23/2009 SWOLLEN ARM, FEELING LOTS O
352306 7/23/2009 CA 51 51 M 7/23/2009 Suffered a transverse myelitis which
352307 7/23/2009 TX 14 14 M 7/23/2009 Ten minutes after receiving immuniz
352308 7/23/2009 AL 4 4 F 7/23/2009 (L) thigh red, swollen with heat. War
352309 7/23/2009 PA 9 9 M 7/23/2009 Pt had syncopal episode post receiv
352310 7/23/2009 AZ 15 15 F 7/23/2009 Swelling / redness with 3 cm x 2 cm
352356 7/24/2009 F 7/16/2009 This case was initially reported by a
352364 7/24/2009 CA 12 12 F 7/17/2009 Developed progressive lower extrem
352365 7/24/2009 U 7/21/2009 Not an adverse event, but I have ha
352366 7/24/2009 MD 11 11 F 7/13/2009 Had a panic attack (shortness of bre
352367 7/24/2009 WA 0.2 0 0.2 M 7/21/2009 (1) very pale, white - bluish lip - one
352368 7/24/2009 TX 22 22 F 7/17/2009 TDAP given in left arm 7-13-2009. P
352369 7/24/2009 IL U Facial swelling, rash
352370 7/24/2009 ID 3 3 F No adverse events. I gave a Hepati
352371 7/24/2009 NY 4 4 M 7/20/2009 Red/ swollen left deltoid, warm to to
352372 7/24/2009 AL 71 71 M 6/30 - Small dark bump around righ
352373 7/24/2009 VT 5 5 M 7/21/2009 5 cm X 6 cm erythema, red, tender
352374 7/24/2009 IL 79 79 F 7/21/2009 4 days after injection, vomited biliou
352375 7/24/2009 CA 20 20 F 7/20/2009 Patient received MMR vaccine on 7
352376 7/24/2009 NM 64 64 M 7/16/2009 After patient received SUB-Q injecti
352377 7/24/2009 MI 18 18 F 6/22/2009 On 6/20/09 per parent, client got ou
352378 7/24/2009 OH 1.1 1 0.1 M 7/21/2009 On 10/11/2007 client had his first co
352379 7/24/2009 PA 15 15 F 7/24/2009 Patient got lightheaded immediately
352380 7/24/2009 VA 36 36 F 7/20/2009 Four hours after taking pill # 1 - bac
352381 7/24/2009 CO 40 40 F 7/8/2009 None stated.
352382 7/24/2009 NC 18 18 M 7/17/2009 Redness, puffiness + warm to touch
352383 7/24/2009 GA 5 4 M 7/20/2009 Swelling/ redness < 24 hrs after adm
352384 7/24/2009 GA 10 10 M 7/21/2009 Red papulo-vesicular rashes all ove
352385 7/24/2009 CA M Red and itchy and a lump at the site
352386 7/24/2009 TX 23 23 M 7/23/2009 Difficulty swallowing began 15 minu
352387 7/24/2009 GA 16 16 F 7/24/2009 Presented with Health Dept today, 7
352388 7/24/2009 FL 11 11 F 7/24/2009 Swelling and redness/induration (R)
352389 7/24/2009 MI 21 21 F 7/23/2009 Patient fainted directly after adminis
352390 7/24/2009 FL 16 16 F 7/24/2009 Patient tolerated the HPV vaccine in
352391 7/24/2009 FL 11 11 F 7/24/2009 clammy skin, right sided chest pain,
352392 7/24/2009 NC 4 4 M 7/24/2009 REDNESS AND SWELLING 3CM B
352393 7/24/2009 OK 57 57 F 7/24/2009 I received a flu shot at this clinic on
352394 7/24/2009 MO 8 8 M 7/24/2009 Local reaction at injection sites, red
352395 7/24/2009 IA 65 65 F 7/24/2009 Patient had large, swollen, firey red
352396 7/24/2009 MI 0.4 0 0.4 F 7/24/2009 Per patient's mother, baby had 4 da
352397 7/24/2009 IL 15 15 F 7/24/2009 Injection site swollen to softball size
352398 7/24/2009 MI 15 15 F 7/24/2009 Immediately after receiving Tdap, M
352399 7/24/2009 CA 34 34 F 7/24/2009 Swollen glands around neck, breast
352400 7/24/2009 ID 1.3 1 0.3 M 7/24/2009 07-21-09 Given vaccines. Started w
352401 7/24/2009 NY 0.2 0 0.2 M 7/24/2009 patient had 2 episodes of seizure-lik
352402 7/24/2009 TN 12 12 M 7/24/2009 On 7/9/09 Patient received Hep a, M
352403 7/24/2009 WI 18 18 F 7/24/2009 Varicella administered on 7/22/09.
352404 7/24/2009 CO 10 10 F 7/24/2009 Initially patient had a red, swollen, w
352405 7/24/2009 MI 0.5 0 0.5 F 7/24/2009 N/A
352406 7/24/2009 OH 57 57 F 7/24/2009 Client treated at ER for steam burn
352407 7/24/2009 NC 5 5 F 7/24/2009 OBLONGED SHAPE RED RASH(P
352408 7/24/2009 NY 0.2 0 0.2 M 7/24/2009 positive guiac stool 1 day after rotav
352409 7/24/2009 AR 37 37 F 7/24/2009 12 hours later started continuous sh
352410 7/24/2009 NY 65 65 M 7/24/2009 Swelling, redness at site and upper
352411 7/24/2009 CA 7 7 M 7/24/2009 VACCINE WAS GIVEN 2 DAYS AG
352412 7/24/2009 MI 22 22 M 7/24/2009 TEMP OF 102.1 FOR TWO DAYS.
352413 7/24/2009 MO 4 4 F 7/24/2009 Pt. develped redness at site and low
352423 7/24/2009 MN 0.2 0 0.2 M 7/24/2009 Parents report (at 4 mo visit) excess
352424 7/24/2009 MI 4 4 M 7/22/2009 Swelling of thigh, development of er
352425 7/24/2009 PA 63 63 M 7/24/2009 Patient developed a debilitating hea
352426 7/24/2009 NH 0.5 0 0.5 M 7/24/2009 Lethargy, poor feeding, fever to 103
352427 7/24/2009 MA 4 4 F 7/24/2009 (R) arm red, warm to touch, red rash
352428 7/24/2009 AZ 12 12 M 7/24/2009 Client talking while receiving vaccin
352429 7/24/2009 AZ 14 14 F 7/24/2009 7/24/09 1300 client became pale, L
352430 7/24/2009 IL 11 11 F 7/25/2009 Fainting immediately after MENACT
352431 7/24/2009 AK 65 65 M 7/26/2009 Pt had received ZOSTAVAX on 7-1
352432 7/24/2009 KY 4 4 M 7/24/2009 4x4 cm erythema around injection s
352433 7/24/2009 CA 0.2 0 0.2 M 7/23/2009 Developed Inflammatory Diarrhea w
352434 7/24/2009 NJ 0 0 0M 7/24/2009 7-17-09 pt was given Hep B vaccine
352435 7/24/2009 PA 10 10 F 7/24/2009 Tender, erythematous, slightly warm
352436 7/24/2009 LA 11 11 M 7/24/2009 Four hours after injection pt started
352437 7/24/2009 GA 11 11 M 7/23/2009 Site reaction to vaccine in left deltoi
352452 7/24/2009 SC 0.7 -1 0.7 M 7/24/2009 This case was reported by a pharma
352453 7/24/2009 IL 32 32 F 7/24/2009 This case was reported by a healthc
352414 7/25/2009 MI 5 5 M 7/25/2009 entire arm swelled that the shot was
352415 7/25/2009 NJ 0.8 0 0.8 M 7/25/2009 Within an hour of the shot (took plac
352416 7/25/2009 NJ 0.7 0 0.7 M 7/25/2009 Lump at injection site, lasted 4 wks(
352417 7/25/2009 AZ 9 9 F 7/25/2009 Erythema (14cm X 15cm), itchiness
352418 7/25/2009 NJ 70 70 F 7/25/2009 Slight itching at injection site immed
352419 7/26/2009 PA 73 73 M 7/26/2009 Redness and itching at injection site
352420 7/26/2009 FL 59 59 M 7/26/2009 6 months post shingles vaccine, I be
352421 7/27/2009 SC 17 17 F 7/27/2009 Nausea & vomiting, abdominal pain
352422 7/27/2009 41 41 M 7/27/2009 Guillain Barre Syndrome developed
352455 7/27/2009 CA 19 19 F 7/27/2009 Fainted briefly after - body was shak
352457 7/27/2009 CA 82 82 F 7/23/2009 Pt developed red lesions with itchin
352458 7/27/2009 PA 14 14 F 7/23/2009 Mother reports,7/17/09 Pt. had redn
352459 7/27/2009 NC 0.2 0 0.2 F 7/24/2009 Prolonged high pitched screaming a
352460 7/27/2009 WA 40 40 F 7/20/2009 Received TDAP 4/21/09. At 7/7/09
352461 7/27/2009 CA 59 59 F 7/17/2009 Blister like spots to back, arms, che
352462 7/27/2009 NY 71 71 F 7/20/2009 Began having painful needle like pri
352463 7/27/2009 OH 28 18 F 7/22/2009 Initially cold, chills, achy, arm pain T
352464 7/27/2009 CA 4 4 F 7/20/2009 Patient experienced severe adverse
352465 7/27/2009 47 47 M 7/6/2009 Macular rash 4 x 4 cm surrounding
352466 7/27/2009 NC 67 67 F 7/21/2009 The vaccine was to prevent further
352467 7/27/2009 SC 1 0 1F 7/20/2009 Rash and mild fever X 2 days starte
352468 7/27/2009 AZ 1.8 1 0.8 M 7/21/2009 Rash 3 cm X 4 cm patch of erythem
352476 7/27/2009 WI 1 1 0M 7/24/2009 Diagnosed with Idiopathic thromboc
352477 7/27/2009 WY 1.7 1 0.7 F 7/27/2009 Had a small outbreak of pox with fe
352478 7/27/2009 GA 11 11 M 7/27/2009 (R) deltoid - MENACTRA - large sw
352479 7/27/2009 NM 54 54 F 7/24/2009 Injection given 7/20/09 right deltoid;
352480 7/27/2009 NY 0.3 0 0.3 M 7/23/2009 10 seconds head & hands shaking.
352481 7/27/2009 NC 2 2 0.7 F 7/22/2009 Fever to 102 degrees F nausea, vom
352482 7/27/2009 52 52 M 7/1/2009 Leg problems, sleep difficulties, phy
352483 7/27/2009 NV 0.2 0 0.2 M 1/29/2008 ROTATEQ given 12/17/07. 12/19/0
352484 7/27/2009 NV 0.3 0 0.3 F 12/5/2008 Received immunization 9/11/08- PE
352485 7/27/2009 PA 0.5 0 0.5 F 7/21/2009 Fever 105(R) 2 days after immuniza
352486 7/27/2009 MN 12 12 F 7/20/2009 12 yr old received VARIVAX and TD
352487 7/27/2009 TX 13 13 F 7/27/2009 Local redness, swelling, blanching,
352488 7/27/2009 VA 13 F 7/27/2009 Varivax on 7/20/09 - Developed, 2 d
352489 7/27/2009 VA 15 15 F 7/27/2009 Received VARIVAX #2 on 7/22/09,
352490 7/27/2009 PA 9 9 M 7/27/2009 Pt stated it started hurting right awa
352491 7/27/2009 NY 0.5 0 0.5 M 7/28/2009 5 seconds hands shaking w/ head s
352492 7/27/2009 AL 10 10 M 7/27/2009 Rash 5 X 5 to right arm, around inje
352493 7/27/2009 TN 1 1 0M 7/23/2009 Elevated temperature with diminishe
352494 7/27/2009 WA 52 52 F 7/10/2009 Erythema, heat, mild edema, pain
352495 7/27/2009 NJ 8 8 F 7/22/2009 Hives on cheeks, chest, arms & legs
352499 7/27/2009 CA 45 45 F 7/22/2009 Post 1st Dose 07.15.09 Throbbing b
352501 7/27/2009 AR 0.2 0 0.2 F 6/12/2009 "Cried for 3 d"; cried for more than 3
352504 7/27/2009 NV 36 36 F 2/19/2009 Hives on thighs BENADRYL and Alo
352511 7/27/2009 PA 50 50 F 7/22/2009 Initial report was received 20 July 20
352526 7/27/2009 MI 33 33 F 7/27/2009 Patient states she had fatique, weak
352527 7/27/2009 ME 3 3 M 7/27/2009 Redness, swollen, nodule, tender to
352528 7/27/2009 PA 4 4 F 7/27/2009 24 hours after immunization, Left ar
352529 7/27/2009 MI 1.4 1 0.4 U UPON PHONE CALL WE MADE TO
352530 7/27/2009 IN 17 17 M 7/27/2009 Immunized on 7/15/09, on 7/16/09 a
352531 7/27/2009 CA 12 12 M 7/27/2009 After the 4th vaccine was given (me
352532 7/27/2009 TX 14 14 U 7/27/2009 3 CM AREA OF ERYTHEMA, WAR
352533 7/27/2009 CA 4 4 M 7/27/2009 KINRIX GIVEN TWICE
352534 7/27/2009 ID 61 61 M 7/27/2009 Patient presented to the ER the follo
352535 7/27/2009 KS 14 14 F 7/27/2009 The back of the right arm where the
352536 7/27/2009 VA 30 30 F 7/27/2009 This employee of the hospital receiv
352537 7/27/2009 MO 1.1 1 0.1 M 7/27/2009 Parent noted swollen lymph nodes i
352538 7/27/2009 TN 52 52 F 7/27/2009 3 inch by 3 inch indurated area with
352539 7/27/2009 OR 10 10 F 7/27/2009 7/25/09 patient came in with 4 x 5 in
352540 7/27/2009 FL 44 44 F 7/27/2009 approximately 30 minutes after Tda
352541 7/27/2009 KY 67 67 F 7/27/2009 24 hours after injection developed a
352542 7/27/2009 AZ 1 1 0M 7/27/2009 RASH ALL OVER BODY
352543 7/27/2009 ND 62 62 F 7/27/2009 Received the Shingles vaccination o
352544 7/27/2009 GA 62 62 F 7/27/2009 Large red, hot and itchy patch or 4"
352545 7/27/2009 CO 30 30 M 7/27/2009 First vaccine in series was given on
352546 7/27/2009 CO 30 30 M 7/27/2009 Twinrix dose #2 given on 7/13/09. P
352547 7/27/2009 KY 18 18 F 7/27/2009 Patient experienced problems breat
352548 7/27/2009 KS 15 15 F 7/27/2009 Had a syncopal episode in the park
352549 7/27/2009 PA 75 75 F 7/27/2009 Red blotch ~ 2 inches in length and
352550 7/27/2009 WA 4 4 F 7/27/2009 upper extremities became stiff imme
352551 7/27/2009 IN 5 5 M 7/27/2009 Left thigh red and raised
352552 7/27/2009 AZ 16 16 F 7/13/2009 VARICELLA - redness / swelling 7/1
352553 7/27/2009 TX 11 11 F 7/23/2009 Localized hives, erythema, itchy wit
352554 7/27/2009 CA 1.3 1 0.3 F Patient got MMR #1, VARICELLA #
352555 7/27/2009 FL 0.2 0 0.2 F 7/27/2009 48 hrs after DTaP Imm. infant sleep
352556 7/27/2009 NY 12 12 F 7/27/2009 Site warm, firm erythematous mild a
352557 7/27/2009 OK 19 19 F 7/27/2009 HEP B injection given on Monday. W
352558 7/27/2009 CA 0.3 0 0.3 F 7/24/2009 Pt developed enlarged left inguinal
352559 7/27/2009 66 F Redness - Soreness proximal to inje
352560 7/27/2009 WI 4 M 7/25/2009 erythema, edema, warmth entire rig
352561 7/27/2009 KY 2 2 0.2 F 7/22/2009 Cellulitis left thigh
352564 7/27/2009 IA 56 F 7/15/2009 This case was reported by a healthc
352565 7/27/2009 OK 77 77 F 7/7/2009 This case was reported by a physici
352566 7/28/2009 AR 15 15 F 7/21/2009 After vaccine started having severe
352567 7/28/2009 CA 12 12 F 7/21/2009 1) Pt fainted / or passed out after va
352568 7/28/2009 CA 1 1 0M 7/23/2009 Febrile seizure the night after immu
352569 7/28/2009 ID 17 17 F 7/22/2009 Before administering vaccine patien
352570 7/28/2009 UT 12 12 M 7/23/2009 Within 1-2 minutes of administration
352571 7/28/2009 PA 1.2 1 0.2 M 7/21/2009 Shingles on 7/19/09. - Acyclonir
352572 7/28/2009 CO 11.2 11 M 7/22/2009 Redness and heat at vaccine sites.
352573 7/28/2009 NC 5 5 M 7/22/2009 Child fever 102 degrees F, sleepy, l
352574 7/28/2009 IN 18 18 F 6/22/2009 Parent stated RA swelled and redde
352575 7/28/2009 HI 10 10 F 7/22/2009 She got vaccinated on Monday 7/20
352576 7/28/2009 KY 11 11 M 7/20/2009 Rash on left forearm and trunk, Sat
352577 7/28/2009 AR 63 63 F 7/17/2009 Pt developed shingles like rash acro
352578 7/28/2009 MD 19 19 F 7/21/2009 7 hours after GARDASIL (HPV) vac
352579 7/28/2009 IN 5 5 F 7/21/2009 Localized rxn with redness, warmth
352580 7/28/2009 OH 0.3 0 0.3 F 7/22/2009 c/o rash, fever, fussy x 1 day. c/o sw
352581 7/28/2009 OH 6 6 F 7/22/2009 Mom called office and stated child w
352582 7/28/2009 MI 13 13 M 7/23/2009 Left arm (entire upper arm) edemato
352583 7/28/2009 FL 73 73 F Face only. Swollen cheeks, hot and
352584 7/28/2009 PA 76 76 F 7/22/2009 Patient is allergic to AVELOX. Deve
352585 7/28/2009 OH 61 61 F 7/22/2009 9 days after ZOSTAVAX - began wi
352586 7/28/2009 KS 12 12 M 7/22/2009 General malaise began day 1 follow
352587 7/28/2009 WI 16 16 F 7/20/2009 Mom reported posterior right arm, 1
352588 7/28/2009 CA 75 75 F 7/3/2009 Raised red area, long, around inject
352589 7/28/2009 MA 0.2 0 0.2 M 7/23/2009 Received 2 mo vaccines at 11 AM o
352590 7/28/2009 TN 46 46 M 7/21/2009 Pt given 4 vaccines (Tdap, MMR, H
352591 7/28/2009 NH 64 64 M 7/21/2009 Temp. 101.2 B.P. elevated @ 160/9
352592 7/28/2009 CA 1.3 1 0.3 F 7/23/2008 Bump on Left leg where vaccine wa
352593 7/28/2009 IL 14 F 7/14/2009 High fever 102 degrees, about 3 da
352594 7/28/2009 KS 18 18 F 7/17/2009 Pt. with brief (< 1 minute) syncopal
352597 7/28/2009 TN 10 10 F 7/24/2009 Initial report received on 07 July 200
352613 7/28/2009 PA 4 4 F 7/27/2009 Received KINRIX on 7/23/09, grand
352614 7/28/2009 PA 4 4 M 7/27/2009 Received KINRIX on 7/21/09, paren
352615 7/28/2009 NC 16 15 F 7/16/2009 Pt experiencing erythema, warmth,
352616 7/28/2009 SC 11 11 M 7/24/2009 Menactra + varicella given wed. 7-2
352617 7/28/2009 OH 12 12 M 7/27/2009 Immediately after shot pt felt light he
352618 7/28/2009 NC 35 35 F 7/7/2009 Patient began having swelling pain,
352619 7/28/2009 WI 40 40 F 7/28/2009 Got injection on 07/24/09. On 07/2
352620 7/28/2009 VA 61 61 F 7/28/2009 Referred to health dept. by Dr. for y
352621 7/28/2009 WA 24 24 F 7/27/2009 L arm pain for five days following va
352622 7/28/2009 TX 11 F 7/28/2009 This child was given a Dtap instead
352623 7/28/2009 TX 5 5 U 7/28/2009 swollen and redness right leg dtap #
352624 7/28/2009 FL 1.1 1 0.1 M 7/28/2009 Patient developed fever, seizure, Le
352625 7/28/2009 TX 12 12 M 7/28/2009 Painful rash to abdomen. treatment
352626 7/28/2009 NY 49 49 F 7/28/2009 Pain, swelling at site of injection on
352627 7/28/2009 PA 36 M 7/28/2009 Discomfort to Left Arm Constant pai
352628 7/28/2009 CA 3 3 M 7/28/2009 Redness,swelling and tenderness 1
352629 7/28/2009 LA 11 11 F 7/28/2009 Tdap, Varicella, MCV4, & Gardasil w
352630 7/28/2009 MI 14 14 F 7/28/2009 Per patients mom, patient complain
352631 7/28/2009 CO 32 32 F 7/28/2009 Dimple at injection site (left upper ar
352632 7/28/2009 TX 15 15 F 7/28/2009 Localized allergic reaction to vaccin
352633 7/28/2009 CA 3 3 M 7/28/2009 L lateral upper extremity with ~ 4 cm
352634 7/28/2009 NV 26 26 F 7/28/2009 Pt developed systemic hives, pruriti
352635 7/28/2009 MO 68 68 F 7/28/2009 redness at site of injection; c/o left s
352636 7/28/2009 VA 4 4 M 7/28/2009 vaccine related varicella (skin rash)
352638 7/28/2009 NE 1 1 0M 7/15/2009 Child had fever for 2 weeks (intermi
352639 7/28/2009 NY 68 68 F 7/28/2009 0 adverse events
352640 7/28/2009 IN 18 18 F 7/28/2009 Feels warm though no fever. Edem
352641 7/28/2009 CT 11 11 F 7/24/2009 Vaccine given: 7/21/09 - Fever day
352642 7/28/2009 IL 0.3 0 0.3 F 7/22/2009 Projectile vomiting irritability Clingy
352643 7/28/2009 PA 43 43 F 7/28/2009 Began 7-25-09 with "mild achy". W
352644 7/28/2009 ID 66 66 F 7/28/2009 TDAP given instead of TD. No adve
352646 7/28/2009 IL 9 9 M 7/24/2009 Vesicular eruption at injection site d
352648 7/28/2009 M 4/3/2009 Initial report received from a consum
352649 7/28/2009 41 41 M This case was received on 05 May 2
352637 7/29/2009 CA 4 4 M 7/29/2009 Had injections at 11:20 am on 7-27-
352653 7/29/2009 85 F 7/23/2009 On 03/20/09 I received ZOSTAVAX
352654 7/29/2009 CO 11 11 M 7/23/2009 Patient contracted Chicken Pox dise
352655 7/29/2009 66 M 7/15/2009 Had shingles vaccine injected on 7-
352656 7/29/2009 67 M 7/23/2009 ZOSTAVAX vaccine injection side e
352657 7/29/2009 WV 59 59 F 7/25/2009 For 1 wk after - can't lift arm (left) - h
352658 7/29/2009 F 7/24/2009 6 days post MMR/VARIVAX adminis
352659 7/29/2009 MO 25 25 F 7/21/2009 Patient c/o lightheadedness, "feeling
352660 7/29/2009 GA 11 11 M 7/24/2009 On 7/22/2009 right arm became sw
352668 7/29/2009 TX 12 12 M 7/24/2009 Got shots just after 9 AM. Left office
352669 7/29/2009 IN 0.3 0 0.3 M 7/28/2009 Child had rectal temp of 101.4 F an
352670 7/29/2009 MA 0.5 0 0.5 M 7/22/2009 Approx. 10 minutes after receiving v
352671 7/29/2009 VA 11 11 F Received VARIVAX #2 on 7/27/09 -
352672 7/29/2009 NY 0.2 0 0.2 F 7/26/2009 More than three weeks of moderate
352673 7/29/2009 PA 19 19 M 7/28/2009 Sitting in waiting area after administ
352674 7/29/2009 IA 26 26 F 7/29/2009 Patient had fainting episode shortly
352675 7/29/2009 MA 12 12 F 7/29/2009 At yearly physical this year 7/22/07,
352676 7/29/2009 TX 5 5 M 7/29/2009 Mother reports she noted large red
352677 7/29/2009 TN 11 11 M 7/29/2009 Patient received Varivax on 7/27/09
352678 7/29/2009 CA 0.2 0 0.2 F 7/29/2009 Intussusception. 8/24/09 Hospital re
352679 7/29/2009 TN 14 14 M 7/29/2009 Patient received 2nd Varivax on 7/2
352680 7/29/2009 NC 1.1 1 0.6 M 7/29/2009 EYTHERMA, WARMTH AND TEND
352681 7/29/2009 CA 1.3 1 0.3 F 7/29/2009 Patient woke up with several large a
352682 7/29/2009 WA 1 1 0M 7/29/2009 Febrile illness without ill contacts, G
352683 7/29/2009 KY 83 83 F 7/29/2009 Patient received vaccine at pharma
352684 7/29/2009 PA 13 13 F 7/29/2009 Received HPV #3 on 7/22/09. Abou
352685 7/29/2009 FL 72 71 F 7/29/2009 Zostavax (0561Y/4131x)administere
352686 7/29/2009 MO 18 18 F 7/29/2009 Within 2-3 minutes following mening
352687 7/29/2009 IA 14 14 M 7/29/2009 Ben went to the school to lift weight
352688 7/29/2009 MN 5 5 F 7/29/2009 4" x 3" area of swelling, hard, red, h
352689 7/29/2009 MD 21 21 F 7/29/2009 bilateral arm rash
352690 7/29/2009 SD 0.9 0 0.9 M 7/29/2009 PATIENT WAS ADMINISTERED A
352691 7/29/2009 SD 0.9 0 0.9 M 7/29/2009 PATIENT WAS GIVEN SECOND D
352692 7/29/2009 ID 67 67 M 7/29/2009 Redness - silver dollar size - at adm
352693 7/29/2009 NV 67 67 M 7/29/2009 Half dollar sized rash and swelling a
352694 7/29/2009 NC 40 40 F 7/29/2009 Moving severe pain in arm from sho
352695 7/29/2009 DE 15 15 F 7/29/2009 Fever 102.9, chills, body aches, mild
352696 7/29/2009 MS 24 24 M 7/29/2009 Vaccine administered day 0, 1000.
352697 7/29/2009 CA 21 21 M 7/28/2009 Pt had seizure (new onset) 19 Apr 2
352704 7/29/2009 FL 14 14 F 7/24/2009 Pt received vaccine - at above clinic
352705 7/29/2009 VI 1.5 1 0.5 M 7/29/2009 On 7/27/09 presented with rash on
352706 7/29/2009 CO 17 17 F Patient got dizzy, 30-60 minutes aft
352707 7/29/2009 OR U Redness at site with swelling and sk
352708 7/29/2009 IL 5 5 M 7/29/2009 Entire L thigh swollen and erythema
352709 7/29/2009 NC 4 4 F 7/29/2009 Pt. reported back to clinic after rece
352710 7/29/2009 KY 0.2 0 0.2 F 7/29/2009 Cellulitis R vastus lateralis
352711 7/29/2009 FL 18 18 F Patient received HPV vaccine (3rd d
352712 7/29/2009 KY 16 16 F 7/29/2009 Hives after injection #1 Gardasil. 1
352713 7/29/2009 IA 18 18 F 7/28/2009 After administering vaccines listed b
352714 7/29/2009 FL 12 12 F 7/29/2009 1-2 seconds after immunizations ad
352715 7/29/2009 NM 5 5 F 7/20/2009 Red and swollen area (approx 31/2"
352716 7/29/2009 TN 0 0 0M 7/29/2009 Mother reports that he spent Sat. ni
352717 7/29/2009 WI 19 19 F 7/29/2009 Period delayed 3 days after 2nd dos
352718 7/29/2009 SC 1.3 1 0.3 F 7/29/2009 Fever 105.7, febrile seizure, eyes ru
352719 7/29/2009 AZ 8 8 F 7/29/2009 Area warm, rash, redness & from pr
352720 7/29/2009 TX 6 6 F 7/29/2009 Right arm posterior area red; very s
352721 7/29/2009 AL 52 52 F 7/29/2009 Vaccinated 7/24/09. 7/25/09 evenin
352722 7/29/2009 NJ 0.3 0 0.3 F 7/29/2009 Rash B/L legs - Bumpy rash with fev
352729 7/30/2009 OK 0.1 0 0.1 M 7/29/2009 Information has been received from
352739 7/30/2009 MD 67 67 M 7/19/2009 May 26, 2007 couldn't walk right - to
352740 7/30/2009 60 F 7/27/2009 After receiving the new shingles vac
352742 7/30/2009 VA M 7/27/2009 None Stated
352744 7/30/2009 ME 14 14 F 7/24/2009 Low grade fever, muscle aches, site
352748 7/30/2009 NE 9 9 F 7/28/2009 Red raised rash on neck, legs, arms
352749 7/30/2009 NJ 5 5 F 7/23/2009 Swollen, red, warm 31/2X4cm area
352750 7/30/2009 NY 4 4 M 7/27/2009 Raised, red, hot, tender to touch. Le
352751 7/30/2009 TX 5 5 F 7/29/2009 Severe swelling at injection site day
352752 7/30/2009 MI 0.2 0 0.2 M Temperature 102 - 103 x 2 days 4 h
352754 7/30/2009 NC 37 37 M 7/29/2009 SM noticed some chest discomfort o
352755 7/30/2009 MI 0.2 0 0.2 M 7/27/2009 Five hours after immunizations, pt. d
352756 7/30/2009 OH 5 5 F 7/24/2009 Gave KINRIX on 7/22/09 in left upp
352757 7/30/2009 NY 1.8 1 0.8 F 7/20/2009 Patient developed an unexplained o
352758 7/30/2009 AZ 67 67 F 7/24/2009 I was in pain felt sick on Sat. and Su
352759 7/30/2009 GA 0.6 0 0.6 F 7/24/2009 7 month old was given pediatric HE
352760 7/30/2009 KY 11 11 F 7/27/2009 10:45 AM fainted - ice pack, counse
352761 7/30/2009 WV 16 16 F 7/24/2009 Shortly after receiving vaccine, while
352762 7/30/2009 AZ 4 4 F 7/24/2009 Rash developed to the medical area
352763 7/30/2009 WV 0.4 0 0.4 F 7/28/2009 Foster-mother reports that approx. 1
352764 7/30/2009 SC 11 11 M 7/24/2009 On right arm: (cm) 11x9 erythemato
352765 7/30/2009 NY 69 69 U Vaccine administered to upper L arm
352766 7/30/2009 NC 5 5 M 7/27/2009 Client was given a TDAP and shoul
352767 7/30/2009 NC 18 18 F 7/27/2009 Client received VARIVAX 17 days a
352768 7/30/2009 NY 2 2 0.1 M 7/16/2009 Thrush on lips and tongue Dr. presc
352770 7/30/2009 20 20 M 7/30/2009 Member was recieving a routine ser
352771 7/30/2009 MS 11 11 F 7/30/2009 Seizure lasting thirty seconds, follow
352772 7/30/2009 FL 31 31 F 7/30/2009 CLIENT RETURNED TO ADULT CL
352773 7/30/2009 MI 63 63 F 7/30/2009 redness, swelling, itching, hardness
352774 7/30/2009 WI 18 18 F 7/30/2009 Immediately following administration
352775 7/30/2009 CA 2 2 0M 7/30/2009 Injection site pain to the point where
352776 7/30/2009 NY 14 14 F 7/30/2009 Came in for Gardisil #3. Layed down
352777 7/30/2009 MO 12 12 F 7/21/2009 Patient recedived vaccines. While p
352778 7/30/2009 PA 4 4 M 7/30/2009 Patient recieved DTaP, MMR, IPV in
352779 7/30/2009 NY 3 3 F 7/30/2009 Patient c/o knee pain x 1 week then
352780 7/30/2009 AZ 11 11 M 7/30/2009 Pt. with syncope x 2 events. Synco
352781 7/30/2009 WA 71 71 M 7/30/2009 Employee was given Tdap by me (M
352782 7/30/2009 U 7/30/2009 Patient received her 2nd Varivax on
352783 7/30/2009 FL 45 45 M 7/30/2009 CLIENT RETURNED TO CLINIC FO
352784 7/30/2009 FL 18 18 F 7/30/2009 PATIENT RECEIVED VZV ON 7-21
352785 7/30/2009 FL 35 35 F 7/30/2009 AFTER RECEIVING MMR INJECTI
352786 7/30/2009 TX 73 73 F 7/30/2009 Client did not state on the screening
352787 7/30/2009 WV 4 4 M 7/30/2009 Patient had wheezing, swelling of lip
352788 7/30/2009 MD 51 51 F 7/30/2009 Initially an area of erythema of abou
352789 7/30/2009 KS 15 15 F 7/30/2009 Less than 8 hours later right leg itch
352790 7/30/2009 CA 6 6 F 7/30/2009 LEFT ARM SWOLLEN, REDDNESS
352791 7/30/2009 CA 61 60 F 7/30/2009 Patient reported to our facility on 4/6
352792 7/30/2009 NC 18 18 F 7/30/2009 Pt was administered Tdap and Men
352793 7/30/2009 NC 46 47 M 7/30/2009 RECEIVED PHONE CALL FROM P
352794 7/30/2009 OK 4 4 M 7/30/2009 Patient went into his Primary Care P
352795 7/30/2009 MI 71 71 M 7/30/2009 location reaction,cellulitis L arm, pt.
352796 7/30/2009 FL 37 0 0F 7/30/2009 Fever of 102.7, extreme weakness
352798 7/30/2009 AL 5 5 M 7/30/2009 Within 15 minutes of administration
352799 7/30/2009 IL 1.5 1 0.5 F 7/30/2009 Progressive vesicular eruptions on t
352800 7/30/2009 CA 38 38 F 7/30/2009 Red, swollen, itchy, hot to touch. Lt
352801 7/30/2009 CA 42 42 F 7/30/2009 Pain, redness, raised semi solid kno
352802 7/30/2009 CA 39 38 F 7/30/2009 Subdermal nodule, pain L axilla x 3-
352803 7/30/2009 VA 11 11 F 7/27/2009 Pt came to doctors office on 7/25/09
352804 7/30/2009 CA 60 67 M 7/30/2009 10 days after injection, chronic urtic
352805 7/30/2009 MN 12 12 M 7/30/2009 Right arm, began to become red/sw
352806 7/30/2009 WI 68 68 F 7/30/2009 3 - 5 cm raised red area. Pt treated
352807 7/30/2009 MI 1.7 1 0.7 F 7/28/2009 MENACTRA given from Lot #U2867
352808 7/30/2009 CA 13 13 F 7/30/2009 Patient almost fainted.
352809 7/30/2009 SD 18 18 F 7/29/2009 HPV vaccine given, no adverse eve
352810 7/30/2009 IL 17 17 F Hives on upper chest. BENADRYL
352811 7/30/2009 WA 5 5 F 7/30/2009 Shot was given on 07/23/09 at clinic
352812 7/30/2009 TX 22 22 F 7/30/2009 22 y/o female, developed unexplain
352813 7/30/2009 TX 10 10 M 7/30/2009 Redness, swelling, warmth, tendern
352814 7/30/2009 GA 12 12 F 7/30/2009 Mother states when client woke up
352815 7/30/2009 TX 1.5 1 0.5 M 7/29/2009 Severe swelling and redness at inje
352816 7/30/2009 NC 38 38 M 7/27/2009 SM developed HA approx 4 hrs afte
352817 7/30/2009 NC 30 30 U 7/30/2009 Approx 5 hrs after receiving his mos
352818 7/30/2009 28 28 F 7/23/2009 SM developed redness, swelling, pa
352797 7/31/2009 39 39 M 7/31/2009 Extreme red skin color, loss of moto
352819 7/31/2009 MA 66 66 F 7/23/2009 1/14-8/3/09. Large local reaction las
352820 7/31/2009 NV 20 20 F 7/27/2009 The following day my throat was sw
352821 7/31/2009 MO 1 1 0M 7/25/2009 Rash all over body x 6 days. Fever
352822 7/31/2009 PA 64 64 F 7/18/2009 Rash around injection site - size of 5
352823 7/31/2009 NE 12 12 M 7/27/2009 Pt received Tdap in Rt deltoid on 7/
352824 7/31/2009 TX 11 11 M None stated
352826 7/31/2009 NY 11 11 M 7/25/2009 C/O redness and slight swelling on
352827 7/31/2009 IN 0.5 0 0.5 M 7/28/2009 Patient developed multiple pruritic e
352828 7/31/2009 CA 18 18 F 7/23/2009 18 year old female became dizzy an
352829 7/31/2009 NY 4 4 M 7/30/2009 Erythematous Edematous and firm
352830 7/31/2009 MI 57 57 F 7/24/2009 Noted red, warm sore area on Lt. de
352832 7/31/2009 CA 47 47 F 7/27/2009 Nausea, vomiting, dizziness.
352833 7/31/2009 NV 50 50 M 4/21/2009 Tetanus (L) arm 6 d ago. Next AM n
352834 7/31/2009 OH 18 18 M 7/27/2009 Red rash on neck and legs.
352836 7/31/2009 67 F 7/30/2009 InformationYhas been received from
352837 7/31/2009 FL 1 1 0M 7/27/2009 - Pt began to have fever 8 days afte
352839 7/31/2009 NC 1.5 1 0.5 F 7/27/2009 Swelling and redness from elbow to
352840 7/31/2009 CA 1.4 1 0.4 M 7/27/2009 Temp. 98.8, redness at the site of im
352841 7/31/2009 TN 1.6 1 0.6 M 7/27/2009 Per mother - 7/25/09 A.M. had feve
352885 7/31/2009 AL 72 72 F 7/31/2009 Large red circle where vaccine was
352886 7/31/2009 GA 4 4 M 7/31/2009 07/20/2009 PATIENT RCD VARICE
352887 7/31/2009 WV 55 55 F 7/31/2009 Shoulder pain, lack of back range m
352888 7/31/2009 VA 5 5 F 7/31/2009 Started a low grade fever yesterday
352889 7/31/2009 TX 0.5 0 0.5 F 7/31/2009 on 07/28/09 patient was brought in
352890 7/31/2009 AZ 8 11 F 7/31/2009 Clt. was administered Varicella vacc
352891 7/31/2009 IL 12 12 F 7/31/2009 Incident occured 7-30-09. After adm
352892 7/31/2009 MO 5 5 M 7/31/2009 Client at clinic for kindergarten immu
352893 7/31/2009 OK 0.2 0 0.2 M 7/31/2009 Vaccines given 7/22/09. Child deve
352894 7/31/2009 AR 74 74 F 7/31/2009 HAD LOCAL RASH, AS WELL AS R
352895 7/31/2009 TX 12 12 F 7/31/2009 Patient received hpv vaccine on 7/2
352896 7/31/2009 WI 13 13 F 7/31/2009 Broke out in hives all over her body
352897 7/31/2009 MD 15 15 F 7/31/2009 Patient received Gardasil immuniza
352898 7/31/2009 CO 35 35 F 7/31/2009 Received the injections in my left ar
352899 7/31/2009 PA 11 11 M 7/31/2009 Redness, swelling, warm to touch, p
352900 7/31/2009 CA 4 4 F 7/31/2009 3" x 3" erythema muscle hot to touc
352901 7/31/2009 WA 18 18 M 7/31/2009 Approximately 5-10 minutes after in
352902 7/31/2009 NY 0.3 0 0.4 M 7/31/2009 intussusception
352903 7/31/2009 TX 45 45 F 7/31/2009 Diffuse papular rash erupted 6/17/0
352904 7/31/2009 MI 5 5 M 7/31/2009 Patient came down with Varicella 8
352905 7/31/2009 CO 68 68 F 7/31/2009 24 hours after vaccination pt noticed
352906 7/31/2009 KY 67 67 F 7/31/2009 Patient did not have any initial probl
352907 7/31/2009 NY 1 1 0F 7/31/2009 patient received 12 mo vaccinations
352908 7/31/2009 PA 26 26 F 7/31/2009 Pt was given the following injections
352909 7/31/2009 TX 11 11 M 7/31/2009 RIGHT ARM HAS A 13CM RED IRR
352910 7/31/2009 WA 12 12 F 7/31/2009 PT'S MOTHER STATED THAT ABO
352911 7/31/2009 CA 34 34 F 7/31/2009 Severe emesis (x7) 24 - 30 hours fo
352912 7/31/2009 TX 2 2 0F 7/31/2009 Approx 1 day after vaccines given, p
352917 7/31/2009 CA 0.4 0 0.4 M 7/30/2009 4 month old male had had upper ex
352923 7/31/2009 TX 1 1 0F 7/31/2009 Vaccines given at 2:40 pm. 2 hives
352924 7/31/2009 NY 25 25 F 7/31/2009 Pt came to clinic 2 days after receiv
352925 7/31/2009 WA 24 24 F 7/31/2009 Red Itching
352926 7/31/2009 CA 12 12 F 7/20/2009 - L.O.C for 2 sec. - Paleness in face
352927 7/31/2009 CA 11 11 M 7/31/2009 Severe headaches evening of vacci
352928 7/31/2009 CA 45 45 F 7/31/2009 Developed golf ball size swelling at
352929 7/31/2009 AK 5 5 M 7/31/2009 Vaccines given 29JUL2009. Mom re
352930 7/31/2009 TX 12 12 F 7/31/2009 She received her vaccines 1 week a
352931 7/31/2009 IL 75 75 F 8/1/2009 Pt received shot on Wed 7/29/9. On
352932 7/31/2009 IN 32 32 F 7/31/2009 7-28-09 Vaccine admin after approp
352933 7/31/2009 FL 11 11 F 7/30/2009 Dizziness and headache.
352934 7/31/2009 IL 21 21 F 7/31/2009 Pt. here today for TBST reading C0
352935 7/31/2009 NY 23 23 F 7/31/2009 Pt presented to clinic 2 days after in
352936 7/31/2009 FL 25 25 F 8/2/2009 The patient received a 1st Hep-B va
352937 7/31/2009 CA 10 F 7/31/2009 Dizziness starting - few hours after v
352939 7/31/2009 NJ 68 68 F 7/31/2009 1-2 min after vaccination of HAVRIX
352940 7/31/2009 FL 1.5 1 0.5 M 7/31/2009 Crankiness at 10:30. Fell asleep, wo
352941 7/31/2009 SC 11 11 M 7/31/2009 Pt received VZV and Hep A immuni
352950 7/31/2009 IL 5 5 M 7/28/2009 This case was reported by a healthc
352913 8/1/2009 NJ 11 11 F 8/1/2009 Within 48 hours of receiving vaccine
352914 8/1/2009 PA 66 66 F 8/1/2009 large red mark at injection site
352915 8/1/2009 CA 4 4 M 8/1/2009 pt developed large area of firmness
352916 8/1/2009 CA 1.1 1 0.1 F 8/1/2009 Within hours, Jonah became letharg
352921 8/2/2009 IA 19 19 F 8/2/2009 After first gardasil shot on 03/27/08
352938 8/3/2009 MA 68 68 F 7/31/2009 None stated
352953 8/3/2009 OH 1.3 1 0.3 M 7/10/2009 Decreased-low eye contact, unresp
352954 8/3/2009 MI 44 44 F 7/28/2009 Went to emergency room, transferre
352955 8/3/2009 NJ 5 5 M 7/29/2009 R arm - swelling on 7/24/09 - site of
352957 8/3/2009 TX 0.2 0 0.2 F 8/3/2009 Intussusception, diarrhea, vomiting,
352958 8/3/2009 IA 12 12 F 8/3/2009 Pt. passed out, 1 day laid back on ta
352960 8/3/2009 PA 45 45 F 8/3/2009 Approximately 5 minutes after being
352962 8/3/2009 NC 0.3 0 0.3 M 7/31/2009 Rash noted this morning by mother
352966 8/3/2009 MT 17 17 M 7/23/2009 Client sitting in chair while vaccines
352969 8/3/2009 NY 45 45 F 7/30/2009 Pt reported fever to 101-102. Pt rep
352971 8/3/2009 IN 0.1 0 0.1 F 7/30/2009 Patient had no adverse event. Patie
352976 8/3/2009 CA 62 62 F 7/24/2009 Developed left arm swelling, rednes
352980 8/3/2009 U Eczematoid rash both legs @ immu
352981 8/3/2009 FL 4 4 F 7/28/2009 Rash, itching and red patch of skin
352982 8/3/2009 NY 5 5 F 7/28/2009 Fever 101 degrees --> 12 hr. after v
352997 8/3/2009 MD 0.2 0 0.2 F 8/3/2009 possible seizure
352998 8/3/2009 FL 17 17 F 8/3/2009 Patient had the menactra vaccine o
352999 8/3/2009 GA 65 65 M 8/3/2009 Approximately 24 hours after pneum
353000 8/3/2009 MI 16 16 M 8/3/2009 2- 2 1/2 inch sized red/hot painful sw
353001 8/3/2009 KS 12 12 M 8/3/2009 Varivax vaccine administered to Rig
353002 8/3/2009 NJ 21 21 F 8/3/2009 rash on face
353003 8/3/2009 NC 1.2 1 0.1 F 8/3/2009 My daughter got her MMR and Varic
353004 8/3/2009 NV 21 21 M 8/3/2009 Fever, Chills, Neausa
353005 8/3/2009 MN 60 60 F 8/3/2009 Client called local health departmen
353006 8/3/2009 GA 19 19 M 8/3/2009 Autoinoculation with the following sk
353007 8/3/2009 IN 11 11 F 8/3/2009 Syncope occurred 5 minutes after im
353008 8/3/2009 AR 72 72 F 8/3/2009 Patient developed a 4 inch are of re
353009 8/3/2009 IN 11 11 F 8/3/2009 Syncopal episode occurred 2 minut
353010 8/3/2009 CA 4 4 F 8/3/2009 patient here with mother for ppd rea
353011 8/3/2009 WY 88 88 M 8/3/2009 A day or two after his vaccination fo
353012 8/3/2009 CA 1.7 1 0.7 F 8/3/2009 Patient developed hives after secon
353013 8/3/2009 IN 2 2 0.3 M 8/3/2009 CT'S MOTHER REPORTS CT VOM
353015 8/3/2009 MN 65 65 F 8/3/2009 Patient complained of jaw pain, dizz
353016 8/3/2009 CA 47 47 F 8/3/2009 Pt states a rash on arms and joint p
353017 8/3/2009 WI 66 66 F 8/3/2009 Patient developed a large red and s
353018 8/3/2009 MI 17 17 M 8/3/2009 Evening of imm. (07/23)developed r
353019 8/3/2009 OK 61 61 M 8/3/2009 patient reports no known drug allerg
353020 8/3/2009 OK 61 61 F 8/3/2009 patient reports no drug allergies. pa
353022 8/3/2009 GU 4 4 M 8/3/2009 Pt developed cellulitis in his right up
353023 8/3/2009 TX 68 68 M 8/3/2009 Two days after administration of Va
353024 8/3/2009 CA 1.8 1 0.8 M 8/3/2009 According to Dr. Lee's report, "VAC
353032 8/3/2009 MO 15 15 F 7/27/2009 Pt fainted very shortly after injection
353033 8/3/2009 SD 0.2 0 0.2 F 7/13/2009 Rash to torso told to leave t-call with
353034 8/3/2009 WA 16 16 F 7/28/2009 Approx. 2 min after injections, beca
353035 8/3/2009 OR 34 34 F 7/22/2009 Nine hours after vaccination, pt dev
353037 8/3/2009 TN 15 15 F 7/24/2009 7/22 Woke up during the night from
353040 8/3/2009 WA 67 67 F 7/29/2009 Injection site visible. Redness is 8-9
353042 8/3/2009 WI 62 62 F 7/27/2009 Patient reported symptoms began in
353044 8/3/2009 OK 10 10 M 6/30/2009 He said it burned.
353045 8/3/2009 WI 1.6 1 0.6 F 7/24/2009 Nausea, vomiting, diarrhea, fever. M
353046 8/3/2009 NC 49 49 M 8/3/2009 Pt received his 3rd AVA booster on
353047 8/3/2009 PA 18 18 M 7/31/2009 Pt received Tdap, MCV, & Varicella
353048 8/3/2009 OR 4 4 M 7/8/2009 7-2-09 per report taken, pt. had c/o
353049 8/3/2009 NM 4 4 F 8/3/2009 Swelling and redness of rt arm. Tx c
353050 8/3/2009 OR 0.5 0 0.5 M 7/7/2009 TC from mother of client on 6/30/09
353051 8/3/2009 13 13 U None Stated
353053 8/3/2009 NY 10 10 F 8/3/2009 Swollen harden area, 7cm x 7cm re
353054 8/3/2009 NE 1.1 1 0.1 F 7/31/2009 Rash over upper torso and fever Ra
353055 8/3/2009 NJ 0.4 0 0.4 F 8/3/2009 Fever 102.4 7-29-09.7-28-09- Seen
353056 8/3/2009 CA 1.6 1 0.6 M 8/3/2009 The Tdap immunization was given i
353057 8/3/2009 IL 5 5 M 8/5/2009 Swelling noted on arm same day af
353058 8/3/2009 KS 14 14 M 8/3/2009 Pt had received a 4th dose of DTP w
353059 8/3/2009 NJ 0.2 0 0.2 F 8/2/2009 Received vaccinations approx. 345p
353060 8/3/2009 MI 17 17 F 7/30/2009 L arm has two welt sites one aprox.
353061 8/3/2009 UT 5 M 8/3/2009 Pt came in on 07/31/09 for vaccines
353062 8/3/2009 AZ 34 34 F 8/3/2009 Had sore throat & some mild swellin
353063 8/3/2009 NY 25 25 F 7/15/2009 Erythema, edema, induration at inje
353064 8/3/2009 MS 5 5 M 8/3/2009 Varicella vaccine admin 7-30-09. Fa
353065 8/3/2009 TN 19 19 M 8/3/2009 None.
353066 8/3/2009 MA 1.1 M 7/28/2009 Fever 102.2.
353067 8/3/2009 CA 2 2 0.4 F 8/3/2009 7/30 PM left thigh big red welt at site
353068 8/3/2009 AZ 28 28 F 8/3/2009 Had sore throat nasal congestion co
353069 8/3/2009 TN 16 16 F 7/24/2009 I want to give a little history on this p
353070 8/3/2009 TN 15 15 F 7/24/2009 1/08 - school reported she was very
353071 8/3/2009 DE 1.6 1 0.6 F 7/29/2009 Received Hep#2 only 4 months afte
353025 8/4/2009 CA 5 5 M 8/4/2009 Redness, pain, swelling, itching, an
353026 8/4/2009 WA 17 17 F 8/4/2009 Was doing fine after first after first s
353079 8/4/2009 SC 23 23 F 8/3/2009 Initial and follow-up information has
353086 8/4/2009 NY 0.5 0 0.5 M 7/29/2009 Intussusception 4 mo after completi
353091 8/4/2009 NH 0 0 0M 8/4/2009 This case was reported by a consum
353094 8/4/2009 IN 12 12 M 6/5/2009 Fever - started night after vaccine. F
353095 8/4/2009 NJ 22 22 M 8/4/2009 Received smallpox vaccination on 7
353096 8/4/2009 IL 16 16 F 7/29/2009 7-8" of redness, itchy and painful fo
353097 8/4/2009 MO 1 1 0F 7/31/2009 Fever, rash.
353098 8/4/2009 CA 11 11 M (R) arm red swollen X 2 days; tende
353099 8/4/2009 ID 61 61 F 7/29/2009 Vaccine was given IM rather than S
353100 8/4/2009 NC 12 12 M 7/31/2009 Pt fainted following immunization. P
353101 8/4/2009 LA 17 17 F 7/31/2009 Rash to hands and feet (blisters) so
353102 8/4/2009 OK 13 13 F 7/31/2009 On 27 July 09 child received 3rd HP
353103 8/4/2009 MN 50 50 F 7/29/2009 Paula woke up on 7-11-09 and her
353104 8/4/2009 MN 59 59 F 7/10/2009 7/6 Arm aches pm. 7/7 Body aches,
353105 8/4/2009 NC 15 15 F 7/31/2009 Neck stiffness, Headache, Extreme
353106 8/4/2009 LA 16 16 F 7/28/2009 7-27-09 1:00 PM Mom called to rep
353107 8/4/2009 TN 4 4 M 7/30/2009 Patient returned to clinic after 30 mi
353108 8/4/2009 FL 18 18 M 7/29/2009 Dizziness, 0 Syncope, diaphoretic w
353109 8/4/2009 GA 1.1 1 0.1 M 7/29/2009 Pt 2 wks after MMR/Varicella develo
353110 8/4/2009 NY 15 15 M 7/27/2009 According to parents woke up next
353111 8/4/2009 IL 14 14 F 7/29/2009 2-3" circular redness-itchy and pain
353112 8/4/2009 12 12 F 7/24/2009 Night of immunization mac/pap rash
353113 8/4/2009 MI 15 15 F 7/30/2009 Vaccine administered to pregnant fe
353114 8/4/2009 AR 20 M 8/4/2009 Possible secondary innoculation to
353115 8/4/2009 MA 60 61 F 8/4/2009 After a few hours the injected arm u
353116 8/4/2009 PA 60 60 M 8/4/2009 TETANUS SHOT WAS GIVEN ON
353117 8/4/2009 OH 13 13 F 8/4/2009 Childs mother called at 9:30am this
353118 8/4/2009 NC 65 65 F 8/4/2009 Patient presented 8/3/2009 concern
353119 8/4/2009 GA 61 61 M 8/4/2009 24 hours after vaccine, arm had slig
353120 8/4/2009 IN 12 12 F 8/4/2009 Syncopal episode 2 minutes after im
353121 8/4/2009 CA 4 4 F 8/4/2009 Redness, swellling and induration o
353122 8/4/2009 CO 23 23 F 8/4/2009 Approximately 1 week prior patient w
353123 8/4/2009 OK 2 2 0.2 M 8/4/2009 Pt given combo vaccine of Dtap/IPV
353124 8/4/2009 FL 27 27 F 8/4/2009 Approximately 1 month after receivi
353125 8/4/2009 AL 1.3 1 0.3 M 8/4/2009 Pt had a seizure 2:00 a.m. the follow
353126 8/4/2009 36 36 M 8/4/2009 had body aches and muscle cramps
353127 8/4/2009 VA 14 14 M 8/4/2009 Herpes Zoster Rash on trunk on the
353128 8/4/2009 TN 1.6 1 0.6 M 8/4/2009 Pt received second Hep A vaccine a
353129 8/4/2009 KY 10 10 F 8/4/2009 About one minute after shot Kayla b
353130 8/4/2009 KY 0.5 0 0.5 M 8/4/2009 Child had 6 month shots at 11:00am
353131 8/4/2009 MA 18 18 M 8/4/2009 Shots administered at 2:30 p.m. app
353133 8/4/2009 NJ 0.2 0 0.2 F 8/4/2009 Intussusception 7/20/09 - symptoms
353134 8/4/2009 PA 56 56 M 8/4/2009 6/23/09 BOOSTRIX given -> mild so
353135 8/4/2009 WI 26 26 F 7/24/2009 Pt has history of seizures. Has C.P.
353136 8/4/2009 UT 60 60 F 8/4/2009 Sweating, dizzy, nausea, rash on fa
353137 8/4/2009 NY 5 5 M 8/4/2009 Temp 101 F x 2 days of markedly sw
353138 8/4/2009 KS 12 12 M 8/4/2009 Temp of 103.1 a few hrs after gettin
353139 8/4/2009 PA 60 60 F 8/4/2009 Local reaction left upper arm 7/23-7
353140 8/4/2009 KY 31 31 F 8/4/2009 Pt noticed redness, swelling, tender
353141 8/4/2009 MA 25 25 F 8/4/2009 Fever, feeling "off", dizziness, red lo
353142 8/4/2009 MI 4 4 M 8/3/2009 Onset of coughing and hives within
353143 8/4/2009 MI 14 14 F 8/4/2009 Within 5 min of receiving HPV #3 in
353144 8/4/2009 NJ 4 4 F 8/4/2009 1/2 upper arm on right side, swollen
353145 8/4/2009 CA 1.5 1 0.5 M Father of patient came to our office
353146 8/4/2009 OH 20 20 F 8/4/2009 Pt. came in 2/+ pain in L elbow on 8
353147 8/4/2009 MA 45 45 M 8/4/2009 Redness, swelling and pain in R arm
353148 8/4/2009 MA 46 46 F 8/4/2009 Redness at injection site, pain at inj
353149 8/4/2009 AZ 19 19 F 7/28/2009 Hives
353150 8/4/2009 KS 38 F 8/4/2009 08/04/2009 MODERATE Other IND
353151 8/4/2009 CA 0.1 0 0.1 F 8/4/2009 Crying, fussy after the vaccines wer
353152 8/4/2009 KS 14 14 M 8/4/2009 07/23/2009 MODERATE Other. FA
353153 8/4/2009 NJ 42 42 F 7/31/2009 7/10/09 Received vaccinations. 7/15
353154 8/4/2009 VA 54 54 F 8/3/2009 (R) upper arm was slightly swollen &
353155 8/4/2009 VA 12 12 F 8/3/2009 Patient fainted after administration o
353156 8/4/2009 LA 27 27 M 7/30/2009 None stated.
353157 8/4/2009 FL 54 54 F 7/29/2009 Red rash/welts on inside portion of
353158 8/4/2009 FL 66 66 F 7/13/2009 6/23/09. Itch developed and got wo
353159 8/4/2009 TX 8 8 F 7/28/2009 Pt with severe erythema localized &
353160 8/4/2009 OK 30 30 F 7/30/2009 Developed VARICELLA Disease (ch
353161 8/4/2009 TX 14 14 F 7/29/2009 Redness, warm, 7 cm X 7 cm
353162 8/4/2009 NM 9 9 F 7/28/2009 Right arm red and warm to touch.
353164 8/4/2009 AZ 5 5 F 8/4/2009 Left arm with immediate itching and
353165 8/4/2009 NJ 0.7 0 0.7 M 8/4/2009 At 10 PM parents reported increase
353174 8/5/2009 RI 61 M 8/4/2009 Information has been received from
353175 8/5/2009 ID 1.8 1 0.8 F 7/20/2009 Febrile seizure. 8/21/09 ERrecords
353182 8/5/2009 5 M 7/31/2009 Initial report was received 27 July 20
353183 8/5/2009 M 8/2/2009 Initial report received on 27 July 200
353186 8/5/2009 KY F 7/31/2009 Initial report was received from anot
353187 8/5/2009 DE 28 28 M 8/5/2009 I received an anthrax shot at 0830 o
353188 8/5/2009 NM 39 39 F 8/5/2009 Vaccination administered in left delt
353189 8/5/2009 ND 15 15 F 8/5/2009 SHORTNESS OF BREATH, CHEST
353190 8/5/2009 MN 85 85 F 8/5/2009 Patient complained of rash, redness
353191 8/5/2009 TX 19 19 F 8/5/2009 Immediately after receiving vaccines
353192 8/5/2009 IA 4 4 M 8/5/2009 Red Swollen at site of injection
353193 8/5/2009 OH 11 11 F 8/5/2009 Vaccines were given at about 1030a
353194 8/5/2009 CA 2 2 0.1 F 8/5/2009 Received vaccines on 7/13/09. Fam
353195 8/5/2009 MI 18 18 F 8/5/2009 Immediately after Hepatitis B vaccin
353196 8/5/2009 MD 11 11 M 8/5/2009 Fluid-filled blister, scab forming afte
353197 8/5/2009 CT 21 21 F 8/5/2009 Weakness, body aches, joint pain, h
353198 8/5/2009 MD 18 18 F 8/5/2009 After receiving MCV4, while seated,
353199 8/5/2009 MA 21 21 F 8/5/2009 Headache, Nausea, Vomiting, Chills
353200 8/5/2009 OH 12 12 F 8/5/2009 Mother brought child to HD office 8/
353201 8/5/2009 NC 15 15 F 8/5/2009 48 hours after the vacination of Gar
353202 8/5/2009 CA 70 69 F 8/5/2009 Within a week, I had begun to expe
353204 8/5/2009 NM 4 4 F 8/5/2009 Mother is stating that 7days after va
353205 8/5/2009 OR 3 3 F 8/5/2009 My daughter received a DTAP vacc
353206 8/5/2009 VA 40 40 F 8/5/2009 Arms and fingers feeling numb. Bo
353207 8/5/2009 IL 25 25 M 8/5/2009 Redness and pain at injection site fo
353208 8/5/2009 IL 44 44 F 8/5/2009 skin erythema and warm to touch -
353209 8/5/2009 IL 49 49 F 8/5/2009 vomiting, diarrhea, fever of 102 x 2
353210 8/5/2009 IL 64 64 F 8/5/2009 Noticed redness/swelling/warmth at
353211 8/5/2009 LA 4 4 M 8/5/2009 Patient received Pentacel vaccine c
353212 8/5/2009 TX 4 4 M 8/5/2009 CHILD SEEN IN EMERGENCY RO
353213 8/5/2009 IA 72 72 F 8/5/2009 Pneumovax administered at approx
353214 8/5/2009 CO 11 M 8/5/2009 Localized red, warm , tender, inflam
353217 8/5/2009 20 F 7/31/2009 Severe stomach pain and weakness
353218 8/5/2009 60 60 F 7/31/2009 Developed vestibular neuritis 12 da
353219 8/5/2009 ID 5 5 F 7/22/2009 Lost consciousness with skin pallor,
353221 8/5/2009 ID 5 5 M 6/26/2009 Large (about size of baseball) Lt thi
353222 8/5/2009 FL 63 63 F 7/30/2009 After a few days of the initial vaccin
353223 8/5/2009 66 66 F 7/31/2009 Pt with Hx radiation to skin years ag
353224 8/5/2009 NM 0.3 0 0.3 M 8/3/2009 Vaccines (PENTACEL, PREVNAR &
353225 8/5/2009 DC 21 21 F 7/31/2009 On the day of the vaccine was given
353226 8/5/2009 PA 15 15 F 8/5/2009 Patient given GARDASIL vaccine a
353227 8/5/2009 NC 44 44 M 8/5/2009 On 12/15/07, SM received AVA (2),
353228 8/5/2009 55 M 7/28/2009 Pt. c/o fever of 102.5, left arm red, s
353229 8/5/2009 MN 4 4 M 8/4/2009 Would this 8/4 L thigh swollen red +
353234 8/5/2009 CA 36 36 M 8/5/2009 Patient reported fever, left arm pain
353235 8/5/2009 WA 14 F Pt getting up from exam table fell fo
353236 8/5/2009 NM 12 12 M 8/5/2009 Red, sore, hot, fever, blister pustule
353237 8/5/2009 IA 12 12 M 8/5/2009 After vaccine given mom then tells R
353238 8/5/2009 TX 12 12 F Pt. received vaccines. Mom stated p
353239 8/5/2009 ND 12 12 F 8/5/2009 Left upper arm, shoulder pain, swel
353240 8/5/2009 PA 1.2 1 0.2 M 8/15/2009 Shingles
353241 8/5/2009 MN 63 63 F 8/3/2009 Pt got a rash on her wrist, arm, ches
353242 8/5/2009 WI 28 28 F 8/5/2009 Redness to upper arm fever 102 de
353243 8/5/2009 CA 72 72 F 8/5/2009 Cellulitis, redness, swelling, warmth
353244 8/5/2009 OH 5 5 M Anaphylaxis ~ 1/2 in after receipt o
353245 8/5/2009 TX 28 28 F 8/5/2009 28 yo girl presented to clinic at 4:05
353246 8/5/2009 CA 23 23 M 8/4/2009 On 7/20/09 received a T booster F a
353247 8/5/2009 CA 2 2 0.1 F 8/3/2009 Local popular pruritic rash around s
353248 8/5/2009 TX 86 86 M 8/15/2009 Debilitating weakness all over, unab
353215 8/6/2009 31 31 F 8/6/2009 Urticaria without systemic symptom
353216 8/6/2009 72 F 8/2/2009 On March 3rd, I received a shingles
353220 8/6/2009 ID 11 11 F 6/22/2009 Patient had a reaction to VARIVAX
353249 8/6/2009 PA 64 64 F 7/23/2009 PPV shot given at top of left should
353251 8/6/2009 F 8/4/2009 My daughter had serious problems
353254 8/6/2009 GA 4 4 M 8/6/2009 Patient received Immunizations, we
353256 8/6/2009 NV 6 6 M 8/6/2009 Anaphylaxis - instant hives - lip swe
353260 8/6/2009 LA 11 11 M 7/31/2009 Localized warm redness to vaccine
353261 8/6/2009 WA 71 71 M 8/4/2009 This case was received from a heal
353262 8/6/2009 OR 18 18 F 7/30/2009 Within one week of vaccination the
353264 8/6/2009 VA 19 19 F 8/3/2009 Following vaccines, episode of sync
353265 8/6/2009 CO 8 8 M 7/29/2009 Itchy sensation, hives. Went to ER,
353266 8/6/2009 CA 1.3 1 0.3 M 7/30/2009 Febrile Illness 103.5 Bronchiolitis po
353268 8/6/2009 CO 67 F 7/30/2009 Developed shingles 3 days after vac
353270 8/6/2009 NY 11 11 M 8/1/2009 Seen on 8/1 (2 days later) with swe
353272 8/6/2009 RI 80 F 8/5/2009 Information has been received from
353278 8/6/2009 NE 28 28 F 7/27/2009 Chills, muscle weakness, body ache
353280 8/6/2009 MO 4 4 M 7/31/2009 Lt. thigh with 5 X 5 cm erythema dis
353281 8/6/2009 NC 11 11 M 8/3/2009 6x5 cm area of pruritic angioedema
353282 8/6/2009 14 F 8/4/2009 Severe fatigue and soreness.
353283 8/6/2009 61 61 F 8/3/2009 side effect to ZOSTAVAX, bright red
353284 8/6/2009 SC 0.3 U Pt had PENTACEL given (never ha
353285 8/6/2009 PA 11 11 F 8/5/2009 Patient received 3 vaccines MENAC
353286 8/6/2009 TX 20 20 F 8/6/2009 8/5/09 upper outer arm red, warm 4
353287 8/6/2009 NC 2 2 0.2 F 8/4/2009 R thigh red, swollen and painful. Fe
353288 8/6/2009 MO 69 69 F 8/6/2009 Pt was bit by lab confirmed rabid fox
353289 8/6/2009 SD M 7/31/2009 Local reaction with swelling of thigh
353290 8/6/2009 NC 1.6 1 0.6 F 7/31/2009 First & 2nd Hep A local erythema in
353295 8/6/2009 OH 14 14 M 8/6/2009 This clinic client became nauseated
353296 8/6/2009 VA 14 14 M 8/6/2009 Mother of patient came by clinic at 8
353297 8/6/2009 MI 19 19 M 8/6/2009 Administered a pediatric Hepatitis A
353298 8/6/2009 PA 2 2 0.2 M 8/6/2009 Baby woke up three days after vacc
353299 8/6/2009 LA 11 10 M 8/6/2009 Varicella was administered to the le
353300 8/6/2009 NH 1.3 1 0.3 F 8/6/2009 Pt in office on 7/31/09 for 15 month
353301 8/6/2009 MN 8 8 F 8/6/2009 Received rabies pre-exposure #3 on
353302 8/6/2009 TX 12 12 F 8/6/2009 Pt represents to clinic with a 4cm x
353303 8/6/2009 GA 11 11 M 8/6/2009 Patient received vaccination of Tdap
353304 8/6/2009 LA 13 13 F 8/6/2009 PT.HERE STATED AREA WHERE
353305 8/6/2009 NE 15 15 F 8/6/2009 APPROXIMATELY 2 MINUTES AFT
353306 8/6/2009 MI 5 5 M 8/6/2009 Redness, rash and swelling at injec
353307 8/6/2009 AL 14 14 F 8/6/2009 7/27/09 Came in to HD c/o side effe
353310 8/6/2009 AL 13 13 F 8/6/2009 Started vomitting at noon 8/4/09 and
353311 8/6/2009 CO 0.2 0 0.2 M 8/6/2009 none, 9/25/09Y Autopsy report receiv
353312 8/6/2009 AL 4 4 M 8/6/2009 Awake, Thurday a.m., 7/30/09, with
353313 8/6/2009 LA 10 10 F 8/6/2009 PT. MOTHER PHONED OFFICE ST
353314 8/6/2009 MO 0.3 0 0.4 M 8/6/2009 Fever 2 days after vaccination, rash
353315 8/6/2009 TX 12 12 F 8/6/2009 On 11/16/08, pt went about her day
353316 8/6/2009 OH 42 42 F 8/6/2009 24 hours after Tdap, client had pain
353317 8/6/2009 CA 17 17 M 8/6/2009 18 yo recruit on day 24 of his trainin
353318 8/6/2009 CA 32 32 F 8/6/2009 Vaccine (Pneumovax 23) was admi
353319 8/6/2009 CA 42 42 M 8/6/2009 8/4/09 TDaP given to client who is a
353324 8/6/2009 CO 31 31 M 8/6/2009 This case was reported by a consum
353326 8/6/2009 UT 4 4 M 8/6/2009 (L) injection (MMR & DTaP) 8/3/09 2
353327 8/6/2009 CA 56 56 F 8/6/2009 Adverse effect fever 100.8, myalgia
353328 8/6/2009 VA 5 5 M 8/6/2009 10cm x 6cm area of induration, warm
353330 8/6/2009 MI 15 15 F 8/6/2009 Became pale 5 min after injection. L
353331 8/6/2009 IN 0.5 0 0.5 M 8/6/2009 Fever began a few hours after immu
353332 8/6/2009 PA 39 39 M 8/6/2009 Headache, (leg, neck, and back pai
353333 8/6/2009 FL 4 4 F 7/29/2009 Patient received vaccines- KINRIX,
353334 8/6/2009 MO 11 11 M 8/6/2009 Pt. c/o wheezing & swelling of face
353335 8/6/2009 CA 16 16 F 8/6/2009 About 4 pm, pt was at a restaurant,
353336 8/6/2009 TX 5 5 M 8/7/2009 Erythema multiforme minor
353337 8/6/2009 AZ 0.9 0 0.9 F 8/6/2009 Diffuse rash to face, torso, buttocks
353338 8/6/2009 NM 8 8 F 8/6/2009 Lt arm swollen, hot touch. Onset Au
353339 8/6/2009 CA 3 3 M 8/6/2009 Right leg with 12cm macule, warm t
353340 8/6/2009 IL 5 5 F 8/6/2009 Received DTAP shot (5th shot) on 8
353341 8/6/2009 CA 48 48 F 6/10/2009 Day after vaccination Pt. experience
353342 8/6/2009 CA 14 14 F 8/6/2009 Presented to urgent care clinic with
353348 8/6/2009 AR M 7/30/2009 Information has been received from
353351 8/6/2009 FL 27 27 F 7/30/2009 Initial and follow up information has
353352 8/6/2009 MS U 7/30/2009 Information has been received from
353356 8/6/2009 FL 36 36 F 7/30/2009 Initial and follow up information has
353421 8/6/2009 MI 1.1 1 0.1 M 7/30/2009 Initial and follow-up information has
353422 8/6/2009 GA 68 68 F 7/30/2009 Initial and follow up information has
353427 8/6/2009 U 7/30/2009 Information has been received conc
353437 8/6/2009 M 7/30/2009 Initial and follow up information has
353441 8/6/2009 F 7/30/2009 Initial and follow up information has
353454 8/6/2009 NY 71 71 F 7/30/2009 Initial and follow up information has
353497 8/6/2009 NE 60 F 7/30/2009 Information has been received from
353498 8/6/2009 MN 78 78 M 7/30/2009 Initials and follow up information ha
353499 8/6/2009 MN 87 87 F 7/30/2009 Initial and follow up information has
353500 8/6/2009 TX 35 35 M 7/30/2009 Initial and follow up information has
353504 8/6/2009 TX 65 65 F 7/30/2009 Initial and follow up information has
353506 8/6/2009 0.4 0 0.4 F 7/30/2009 Initial and follow up information has
353510 8/6/2009 FL 36 F 7/30/2009 Initial and follow-up formation has b
353511 8/6/2009 MN 66 66 M 7/30/2009 Information has been received from
353532 8/6/2009 CA 65 65 F 7/30/2009 Initial and follow up information has
353546 8/6/2009 GA 82 82 M 7/30/2009 Initial and follow up information has
353555 8/6/2009 KS 60 60 M 7/30/2009 Initial and follow up information has
353558 8/6/2009 OR 0.5 M 7/30/2009 Information has been received from
353568 8/6/2009 NC 56 M 7/30/2009 Information has been received from
353572 8/6/2009 MI 44 F 7/30/2009 Initial and follow-up information has
353654 8/6/2009 GA 0.3 F 7/30/2009 Information has been received from
353655 8/6/2009 WA 48 48 M 7/30/2009 Information has been received from
353662 8/6/2009 NJ 46 46 F 7/30/2009 Initial and follow up information has
353668 8/6/2009 WV U 7/30/2009 Information has been received from
353670 8/6/2009 WV M 7/30/2009 Information has been received from
353671 8/6/2009 WV 86 M 7/30/2009 Information has been received from
353673 8/6/2009 AR 55 55 M 7/30/2009 Information has been received from
353676 8/6/2009 WV 73 73 M 7/30/2009 Information has been received from
353680 8/6/2009 MO 69 69 F 7/30/2009 Initial and follow-up information has
353681 8/6/2009 TN 61 M 7/30/2009 Information has been received from
353704 8/6/2009 NY 22 22 F 7/30/2009 Initial and follow-up information has
353706 8/6/2009 WA 0.5 0 0.5 U 7/30/2009 Information has been received from
353711 8/6/2009 IA F 7/30/2009 Information has been received from
353713 8/6/2009 MA 50 U 7/30/2009 Information has been received from
353715 8/6/2009 CA 65 65 F 7/30/2009 Initial and follow-up information has
353726 8/6/2009 MI 0.3 U 7/30/2009 Information has been received from
353728 8/6/2009 ID 73 73 M 7/30/2009 Initial and follow-up information has
353845 8/6/2009 MS M 7/30/2009 Information has been received from
353848 8/6/2009 NJ 63 F 7/30/2009 Initial and follow-up information has
353851 8/6/2009 NY M 7/30/2009 Information has been received from
353857 8/6/2009 MS M 7/30/2009 Information has been received from
353862 8/6/2009 MS 60 M 7/30/2009 Information has been received from
353966 8/6/2009 OH 65 65 F 7/30/2009 Initial and follow up information has
353968 8/6/2009 UT F 7/30/2009 Information has been received from
353971 8/6/2009 SD 65 F 7/30/2009 Information has been received from
353975 8/6/2009 WI 63 63 F 7/30/2009 Initial and follow-up information has
353984 8/6/2009 IN 65 65 F 7/30/2009 Initial and follow-up information has
353985 8/6/2009 IN 70 70 F 7/30/2009 Initial and follow-up information has
353994 8/6/2009 WI 13 13 M 7/30/2009 Information has been received from
353995 8/6/2009 CA 0.2 0 0.2 U 7/30/2009 Information has been received from
353997 8/6/2009 NY 46 F 7/30/2009 Initial information has been received
354018 8/6/2009 NY 84 F 7/30/2009 Initial information has been received
354028 8/6/2009 NC U 7/30/2009 Information has been received from
354101 8/6/2009 U 7/30/2009 This report was received from Sano
354152 8/6/2009 WV 61 61 M 7/30/2009 Information has been received from
354159 8/6/2009 ID M 7/30/2009 Information has been received from
354160 8/6/2009 CT 62 62 M 7/30/2009 Information has been received from
354161 8/6/2009 TN 65 65 M 7/30/2009 Information has been received from
354164 8/6/2009 KS F 7/30/2009 Information has been received from
354165 8/6/2009 ID U 7/30/2009 Information has been received from
354176 8/6/2009 NH 37 37 M 7/30/2009 Information has been received from
354182 8/6/2009 TX 2 U 7/30/2009 Information has been received from
354184 8/6/2009 CT M 7/30/2009 Information has been received from
354212 8/6/2009 OK F 7/30/2009 Information has been received from
354213 8/6/2009 54 54 M 7/30/2009 Initial and follow-up information has
354216 8/6/2009 GA 50 50 M 7/30/2009 Information has been received from
354225 8/6/2009 CO 1 1 0M 7/30/2009 Information has been received from
354233 8/6/2009 WA 1 1 0F 7/30/2009 Information has been received from
354249 8/6/2009 KY U 7/30/2009 Information has been received from
354331 8/6/2009 OR 69 69 F 7/30/2009 Information has been received conc
354332 8/6/2009 AZ 80 80 M 7/30/2009 Information has been received by a
354339 8/6/2009 NC 58 58 M 7/30/2009 Information has been received conc
354597 8/6/2009 VA M 7/30/2009 Information has been received from
354598 8/6/2009 NM 57 M 7/30/2009 Information has been received from
354604 8/6/2009 IA 0.7 0 0.7 F 7/30/2009 Information has been received from
354673 8/6/2009 MD U 7/30/2009 Information has been received from
354674 8/6/2009 M 7/30/2009 Information has been received conc
354677 8/6/2009 NC 1 1 0M 7/30/2009 Information has been received from
354679 8/6/2009 VA 75 75 U 7/30/2009 Information has been received from
354686 8/6/2009 F 7/30/2009 Information has been received via N
354693 8/6/2009 NV U 7/30/2009 Information has been received from
354699 8/6/2009 MA M 7/30/2009 Information has been received from
354700 8/6/2009 MO 81 M 7/30/2009 Information has been received from
354709 8/6/2009 FL F 7/30/2009 Information has been received form
354712 8/6/2009 WV F 7/30/2009 Information has been received from
354713 8/6/2009 WV U 7/30/2009 Information has been received from
354714 8/6/2009 VA 19 F 7/30/2009 Information has been received form
354718 8/6/2009 GA 2 2 0.2 M 7/30/2009 Information has been received from
354722 8/6/2009 PA 67 67 F 7/30/2009 Information has been received form
354765 8/6/2009 MI 27 M 7/30/2009 Information has been received from
354789 8/6/2009 SC 1 1 0F 7/30/2009 Information has been received from
354833 8/6/2009 RI 21 21 M 7/30/2009 Information has been received from
354852 8/6/2009 SC 0.6 0 0.6 F 7/30/2009 Information has been received from
354892 8/6/2009 OR 0.4 0 0.4 F 7/30/2009 Information has been received from
353374 8/7/2009 MD 34 34 M 8/4/2009 Service member reports that in Jan
353375 8/7/2009 FL 4 4 M 7/28/2009 Vaccine on the 10th, Left thigh into
353376 8/7/2009 GA 84 84 F 8/3/2009 ZOSTAVAX administered 2/18/08. H
353377 8/7/2009 NY 4 4 F 7/28/2009 None stated.
353378 8/7/2009 NJ 5 5 F 7/31/2009 Suspected seizure. Disoriented. Diff
353379 8/7/2009 WI 73 73 F Pt. was given zoster vaccine 7/10/0
353380 8/7/2009 NC 69 69 F 8/3/2009 Rash, small dots on neck
353381 8/7/2009 70 U 7/14/09 Shingle shot - 4 days later b
353382 8/7/2009 CA 4 4 F 8/5/2009 (R) upper arm red warm to touch. B
353383 8/7/2009 WA 10 10 F 8/3/2009 Pt had TDAP vaccination in the (L)
353384 8/7/2009 WA 69 69 F 7/16/2009 Dev a rash 6d after ZOSTAVAX inje
353385 8/7/2009 IA 18 18 F 8/6/2009 Pt received immunizations at 0800 a
353386 8/7/2009 KS 12 12 F 8/7/2009 103.0 fever the night of injection, he
353395 8/7/2009 0.3 0 0.3 M 8/7/2009 This case wasY reported by a healthc
353396 8/7/2009 CO F 8/7/2009 This case was reported by a physici
353398 8/7/2009 TX 12 12 M 8/7/2009 Surrounding erythema and swelling
353399 8/7/2009 VA 4 4 M 8/7/2009 VARIVAX given 8/5/09 - 48hrs later
353400 8/7/2009 NE 0.3 0 0.3 M 8/7/2009 (L) upper thigh dime size red swolle
353401 8/7/2009 OH 67 67 F 8/7/2009 Received ZOSTAVAX on Friday, Ju
353402 8/7/2009 MI 63 63 F 8/7/2009 Fever developed day of immunisatio
353403 8/7/2009 TX 11 U Redness at the site of injection. Ant
353405 8/7/2009 MD 19 19 F 7/15/2009 Initial report received on 14 July 200
353406 8/7/2009 IL 67 67 F 8/8/2009 Mild headaches all day long.
353407 8/7/2009 TX 0.5 0 0.5 M 8/8/2009 Stridor and bronchospasm gave Ra
353408 8/7/2009 VA 58 58 M 8/7/2009 Patient had some arm swelling that
353409 8/7/2009 CA 0.5 0 0.5 F 8/7/2009 7 AM red face, trouble breathing 3 P
353410 8/7/2009 WI 10 10 M 8/8/2009 Pt fainted after receiving BOOSTRIX
353412 8/7/2009 DC 4 4 F 8/6/2009 Live vaccine administered less than
353413 8/7/2009 MI 13 13 F 7/29/2009 This report was received from a hea
353414 8/7/2009 MA 0.3 0 0.3 F 8/7/2009 Lethargy and poor feeding in the 1s
353415 8/7/2009 CA 14 14 F 8/5/2009 Four days after vaccines (8/4/09), te
353416 8/7/2009 TX 13 13 F 8/7/2009 Tenderness, inflammation, runny no
353417 8/7/2009 LA 4 4 F 8/6/2009 Erythema to L deltoid with edema n
353419 8/7/2009 AZ 68 68 F 8/7/2009 Swollen left arm- inflammation and t
353420 8/7/2009 NY 5 5 M 8/6/2009 Patient had cough and shortness of
353423 8/7/2009 TX 10 10 M 8/6/2009 2 inch by 4 inch erythematous on (L
353425 8/7/2009 PA 5 5 M 8/5/2009 Left lateral thigh SC with 3 inch in d
353426 8/7/2009 MN 4 4 M 8/5/2009 Multiple large masses of lymph nod
353428 8/7/2009 PA 58 58 M 8/5/2009 Localized redness and swelling at in
353429 8/7/2009 CA 2 2 0.4 M 8/7/2009 Left leg upper medial side swollen,
353430 8/7/2009 IL 17 17 F 8/6/2009 Received Hepatitis A #1 vaccine on
353431 8/7/2009 CA U Noted to have maculopapular rash 1
353432 8/7/2009 DC 0.5 0 0.5 M 8/6/2009 3rd Hepatitis B administered 7 week
353433 8/7/2009 DC 4 4 F 8/6/2009 Live vaccines administered less tha
353434 8/7/2009 TX 12 12 F 8/7/2009 5 X 8 cm erythema at site of VARIV
353435 8/7/2009 CA 68 68 F 8/5/2009 Pt. given VARIVAX instead of ZOST
353436 8/7/2009 TX 13 13 M 8/4/2009 5 X 8 erythema at site of VARIVAX
353438 8/7/2009 OH 65 65 F 8/7/2009 Local skin reaction with warmth, dis
353439 8/7/2009 CA 6 6 F 8/6/2009 L arm red in area vaccinated not wa
353440 8/7/2009 AZ 15 15 F Presyncope, Hypotension, diaphore
353442 8/7/2009 DC 55 55 M 8/4/2009 55 year old staff physician, active du
353444 8/7/2009 WI 11 11 F 7/31/2009 Noticed round red spot size of a bas
353445 8/7/2009 LA 9 9 M 8/3/2009 (L) leg (pt seen @ urgent care) 2" d
353447 8/7/2009 GA 1.5 1 0.5 M 7/30/2009 Patient developed redness and swe
353448 8/7/2009 MD 9 9 M 8/7/2009 Vaccine given 8/4/09; Seen on 8/6/
353456 8/7/2009 MI 4 4 F 8/7/2009 2" x 3" raised erythema on L thigh, s
353457 8/7/2009 NC 18 18 F 8/7/2009 AFTER RECEIVING VACCINES, C
353458 8/7/2009 NV 23 23 M 8/7/2009 Red, itchy rash on trunk, shest, and
353459 8/7/2009 TX 10 10 F 7/30/2009 Patient had syncope ~ 10 min after
353460 8/7/2009 CA 60 60 F 8/7/2009 7/29/09 TDaP placed in Travel Clini
353461 8/7/2009 PA 19 20 F 8/7/2009 Patient received Tdap on 07-31-09.
353462 8/7/2009 IN 72 72 F 8/7/2009 Patient reported that she received Z
353463 8/7/2009 WA 46 46 F 8/7/2009 First injection of Engerix B: 04/17/02
353464 8/7/2009 IL 14 14 F 8/7/2009 Child received Menactra 8/6/2009am
353465 8/7/2009 MT 64 64 F 8/7/2009 First, dizziness and diarrhea. Later,
353466 8/7/2009 PA 55 U 8/7/2009 subject in pneumococcal vaccine tri
353470 8/7/2009 MA 0.5 0 0.5 M 8/7/2009 Received 6 mo immunizations on 7/
353472 8/7/2009 MA 1 1 0M 8/7/2009 Recieved Prevnar on 7/28/09, on 7/
353475 8/7/2009 MO 1 1 0M 8/7/2009 High fever ranging from 101.5-104 d
353476 8/7/2009 NC 12 12 F 8/7/2009 Patient received Tdap. Approximat
353477 8/7/2009 MI 56 56 M 8/7/2009 12 hours after injection, arm becam
353479 8/7/2009 CA 1.3 1 0.3 M 8/7/2009 6.5cmX6.0cm erythematous indurat
353480 8/7/2009 MI 41 F 8/7/2009 24 hours after receiving Tdap client
353481 8/7/2009 FL 5 5 F 8/7/2009 Cellulitis around injection site. Hive
353482 8/7/2009 KS 35 35 F 8/7/2009 Fever 102.5, headache, chills, naus
353483 8/7/2009 TN 65 F 8/7/2009 pt said she had a reaction, it was th
353484 8/7/2009 CA 12 12 F 8/7/2009 fainted as leaving clinic after receivi
353501 8/7/2009 WA 67 67 F 7/30/2009 Initial and follow-up information has
354607 8/7/2009 NY 0.2 0 0.2 F 8/5/2009 This case was reported by a healthc
354894 8/7/2009 MD 0.3 0 0.3 F 8/5/2009 This case was reported by a physici
354895 8/7/2009 GA 0.2 0 0.2 F 8/5/2009 This case was reported by a physici
354896 8/7/2009 GA 0.3 F 8/5/2009 This case was reported by a physici
354897 8/7/2009 0.2 F 8/5/2009 This case was reported by a consum
354898 8/7/2009 0.1 F 8/5/2009 This case was reported by a consum
353485 8/8/2009 MO 5 5 F 8/8/2009 Destiny had fevers of 102 for 3 days
353486 8/8/2009 MI 14 14 F 8/8/2009 Stomach hurt, body red and itchy, m
353487 8/8/2009 MA 0.2 0 0.2 F 8/8/2009 Dramatic irritability several hours aft
353488 8/8/2009 AL 0.6 0 0.6 M 8/8/2009 he receved vaccination on a friday a
353489 8/8/2009 CA 24 24 M 8/8/2009 Sweating, chills, headache, head c
353490 8/8/2009 MA 4 4 M 8/8/2009 Limping, favoring right leg. Limitatio
353491 8/8/2009 CA 20 20 F 8/8/2009 Tingling and numbness in both hand
353492 8/8/2009 CA 72 72 M 8/8/2009 PER PATIENT'S FAMILY, PATIENT
353493 8/9/2009 PA 1.3 M 8/9/2009 fever, seizure x2
353494 8/9/2009 CA 0 1 0F 8/9/2009 After first vaccination (Hepatitis B) -
353495 8/9/2009 NY 2 2 0.1 M 8/9/2009 On August 6, 2009 my son recieved
353404 8/10/2009 MI 15 15 F 8/7/2009 Client received 1st GARDASIL and
353418 8/10/2009 CA 14 14 F 8/6/2009 Pt was nervous prior to receiving va
353496 8/10/2009 TX 1.3 1 0.3 F 8/9/2009 she has developed hives all over he
353514 8/10/2009 AL 18 18 F 8/7/2009 Information have been received from
353526 8/10/2009 WA 32 32 F 8/7/2009 Information has been received for th
353528 8/10/2009 OH 5 U 8/6/2009 Initial report received on 29 July 200
353529 8/10/2009 OH 5 U 8/6/2009 Initial report received on 29 July 200
353547 8/10/2009 FL 4 4 F 8/3/2009 Following administration of DTaP-IP
353551 8/10/2009 AZ 1 1 0F 5/28/2009 Upper lip swelling 3 hour after Immu
353553 8/10/2009 TX 0.5 0 0.5 F 7/23/2009 None Stated
353556 8/10/2009 TX 57 57 F 3/10/2009 After immunization, patient develop
353557 8/10/2009 FL 1.2 1 0.2 F 8/3/2009 Temp on & off X 4 days, rash on ba
353559 8/10/2009 AK 74 74 F 8/4/2009 Pt reported 35 days post vaccinatio
353561 8/10/2009 VA 14 14 F 8/4/2009 14 yo female fainted for seconds an
353565 8/10/2009 OK 1.1 1 0.1 M 8/3/2009 VARICELLA lesions erupted 8/3/09
353567 8/10/2009 NC 1.4 1 0.4 M 8/4/2009 Erythema multiforme skin RXN.
353570 8/10/2009 IA 17 17 M 8/4/2009 8/3/09 Mother phoned at approx. 3:
353571 8/10/2009 WI 73 73 F 8/5/2009 Headache - Induration at site of inje
353574 8/10/2009 GA 27 27 F 8/3/2009 Patient reports pain at injection site
353576 8/10/2009 NC 18 18 M 8/15/2009 Headache, neck, back pain, nausea
353577 8/10/2009 CA 37 37 F 8/3/2009 Site was reddened warm to touch, &
353578 8/10/2009 IL 5 5 M Left leg swelling, left arm bumps.
353579 8/10/2009 GA 11 11 F Client received MCV4 on 8/4/09 in l
353580 8/10/2009 CA 15 15 F Patient fainted and fell to the floor, s
353581 8/10/2009 NC 80 80 F 8/5/2009 Pt received ZOSTAVAX on 7/16/09
353582 8/10/2009 IN 11 11 U Vaccines given on Aug. 4, 2009, we
353583 8/10/2009 KS 16 16 F 8/6/2009 Arm pain followed by tingling in the
353584 8/10/2009 LA 4 4 M 8/6/2009 Red, swollen upper/forearm, warmth
353585 8/10/2009 AZ 0.3 0 0.3 F 8/5/2009 Fever, hives 7/27 went to ER CXR N
353586 8/10/2009 OH 11 11 F 8/7/2009 8x9mm area of redness, warm to to
353587 8/10/2009 NC 10 10 F 8/4/2009 Pt fainted with assistance to floor. P
353588 8/10/2009 12 F 8/5/2009 My daughter received her 1st dose
353589 8/10/2009 U Fatigue, achy muscles, fever warmt
353590 8/10/2009 TX 11 11 F 8/7/2009 Reddened/ raised area. Warm to to
353591 8/10/2009 TX 11 11 F 8/7/2009 Pt developed nausea, paleness, dia
353592 8/10/2009 MD 30 30 F 2-3 days mild itchy scattered pruritic
353593 8/10/2009 NY 11 11 F 8/10/2009 Injection site red and swollen - Advi
353594 8/10/2009 M Developed diffuse macular rash and
353595 8/10/2009 SC 51 51 F 8/10/2009 SC DAY AFTER VACCINES- FATIG
353596 8/10/2009 MO 18 18 F 8/10/2009 Mom reports that Friday (8/7/09)eve
353597 8/10/2009 TX 14 14 M 8/10/2009 Patient had just received Tdap, Hep
353598 8/10/2009 KS 15 15 F 8/10/2009 Pt presents to HD 08/10/09 @ 800a
353599 8/10/2009 SD 12 12 F 8/10/2009 No contraindications to vaccine on s
353600 8/10/2009 IL 5 5 M 8/10/2009 Swollen left arm-deltoid area-was se
353601 8/10/2009 CA 4 4 F 8/10/2009 PT GIVEN IPV AND MMR RIGHT A
353602 8/10/2009 CA 0.3 0 0.3 M 8/10/2009 Persistent high pitched crying x 3 da
353603 8/10/2009 WA 7 7 F 8/10/2009 Localized swelling measuring 3.5 in
353604 8/10/2009 WA 1.5 1 0.5 M 8/10/2009 Localized redness measuring 6.5 in
353605 8/10/2009 DE 44 44 F 8/10/2009 States 12-14 hours after immunizati
353606 8/10/2009 AK 11 11 M 8/10/2009 2.5 inch raised red welt formed the
353607 8/10/2009 MO 14 14 M 8/10/2009 Several minutes after shots were giv
353608 8/10/2009 TN 25 25 F 8/10/2009 Approx. 2 days after the vaccine wa
353609 8/10/2009 PA 11 11 F 8/10/2009 Received Gardasil dose #2. Walked
353610 8/10/2009 CA 61 61 F 8/10/2009 Shingles vaccination Zostevax rece
353611 8/10/2009 WI 24 24 F 8/10/2009 Vaccine administered May22, 2009
353612 8/10/2009 CA 0.2 0 0.2 F 8/10/2009 Non stop crying for more than 4 hou
353613 8/10/2009 MS 37 37 F 8/10/2009 chills, dizziness, difficulty breathing,
353614 8/10/2009 WI 1 1 0F 8/10/2009 Varicella vaccine administered on 7
353615 8/10/2009 OH 16 16 F 8/10/2009 Immediately following HPV#2 and V
353616 8/10/2009 SD 11 11 M 8/10/2009 Developed papular rash over entire
353617 8/10/2009 CA 1.3 1 0.3 F 8/10/2009 left thigh with mild erythema, 3cm w
353618 8/10/2009 WA 25 25 F 8/10/2009 Received vaccines on 07/29/09, Va
353619 8/10/2009 LA 4 4 F 8/10/2009 c/o Rash for 3 days left side around
353624 8/10/2009 TX 20 20 F 8/6/2009 Severe erythema, warmth, tenderne
353625 8/10/2009 KS 18 18 M 8/10/2009 Pain left arm, armpit, down side from
353626 8/10/2009 NC 20 20 M 8/10/2009 20 y/o AA male ADSM/Specialist is
353627 8/10/2009 KS 19 19 F 8/10/2009 08/09/2009 Mild, other. Redness. 3
353628 8/10/2009 KS 0.4 0 0.4 M 7/28/2009 Inj. site top R thigh covered by band
353629 8/10/2009 NJ 20 20 F 8/10/2009 Syncope. Bradycardia - pulse < 40.
353630 8/10/2009 AZ 0.3 0 0.3 F 7/27/2009 Vaccines given 7/20 including ROTA
353631 8/10/2009 CA 4 4 F 8/7/2009 On 8/5/09 pt rec'd KINRIX on L arm
353632 8/10/2009 WA 19 19 M 6/17/2009 Per clinical notes: 19 y/o male who
353633 8/10/2009 MN 5 5 F 8/10/2009 5 yo with onset of LE and buttock pu
353634 8/10/2009 TN 4 4 F 8/10/2009 Gave pt vaccine in R DM. approxim
353635 8/10/2009 TN 5 5 M 8/10/2009 Approx dime sized induration, quart
353636 8/10/2009 MD 4 4 F 8/6/2009 Local red indurated area @ site of v
353637 8/10/2009 MD 65 65 F 10 days post vaccine increase itchy
353638 8/10/2009 OR 2 1 1M 8/3/2009 Mother described red swollen extrem
353639 8/10/2009 2 1 1M 8/3/2009 Red, warm, swollen extremity where
353640 8/10/2009 TX 8 8 M 7/31/2009 Had HA and was nauseated 7/29 ev
353641 8/10/2009 MA 69 F 8/3/2009 Received pneumococcal vaccine in
353642 8/10/2009 CA 14 14 F 7/27/2009 6-10-09 at 5 PM lips started swelling
353643 8/10/2009 GA 7 7 M 8/4/2009 Pt had urticaria, and extreme erythe
353644 8/10/2009 NV 4 4 F 7/31/2009 Mom reports swelling & redness in r
353645 8/10/2009 MO 1.5 1 0.5 M 8/5/2009 An 18 cm X 14 cm red, warm to tou
353646 8/10/2009 GA 9 9 F 8/4/2009 Varicella vaccine administered with
353647 8/10/2009 CT 7 7 M Facial and nasal swelling, throat cle
353648 8/10/2009 NE 39 39 F 8/5/2009 Very painful. States on 7/2 her Lt. a
353649 8/10/2009 NC 7 7 M 8/5/2009 Within 24 hours the pt. developed e
353650 8/10/2009 TX 8 8 M 8/7/2009 Swelling, redness, warmth @ site o
353693 8/11/2009 KS 0.2 0 0.2 M 8/10/2009 Information has been received from
353731 8/11/2009 TN 17 17 M Pt. committed Y suicide on 8-3-09. 9/2
353732 8/11/2009 TN 2 2 0.1 M 8/4/2009 Wheezing - admitted 7/31/09 for 24
353734 8/11/2009 CA 1.6 1 0.6 M 8/4/2009 5/15/9 - MMR given with Hep A, Hib
353736 8/11/2009 NE 26 26 F 6/17/2009 Pt had taken an MMR vaccine 2 day
353738 8/11/2009 PA 4 4 F 8/6/2009 A LU arm slightly red and tender.
353740 8/11/2009 MS 4 4 M 8/1/2009 Fever and shaking chills X 16-17 hr
353741 8/11/2009 CA 0.4 0 0.4 M 8/7/2009 Pt. had vaccine on 7/31/09 in late a
353742 8/11/2009 AZ 5 5 F 8/6/2009 Left arm swollen, tight 24 hours.
353744 8/11/2009 IN 16 16 F 8/3/2009 C/o fainting
353745 8/11/2009 IN 5 5 F 8/5/2009 20 minutes post immunizations pt.'s
353746 8/11/2009 PA 59 59 M Servere left hip pain at injection site
353747 8/11/2009 HI 66 66 F reddened area (4 cm X 6 cm) below
353748 8/11/2009 HI 64 64 M 8/5/2009 Redness and slight swelling below a
353749 8/11/2009 DE 22 -1 0.9 F 7/30/2009 Seen @ Sick call with headache aft
353750 8/11/2009 MI 15 15 F 8/6/2009 Left health department, in car-driven
353751 8/11/2009 VA 11 11 M 8/6/2009 Seizure within 2-3 minutes after give
353753 8/11/2009 TX 14 14 F 8/4/2009 On 08/04/09 approx 10:10 AM vacc
353754 8/11/2009 OH 13 13 M 8/5/2009 Developed "tiny red bumps" on arm
353755 8/11/2009 OH 13 13 F 7/30/2009 Syncope, vomiting, grey skin tone. S
353756 8/11/2009 NY 19 19 M 8/5/2009 Fever to 101 degrees F, myalgias, c
353757 8/11/2009 KY 11 11 F 8/5/2009 About 24 hrs after receiving vaccine
353758 8/11/2009 UT 12 12 F 8/10/2009 Polyarthralgias, rash 24 hours post
353759 8/11/2009 TX 15 15 F 8/11/2009 Pt developed marked redness and s
353760 8/11/2009 IN 15 15 F 8/11/2009 Body aches, fatigue, blisters inside
353761 8/11/2009 KY 4 4 M 8/11/2009 R arm swollen, red, hot over entire a
353762 8/11/2009 TN 18 18 M 7/28/2009 Received MENACTRA 7/24/09. Felt
353763 8/11/2009 NC 18 18 F 8/10/2009 Severe diarrhea w/in 48 hrs. of 3rd
353764 8/11/2009 NC 10 10 M 8/3/2009 Pt received HEP A & VARIVAX on 7
353765 8/11/2009 0.2 M 7/31/2009 Severe crying episode lasting > one
353766 8/11/2009 MS 73 73 F 8/5/2009 On 7/27/09, Pt. was administered te
353767 8/11/2009 NY 5 5 F 7/15/2009 Edema & mild erythema of injection
353768 8/11/2009 9 9 M 8/6/2009 Pt presented to clinic today one day
353769 8/11/2009 CO 5 5 M 8/5/2009 Pt. developed large red area around
353770 8/11/2009 KY 1 1 0M 8/6/2009 5/24 developed fever 103.4 given A
353771 8/11/2009 MS 36 36 F 8/5/2009 (Left arm) swelling, redness, itching
353773 8/11/2009 MI 4 4 F 8/1/2009 Redness around injection site. Swe
353774 8/11/2009 CA 3 3 F 8/6/2009 On 8/6/09, Pt was brought in by her
353775 8/11/2009 WI 29 29 F 7/27/2007 1115 immediately c/o light headedn
353776 8/11/2009 DE 25 25 U Anthrax vaccine administered Frida
353777 8/11/2009 IN 12 12 F 8/11/2009 About 10-15 minutes after receiving
353778 8/11/2009 MI 69 69 F 8/11/2009 11x11" R deltoid, 7x7" distal, increa
353779 8/11/2009 MI 4 4 M 8/11/2009 Swollen, hot and red on anterior left
353780 8/11/2009 IN 5 5 M 8/11/2009 Mother noted redness, swelling, and
353781 8/11/2009 IA 0.5 0 0.5 F 8/11/2009 Patient was given vaccines in AM a
353782 8/11/2009 PA 20 20 F 8/11/2009 had 2 episodes of numbness and tin
353783 8/11/2009 OH 0.2 0 0.2 F 8/11/2009 7/29/09 - 2Pm Shots. Fever - mid.
353784 8/11/2009 CA 2 2 0.7 M 8/11/2009 Fever to 103, tachycardia, flushing o
353785 8/11/2009 KY 24 24 F 8/11/2009 C/o itching on arms and legs. Fine r
353786 8/11/2009 MI 51 51 M 8/11/2009 Generalized body aches, elevated t
353787 8/11/2009 NC 26 26 F 8/11/2009 Induration and erythema at the injec
353788 8/11/2009 WA 1 1 0F 8/11/2009 Fevers to 104.8 starting ~36 hours a
353789 8/11/2009 OH 24 24 F 8/11/2009 Spoke to patient. States had pain rig
353790 8/11/2009 CA 17 17 F 8/11/2009 Pt received HPV4 vaccine injection
353791 8/11/2009 MN 5 5 F 8/11/2009 Pt was given kindergarden immuniz
353792 8/11/2009 MA 18 18 F 8/11/2009 Two episodes of malaise, headache
353793 8/11/2009 MT 5 5 F 8/11/2009 rt arm red and very warm to touch. s
353794 8/11/2009 CA 24 24 U 8/11/2009 Arrythmia, Rapid Heart Rate, Exces
353795 8/11/2009 AZ 51 51 F 8/11/2009 received hepatitis B vaccine at emp
353796 8/11/2009 FL 1.4 1 0.4 F 8/11/2009 8th and 9th day after shot patient ra
353797 8/11/2009 TX 15 15 F 8/11/2009 APPROX 3-4 MIN AFTER ADMINIS
353801 8/11/2009 TX 0.5 0 0.5 F 8/10/2009 Vomiting. Bile stained. Abdominal
353803 8/11/2009 CO 21 21 F 7/29/2009 A couple of hours after 1st shot, my
353804 8/11/2009 CA 4 4 F 8/10/2009 4 1/2 X 4 cm left arm swollen with re
353805 8/11/2009 KS 60 60 F 8/11/2009 "3 days after vaccination pt develop
353806 8/11/2009 CO 11 11 M 7/29/2009 Approximately 24 hours after receiv
353807 8/11/2009 IA 79 79 F 8/11/2009 Injection site reaction- 1/2 dollar size
353808 8/11/2009 IA 67 67 F 8/10/2009 Injection site reaction - 2.5 inch diam
353809 8/11/2009 NC 5 5 M 8/11/2009 Pt had erythema of head, chest, arm
353810 8/11/2009 NY 1.4 1 0.4 F 8/16/2009 Within 10-15 min's developed hives
353811 8/11/2009 TX 3 3 M 8/11/2009 Given R upper lat leg - VARIVAX - 4
353812 8/11/2009 MD 16 16 M 8/6/2009 Localized erythema/induration w/ sp
353813 8/11/2009 NE 27 27 F 8/5/2009 Received 7/31/09- R. arm hives tha
353814 8/11/2009 CA 4 4 M 8/4/2009 Erythematous, indurated are 4.5 x 4
353815 8/11/2009 VA 2 2 0.6 F 8/6/2009 Patient started coughing, wheezing,
353816 8/11/2009 VA 69 69 F 8/10/2009 5 X 7 erythematous swelling of the l
353817 8/11/2009 CA 73 73 F 8/11/2009 Localized redness at injection site.
353818 8/11/2009 FL 70 70 M 8/10/2009 Localized edema/erythema.
353819 8/11/2009 OH 1.6 1 0.6 F 8/11/2009 - Pt developed swelling of and eryth
353820 8/11/2009 GA 9 9 F 7/27/2009 Approximately 5 minutes after vacci
353821 8/11/2009 CA 4 4 F 8/11/2009 Pt. rev'd 3 vaccines on left arm (DTA
353798 8/12/2009 TN 11 11 F 8/12/2009 Severe pain at injection sight in left
353799 8/12/2009 AZ 59 59 M 8/11/2009 I had a flu vaccine on 10-18-26 on t
353800 8/12/2009 FL 0.9 0 0.9 F 8/12/2009 Red un-raised splotches appeared o
353858 8/12/2009 MI 28 28 F 8/12/2009 no fever, but pain from the shoulder
353859 8/12/2009 57 57 F 8/12/2009 LEFT DELTOID 6 X 8 CM OF ERYT
353860 8/12/2009 TX 36 36 M 8/12/2009 Received Varicella vaccine on June
353861 8/12/2009 MO 17 17 F 8/5/2009 15-20 minutes after injection client e
353879 8/12/2009 SC 12 12 U 8/12/2009 Fever 102, dizzy, nausea weak nex
353880 8/12/2009 LA 1.1 1 0.1 M 8/12/2009 Pt presented to clinic on 8/11/09 wit
353881 8/12/2009 AZ 4 4 M 8/10/2009 Pt had diffuse swelling/redness of (L
353882 8/12/2009 NC 13 13 M 7/31/2009 Severe headache and low grade tem
353883 8/12/2009 GA 0.9 0 0.9 M 8/6/2009 1) Approximately 2.5 + 2.0 erythema
353884 8/12/2009 NC 18 18 F 8/7/2009 Tdap given before realizing patient
353885 8/12/2009 AZ 4 4 F Patient given 4 go shots (DTAP, IPV
353886 8/12/2009 TX 0.4 0 0.4 M 7/31/2009 Swelling to injection sites 2 1/2 cm.
353887 8/12/2009 TX 61 61 F Went to eye doctor = pt thought she
353888 8/12/2009 CO 14 14 M 8/6/2009 Arm red, swollen, warm to touch. Sk
353889 8/12/2009 TX 1.3 1 0.3 M 7/31/2009 Increase swelling thigh - 10 cm swe
353890 8/12/2009 MI 30 30 F 8/4/2009 A cluster of four patients (patient ide
353891 8/12/2009 MI 51 51 F 7/20/2009 A cluster of four patients (patient ide
353892 8/12/2009 MI 82 82 F 8/4/2009 This non serious case was received
353893 8/12/2009 MI 76 76 M 7/20/2009 This non serious case was received
353894 8/12/2009 TX 18 19 F 8/12/2009 Patient developed severe and longl
353895 8/12/2009 MI 0.3 0 0.4 M 8/12/2009 Day after vaccines were given, pt w
353896 8/12/2009 PA 67 67 F 8/12/2009 Pt received Zostavax on 08/10/09 a
353897 8/12/2009 TX 4 4 F 8/12/2009 Parent states the child had "vomitin
353898 8/12/2009 MA 0.2 0 0.2 F 8/12/2009 According to parents child had decr
353899 8/12/2009 TX 0.5 0 0.5 F 8/12/2009 Patient with symptoms c/w partial se
353901 8/12/2009 TX 16 16 F 8/6/2009 Maryan rec'd 6 immunizations here
353902 8/12/2009 TX 15 15 M 8/6/2009 Pt rec'd 6 immunizations. Waiting fo
353903 8/12/2009 TX 12 12 F 8/4/2009 Welps on arms, trunk, back, neck
353904 8/12/2009 AZ 9 9 M 8/12/2009 Redness, swelling at injection site, e
353905 8/12/2009 WI 61 61 F 8/12/2009 Pt was given Zostavax to LUE on 08
353906 8/12/2009 WA 5 5 M 8/12/2009 Onset of low-grade fever (100.2 ora
353907 8/12/2009 SC 22 22 F 8/12/2009 Fever of 100.0,joint pain, body ache
353908 8/12/2009 IA 17 17 F 8/12/2009 Patient was sent to the nurses statio
353909 8/12/2009 WA 13 13 F 8/12/2009 Patient passed out about 5 minutes
353910 8/12/2009 IL 11 11 F 8/12/2009 Patient experienced vomitting appro
353912 8/12/2009 PA 4 4 M 8/12/2009 PATIENT WOKE UP LAST NIGHT,
353913 8/12/2009 CA 16 16 F 8/12/2009 PT WAS GIVEN AN EXTRA IPV NA
353914 8/12/2009 PA 83 83 F 8/12/2009 3 days after receiving Zostavax pati
353915 8/12/2009 OH 15 15 F 8/12/2009 Pt became shaky and nauseuos wit
353916 8/12/2009 WA 1 0 1M 8/12/2009 Febrile Seizure 8-11-09 Seen in ER
353917 8/12/2009 CA 5 5 F 8/12/2009 pt presented 2 days post vaccinatio
353918 8/12/2009 MO 5 5 M 8/12/2009 The area is very red and swollen. It
353920 8/12/2009 21 21 F 8/12/2009 This case was reported by a physici
353922 8/12/2009 GA 5 5 F 8/11/2009 Pt c/o acute abdominal pain then sy
353923 8/12/2009 CT 60 60 F 8/13/2009 Swelling pain at site of vaccine 8/6/0
353924 8/12/2009 GA 2 2 0.4 F 8/12/2009 After receiving 4 mos. vaccines child
353925 8/12/2009 PA 5 5 F 8/12/2009 Pt's mother, called this RN at 12:15
353927 8/12/2009 VA 4 4 F 8/12/2009 Pt had redness; Itching and warmth
353928 8/12/2009 CA 28 28 F 8/12/2009 Rash / Urticaria appears 2 days afte
353930 8/12/2009 CA 4 4 F 8/12/2009 Swollen injection site with vesicles,
353932 8/12/2009 NC 8 8 F 8/10/2009 Left thigh @ injection site by day 2 a
353933 8/12/2009 AK 9 9 F Varicella administered R upper arm
353934 8/12/2009 TX 1.8 1 0.8 F 8/12/2009 Rash and lump to site fever 103.4.
353936 8/12/2009 CO 24 24 F 8/12/2009 Pt received DTaP left deltoid at hos
354034 8/13/2009 MN 37 37 F 8/11/2009 This case was received from a heal
354035 8/13/2009 AZ F 8/11/2009 Initial report received on 07 August
354036 8/13/2009 MO 0.5 0 0.5 M 8/12/2009 Intussusception. Vaccine give 7/22/
354037 8/13/2009 NJ 16 16 F 8/5/2009 Vaccine was administered, patient b
354039 8/13/2009 UT 12 F 8/11/2009 Approximately 20 seconds after the
354040 8/13/2009 KS 15 15 M 7/30/2009 Pt. passed out in lobby after receivin
354041 8/13/2009 PA 15 15 F 8/13/2009 Pt acquired PCR positive for pertuss
354042 8/13/2009 PA 5 5 M 8/13/2009 Patient acquired pertussis (positive
354043 8/13/2009 PA 11 11 F 8/13/2009 Pt developed pertussis (PCR positiv
354044 8/13/2009 PA 2 2 0.4 F 8/13/2009 Patient acquired pertussis and was
354045 8/13/2009 AL 10 10 F 8/13/2009 Approximately 5 minutes after inject
354046 8/13/2009 PA 1.5 1 0.5 F 8/13/2009 Pt acquired pertussis and was PCR
354047 8/13/2009 PA 1.5 1 0.5 F 8/13/2009 Patient acquired PCR positive pertu
354048 8/13/2009 AL 13 13 F 8/13/2009 Approximately 5 minutes after recei
354049 8/13/2009 WA 4 4 F 8/13/2009 Irritation at site of injection (right sho
354050 8/13/2009 TN 5 5 M 8/13/2009 Mother of patient reported some sw
354051 8/13/2009 WI 64 64 F 8/12/2009 Pt developed shingles 8/12/09.
354052 8/13/2009 VA 21 21 F 8/5/2009 Patient reported to us on 8/5/09. Sh
354053 8/13/2009 FL 4 5 F 8/13/2009 R arm. Site of injection became hard
354054 8/13/2009 MN 0.3 0 0.3 F 8/7/2009 Vaccinated 8/5/09. Projectile vomitin
354055 8/13/2009 TN 5 5 F 8/7/2009 Red, raised area on left upper thigh
354056 8/13/2009 MD 69 69 M 8/9/2009 4 days after admin - diffuse trunk pa
354057 8/13/2009 FL 16 16 F 7/23/2009 Patient experienced dizziness and n
354058 8/13/2009 PA 11 11 M Vomiting, high fever (104 Rectal), h
354059 8/13/2009 IL 14 14 M 8/4/2009 Received Tdap & Varicella L arm 7/
354075 8/13/2009 IL 4 4 M 8/6/2009 Left leg 4" diameter erythema with m
354076 8/13/2009 OH 5 F 8/10/2009 L arm site. Mother called Health De
354077 8/13/2009 IA 5 5 F 8/10/2009 Immunizations listed below given in
354078 8/13/2009 CA 39 39 F 8/7/2009 Patient came in on 7/27/09 c/o sore
354080 8/13/2009 WA 1.3 1 0.3 M 8/7/2009 6-0.5-1 mm red papules with surrou
354081 8/13/2009 65 65 F 8/8/2009 I had the ZOSTAVAX injection at a
354082 8/13/2009 74 F 8/8/2009 I received the ZOSTAVAX on April 1
354083 8/13/2009 5 5 M 5/3/2006 About 24 hours after DTaP + IPU gi
354084 8/13/2009 PA 16 16 U 8/13/2009 pt had headace and stomache slef r
354085 8/13/2009 TN 13 13 F 8/13/2009 Patient received 4 immunizations on
354086 8/13/2009 NC 11 11 F 8/13/2009 Fever to Tmax of 103, soft tissue sw
354087 8/13/2009 MN 26 26 F 8/13/2009 Pt described feeling lousy, muscle a
354088 8/13/2009 VA 66 66 F 8/13/2009 reddish rash and swelling, similar to
354090 8/13/2009 3 3 F 7/23/2009 Redness, swelling, cool compress.
354091 8/13/2009 AZ 5 5 F 7/23/2009 Redness & swelling of arm. Cool co
354092 8/13/2009 MN 9 M 8/11/2009 Developed a 4x4 in erythematous, w
354093 8/13/2009 NC 17 17 F 8/6/2009 1st dose of HEP A gave pt. "severe
354094 8/13/2009 NV 1.3 1 0.3 M 7/31/2009 PCV 7 #4 vaccine given @ 12 mont
354095 8/13/2009 CO 62 62 F 8/10/2009 High fever, accelerated heart rate, m
354096 8/13/2009 FL 14 14 F 8/12/2009 Patient became very dizzy, nauseou
354097 8/13/2009 CA 4 4 F 8/12/2009 Pt mother called health center on 8-
354098 8/13/2009 NC 4 4 F 8/13/2009 Injection site reaction- erythema, wa
354099 8/13/2009 NC 8 8 F 8/14/2009 Varicella vaccine given in left arm a
354100 8/13/2009 CA 5 5 F 8/12/2009 Pt given immunization and within fiv
354112 8/13/2009 AZ 11 11 M 8/13/2009 Pain, redness right upper arm.
354113 8/13/2009 NH 21 21 F 8/13/2009 urticaria, throat scratchiness
354114 8/13/2009 FL 22 22 F 8/13/2009 Blood work was done as a routine p
354115 8/13/2009 MI 19 19 F 8/13/2009 Patient received third dose of series
354116 8/13/2009 AL 4 4 F 8/13/2009 Hundres of lesions on body
354117 8/13/2009 TX 10 11 F 8/13/2009 Received the following vaccinations
354118 8/13/2009 WI 72 72 M 8/13/2009 08/13/2009 Caregiver noted a red a
354119 8/13/2009 WA 23 23 F 8/13/2009 Pt was given Smallpox vaccine and
354120 8/13/2009 SD 0.4 0 0.4 F 8/13/2009 2 days after 1-09 4 month shots of D
354121 8/13/2009 CA 74 74 M 8/13/2009 Swollen Arm, Muscle Aches, 100 F
354122 8/13/2009 TX 4 4 F 8/13/2009 Both legs swollen & red.
354123 8/13/2009 TX 12 12 F Both arms swollen & red.
354124 8/13/2009 NY 0.4 0 0.4 M 8/11/2009 Mom called office child screaming (u
354125 8/13/2009 CA 5 5 M 8/13/2009 8/12/09 - Swelling of left arm where
354126 8/13/2009 WI F 7/28/2009 Loc for a few seconds body stiffene
354127 8/13/2009 NE 12 12 M 8/13/2009 Hives on right arm, right leg and abd
354128 8/13/2009 WI 11 11 F 8/13/2009 Pt felt lightheaded and was pale.
354129 8/13/2009 NH 11 11 F 8/13/2009 Red, Raised, Warm, Size -->1.5 in d
354130 8/13/2009 MN 12 12 M 8/13/2009 Local reaction: swelling, redness, w
354131 8/13/2009 NC 1.2 1 0.2 M 8/13/2009 Varicella - low grade temp and red s
354132 8/13/2009 KS 1.2 1 0.2 M 8/13/2009 8/12 3:40 PM- vomited - (crying sinc
354133 8/13/2009 SD 33 33 F 7/22/2009 None
354134 8/13/2009 MO 1.9 1 0.9 M 8/13/2009 Child received immunization 1 on 8-
354135 8/13/2009 MI 13 13 M 8/12/2009 R shoulder (trapezius muscle) enlar
354136 8/13/2009 WV 18 18 F 8/13/2009 Immediately following HPV injection
354137 8/13/2009 MO 0.5 0 0.5 M 8/13/2009 Parent brought pt into clinic on 7/24
354139 8/13/2009 TX 10 10 F 8/13/2009 Both legs swollen & red.
354140 8/13/2009 CA 8 M 8/13/2009 Patient came in with ~24 hr history o
354141 8/13/2009 GA 10 10 M 8/10/2009 Blisters around injection site swellin
354143 8/13/2009 CA 1.8 1 0.8 M 8/13/2009 08/12/09 Pt returned with reddened
354144 8/13/2009 34 34 F 8/11/2009 This 42 year old USAF services me
354145 8/13/2009 AZ 1.5 1 0.5 F 8/11/2009 Diagnosed with R OM 7/22/09, put o
354941 8/13/2009 CA 4 M 9/5/2008 A non-serious spontaneous report o
355008 8/13/2009 NC 4 4 U ### A non-serious spontaneous report o
355011 8/13/2009 MN 9 9 M ### A serious labeled spontaneous repo
355104 8/13/2009 CA 5 5 F ### A non-serious report of expired dos
355105 8/13/2009 14 F 8/11/2008 A non-serious spontaneous report o
355106 8/13/2009 MI 31 F 8/20/2008 A non-serious spontaneous report o
355107 8/13/2009 PA 7 M 8/21/2008 A non-serious spontaneous report o
355108 8/13/2009 U 8/22/2008 A non-serious spontaneous report o
355114 8/13/2009 13 M 8/22/2008 A non-serious spontaneous report o
355115 8/13/2009 OH M 9/3/2008 A non-serious spontaneous report o
355116 8/13/2009 NY 52 M 9/29/2008 A non-serious spontaneous report o
355117 8/13/2009 MD 27 27 F 9/30/2008 A non-serious spontaneous report o
355118 8/13/2009 MO 7 M 3/24/2009 A non-serious spontaneous report o
355119 8/13/2009 FL 6 F 9/11/2008 A non-serious spontaneous report o
355120 8/13/2009 MN 5 F 9/19/2008 A Non - serious spontaneous report
355121 8/13/2009 VA 12 M 9/25/2008 A non-serious spontaneous case of
355122 8/13/2009 MD 40 40 M 9/17/2008 A non-serous spontaneous report o
355123 8/13/2009 MD 5 5 M 9/17/2008 A non-serious spontaneous report o
355124 8/13/2009 KY 31 F 9/19/2008 A non-serious spontaneous report o
355125 8/13/2009 MN 5 5 F 9/30/2008 A non-serious spontaneous report o
355126 8/13/2009 NY 11 M 9/24/2008 A non-serious spontaneous report o
355127 8/13/2009 IL 5 F 9/25/2008 A non-serious spontaneous report o
355129 8/13/2009 FL 5 M 9/26/2008 A non-serious spontaneous report o
355151 8/13/2009 9 M 9/29/2008 A non-serious report of administratio
355152 8/13/2009 TX 8 8 F 9/29/2008 A non-serious, spontaneous report
355153 8/13/2009 PA 9 M 11/6/2008 A serious report of vomiting, diarrhe
355154 8/13/2009 IL 5 5 M 1/12/2009 A non-serious unlabeled spontaneo
355155 8/13/2009 MI F 10/3/2008 A non-serious spontaneous report o
355156 8/13/2009 MI 7.5 M 10/6/2008 A non-serious spontaneous report o
355157 8/13/2009 MT 19 M 11/7/2008 A non-serious report of administratio
355160 8/13/2009 MT 26 F 11/7/2008 A non-serious report of administratio
355162 8/13/2009 MT 22 F 11/7/2008 A non-serious report of administratio
355163 8/13/2009 NC 5 M 10/6/2008 A non-serious, spontaneous report
355164 8/13/2009 TX 7 F 10/6/2008 A non-serious labeled, spontaneous
355171 8/13/2009 MT 22 M A non-serious report of administratio
355173 8/13/2009 MT 21 F A non-serious report of administratio
355174 8/13/2009 MT 19 M A non-serious report of administratio
355176 8/13/2009 TN 24 F 10/6/2008 A non-serious, spontaneous report
355179 8/13/2009 NM F 10/6/2008 One of twenty-one cases: A non-se
355180 8/13/2009 NM F 10/6/2008 One of twenty-one cases: A nonser
355182 8/13/2009 NM F 10/6/2008 One of twenty-one cases: A non - s
355183 8/13/2009 NM M 10/6/2008 One of twenty-one cases: A non-se
355186 8/13/2009 NM M 10/6/2008 Inappropriate dose of vaccine admin
355197 8/13/2009 NM M 10/6/2008 One of twenty-one cases: A non ser
355286 8/13/2009 IA 85 F ### A non-serious spontaneous report o
355287 8/13/2009 SD 24 M 10/9/2008 A non-serious, spontaneous report
355290 8/13/2009 NJ F 10/9/2008 A non-serious spontaneous report o
355292 8/13/2009 FL 48 M ### A non-serious, spontaneous report
355294 8/13/2009 KY 45 F ### A non-serious Spontaneous report o
355297 8/13/2009 CO 28 F ### A non-serious, spontaneous report
355298 8/13/2009 OH 43 F ### A non-serious, spontaneous report
355299 8/13/2009 CO 7 M ### A non-serious spontaneous report o
355300 8/13/2009 GA M 11/3/2008 A non-serious spontaneous report o
355304 8/13/2009 GA M 11/3/2008 A non-serious spontaneous report o
355305 8/13/2009 KS 8 M 11/7/2008 A non-serious, spontaneous report
355306 8/13/2009 UT 7 F ### A non-serious, spontaneous report
355307 8/13/2009 NC 52 M ### A non-serious, spontaneous report
355308 8/13/2009 TX 69 69 U ### A non-serious, spontaneous report
355309 8/13/2009 KS 16 F A non-serious report of inadvertentl
355310 8/13/2009 MD 56 M ### A non-serious spontaneous report o
355311 8/13/2009 F ### A non-serious, spontaneous report
355312 8/13/2009 TX 76 76 U ### A non-serious, spontaneous report
355313 8/13/2009 OH 62 F 11/7/2008 A non-serious, spontaneous report
355314 8/13/2009 NC 7 7 M ### A non-serious, spontaneous report
355315 8/13/2009 OH 5 5 M ### A non-serious report of Henoch Sch
355317 8/13/2009 KY M ### A non-serious, spontaneous report
355318 8/13/2009 FL 5 F ### A non-serious report of runny nose
355319 8/13/2009 GA 28 28 M 11/3/2008 A non-serious spontaneous report o
355320 8/13/2009 MN 10 F ### A non-serious, spontaneous report
355321 8/13/2009 KY 9 M ### A non-serious, spontaneous report
355322 8/13/2009 12 12 F ### A non-serious spontaneous report o
355323 8/13/2009 IN 13 F 1/8/2009 A non-serious spontaneous report o
355324 8/13/2009 NV 50 M ### A non-serious spontaneous report o
355325 8/13/2009 MN 34 M 11/6/2008 A non-serious spontaneous report o
355326 8/13/2009 MN 5 M ### A non-serious spontaneous report o
355327 8/13/2009 IL 8 M 11/7/2008 A non-serious, spontaneous report
355328 8/13/2009 IL 13 M ### A serious spontaneous report of par
355329 8/13/2009 UT 8 U 3/24/2009 A non-serious spontaneous report o
355330 8/13/2009 MN 34 34 M A non-serious spontaneous report o
355331 8/13/2009 WA 37 F ### A non-serious, spontaneous report
355332 8/13/2009 TX 6 M ### A non-serious report of swelling of t
355333 8/13/2009 NC 35 F ### A non-serious spontaneous report o
355334 8/13/2009 IN 9 9 M ### A non-serious, spontaneous report
355335 8/13/2009 MN 59 M ### A non-serious spontaneous report o
355336 8/13/2009 WI F ### A non-serious, spontaneous report
355337 8/13/2009 KS U 4/9/2009 A non-serious report of expired FLU
355342 8/13/2009 NM 58 F ### A non-serious spontaneous report o
355345 8/13/2009 VA 30 F ### A non-serious, spontaneous report
355347 8/13/2009 FL 5 M ### A non-serious spontaneous report o
355351 8/13/2009 CA F ### A non-serious spontaneous report o
355356 8/13/2009 CA 8 M 1/13/2009 A non-serious spontaneous report o
355359 8/13/2009 AL 5 5 F 11/3/2008 A non-serious, spontaneous report
355390 8/13/2009 PA 6 F 11/3/2008 A non-serious, spontaneous report
355395 8/13/2009 KS U 4/9/2009 A non-serious report of expired FluM
355438 8/13/2009 KS U 4/9/2009 A non-used report of expired FluMis
355440 8/13/2009 SD 24 24 F ### A non-serious spontaneous report o
355441 8/13/2009 MN 27 F 11/5/2008 A non-serious, spontaneous report
355442 8/13/2009 OR F 11/4/2008 A non-serious spontaneous report o
355443 8/13/2009 KS 11 F 11/5/2008 A non-serious, spontaneous report
355444 8/13/2009 CA 11 11 F 11/5/2008 A non-serious spontaneous report o
355445 8/13/2009 MA F 11/6/2008 A non-serious spontaneous report o
355447 8/13/2009 NC 8 M 11/6/2008 A non-serious spontaneous report o
355448 8/13/2009 TN 7 F 11/6/2008 A non-serious, spontaneous report
355449 8/13/2009 MN 54 F 11/6/2008 A non-serious spontaneous report o
355450 8/13/2009 F 11/5/2008 A non-serious, spontaneous report
355451 8/13/2009 CO 41 41 F ### A non-serious, spontaneous report
355452 8/13/2009 PA 43 F 11/7/2008 A non-serious spontaneous report o
355453 8/13/2009 NY 7 M ### A non-serious spontaneous report o
355454 8/13/2009 VA 17 17 F ### A non-serious spontaneous report o
355455 8/13/2009 GA F ### A non-serious spontaneous report o
355458 8/13/2009 GA U ### A non-serious spontaneous report o
355464 8/13/2009 GA F ### Inappropriate dose of vaccine admin
355532 8/13/2009 GA M ### A non-serious spontaneous report o
355546 8/13/2009 IN 8 F ### A non-serious spontaneous report o
355560 8/13/2009 VA 6 6 F 4/9/2009 A non-serious spontaneous report o
355561 8/13/2009 NV 57 F A non-serious spontaneous report o
355563 8/13/2009 CT 10 F 4/9/2009 A non-serious spontaneous report o
355564 8/13/2009 TX 31 31 F ### A non-serious report of administrati
355565 8/13/2009 MD 19 19 M 12/3/2008 A non-serious, spontaneous report
355566 8/13/2009 NY 10 F ### A spontaneous non-serious report o
355567 8/13/2009 OH 10 10 F 1/8/2009 A non-serious spontaneous report o
355568 8/13/2009 OH 9 9 F 12/2/2008 A non-serious unlabeled spontaneo
355569 8/13/2009 KY 7 M 12/3/2008 A non-serious spontaneous report o
355570 8/13/2009 WI 52 F 12/3/2008 A non-serious spontaneous report o
355571 8/13/2009 CA 34 F ### A spontaneous non-serious report o
355572 8/13/2009 NV 35 35 F ### A non-serious, spontaneous report
355573 8/13/2009 IA 12 12 F 4/9/2009 A non-serious spontaneous report o
355574 8/13/2009 KY 55 M 12/8/2008 A spontaneous non-serious report o
355575 8/13/2009 VT 10 F ### A non-serious report of fever, vomiti
355576 8/13/2009 WI 48 48 F ### A non-serious spontaneous report o
355577 8/13/2009 MD 46 U 4/9/2009 A non-serious spontaneous report o
355579 8/13/2009 TX 12 12 F ### Neither relevant medical history nor
355580 8/13/2009 TX 9 9 F ### A non-serious, spontaneous, report
355581 8/13/2009 IA 42 M 3/31/2009 A non-serious spontaneous report o
355582 8/13/2009 NY 6 F 12/8/2008 A spontaneous non-serious report o
355583 8/13/2009 NY 9 M 12/8/2008 A spontaneous non-serious report o
355584 8/13/2009 IN 6 6 M ### A non-serious spontaneous report o
355585 8/13/2009 TX 9 U 12/1/2008 A non-serious spontaneous report o
355586 8/13/2009 CA 7 7 M 1/5/2009 A non-serious spontaneous report o
355587 8/13/2009 MI 54 F ### A non-serious, spontaneous report
355588 8/13/2009 PA 5 F ### A spontaneous non-serious report o
355589 8/13/2009 PA 26 26 F 4/21/2009 A non-serious spontaneous report o
355596 8/13/2009 MO 49 49 F 4/9/2009 A non-serious spontaneous report o
355597 8/13/2009 TX 14 F ### A spontaneous non-serious report o
355598 8/13/2009 OH 6 F ### A spontaneous non-serious report o
355599 8/13/2009 NV 22 22 F ### A non-serious spontaneous report o
355600 8/13/2009 MD 23 F ### Vaccine exposure during pregnancy
355601 8/13/2009 MI 6 M 4/9/2009 A non-serious, spontaneous report
355602 8/13/2009 IN 55 55 M 1/13/2009 A non-serious spontaneous report o
355604 8/13/2009 CA 6 F 4/9/2009 A non-serious spontaneous report o
355606 8/13/2009 MI 24 24 F ### A non-serious spontaneous report o
355607 8/13/2009 MD 5 M ### A spontaneous non-serious report o
355608 8/13/2009 MI 28 28 F ### A spontaneous non-serious report o
355610 8/13/2009 MI 6 F 3/27/2009 A non-serious spontaneous report o
355611 8/13/2009 KY 52 F 4/9/2009 A non-serious spontaneous report o
355612 8/13/2009 WI 14 M 4/9/2009 A non-serious spontaneous report o
355613 8/13/2009 WA 11 11 M 4/9/2009 A non-serious spontaneous report o
355614 8/13/2009 WV 7 7 M 3/20/2009 A non-serious report of administered
355615 8/13/2009 RI 9 M 4/9/2009 A non-serious, spontaneous report
355616 8/13/2009 AZ 14 M 3/13/2009 A spontaneous non-serious report o
355617 8/13/2009 MN 15 M 4/9/2009 A non-serious spontaneous report o
355619 8/13/2009 CT 13 13 F 4/9/2009 A non-serious spontaneous report o
355620 8/13/2009 MN 17 F 4/9/2009 A non-serious report of expired FLU
355622 8/13/2009 AL 9 9 F 1/5/2009 A spontaneous non-serious report o
355625 8/13/2009 MO 29 29 M 4/9/2009 A non-serious report of expired FLU
355628 8/13/2009 IA 43 43 F 4/9/2009 A non-serious report of administratio
355631 8/13/2009 OR 22 F 3/20/2009 A non-serious report of administratio
355633 8/13/2009 MO 5 5 M 4/9/2009 A non-serious, spontaneous report
355636 8/13/2009 MO 5 5 F 4/9/2009 A non-serious, spontaneous report
355637 8/13/2009 MO 8 8 F 4/9/2009 A non-serious, spontaneous report
355640 8/13/2009 MD 12 12 M 4/9/2009 A spontaneous non-serious report o
355643 8/13/2009 AR 5 5 U 1/7/2009 A non-serious report of "six patients
355648 8/13/2009 RI 15 M 3/27/2009 A non-serious spontaneous report o
355650 8/13/2009 RI 18 F 4/9/2009 A non-serious spontaneous report o
355651 8/13/2009 CA U 3/20/2009 A non-serious spontaneous report o
355652 8/13/2009 AZ 6 6 U 4/9/2009 A spontaneous non-serious report o
355653 8/13/2009 MN U 4/9/2009 A non-serious, spontaneous report
355654 8/13/2009 OH 5 5 F 4/9/2009 A non-serious spontaneous report o
355655 8/13/2009 DC 10 10 F 4/9/2009 A non-serious, spontaneous report
355656 8/13/2009 DC 11 11 F 4/9/2009 A non-serous, spontaneous report o
355662 8/13/2009 NJ 7 7 M 1/6/2009 A non serious spontaneous report o
355666 8/13/2009 MO 9 F 4/9/2009 A non-serious spontaneous report o
355667 8/13/2009 GA 26 26 F 1/13/2009 A spontaneous non-serious report o
355669 8/13/2009 9 9 F 4/9/2009 A non-serious spontaneous report o
355671 8/13/2009 NC 20 20 F 1/20/2009 A non-serious spontaneous report o
355763 8/13/2009 NM 27 F 1/23/2009 A non-serious spontaneous report o
355764 8/13/2009 IA 13 F 1/27/2009 A non-serious spontaneous report o
355765 8/13/2009 FL 9 M 1/27/2009 A spontaneous, non-serious report
355768 8/13/2009 MN 59 M 1/27/2009 A spontaneous, non-serious report
355770 8/13/2009 5 M 4/9/2009 A non-serious spontaneous report o
355775 8/13/2009 VA 30 F 2/2/2009 A non-serious spontaneous report o
355776 8/13/2009 MA 11 M 2/2/2009 A spontaneous, non-serious report
355777 8/13/2009 IL F 4/9/2009 A spontaneous, non-serious report
355778 8/13/2009 MN 36 F 4/9/2009 A non-serious, spontaneous report
355779 8/13/2009 SC 6 F 4/9/2009 A non-serious spontaneous report o
355781 8/13/2009 TN 11 M 3/31/2009 A non-serious spontaneous report o
355785 8/13/2009 TX 9 U 2/5/2009 A non-serious spontaneous report o
355786 8/13/2009 LA 7 7 F 2/6/2009 A non-serious spontaneous report o
355787 8/13/2009 NJ 14 M 2/10/2009 A non-serious spontaneous report o
355788 8/13/2009 MD 10 M 2/11/2009 A non-serious spontaneous report o
355789 8/13/2009 AZ 65 M 3/31/2009 A non-serious, spontaneous report
355790 8/13/2009 AZ 42 F 3/31/2009 A non-serious, spontaneous report
355792 8/13/2009 IN 11 11 M 3/9/2009 A non-serious, spontaneous report
355798 8/13/2009 14 F 2/23/2009 A non-serious spontaneous report o
355800 8/13/2009 5 F 2/27/2009 A non-serious, spontaneous report
355806 8/13/2009 TX 11 M 4/9/2009 A spontaneous, non-serious report
355918 8/13/2009 NJ M 5/12/2009 A non-serious spontaneous report o
355921 8/13/2009 NJ 48 48 F 5/12/2009 Expired vaccine used. A non-seriou
355930 8/13/2009 NJ 48 48 M 5/12/2009 Expired vaccine used. A non-seriou
355991 8/13/2009 NJ 27 27 F 5/12/2009 Expired vaccine used. A non-seriou
356013 8/13/2009 NJ 23 23 M 5/12/2009 A non - serious spontaneous report
356021 8/13/2009 NJ 24 M 5/12/2009 Expired vaccine used. A non-seriou
356142 8/13/2009 NJ 30 30 U 5/12/2009 A non-serious spontaneous report o
356148 8/13/2009 NC 8 F 5/19/2009 A non-serious report of positive influ
354235 8/14/2009 4 4 M 8/14/2009 Pt presented on 14 Aug 2009 for cli
354236 8/14/2009 ME 48 48 M 8/14/2009 24 hours post Pneumococcal Vacci
354237 8/14/2009 MO 23 33 M 8/14/2009 Complains of muscle soreness at in
354241 8/14/2009 NY 1.2 1 0.2 F 8/14/2009 Pt has had a fever with rash on face
354242 8/14/2009 OK 9 9 M 8/13/2009 Pt received shots stayed in office fo
354245 8/14/2009 MI 12 12 F 8/13/2009 Severe headache 2-3d after vaccine
354246 8/14/2009 TX 11 11 M 8/13/2009 (1) Fever (T max 103.2) began with
354248 8/14/2009 GA 1 1 0M 8/11/2009 MMR and PREVNAR given, child w
354250 8/14/2009 IN 0.5 0 0.5 F 8/11/2009 Temperature of 104.5 R.
354251 8/14/2009 KS 4 4 F 8/10/2009 Erythema surrounding injection site
354253 8/14/2009 IN 7 11 M 8/14/2009 Hep A vaccine given IM L deltoid. R
354264 8/14/2009 MI 36 38 M 8/14/2009 injection give 8-13-2009 approx. 11
354265 8/14/2009 TX 68 68 F 8/14/2009 Extreme pain, swelling, unable to m
354266 8/14/2009 IA 4 4 F 8/14/2009 large area of erythema, warm to tou
354267 8/14/2009 TX 12 12 M 8/14/2009 Had Fever on day after shots was g
354268 8/14/2009 OK 9 9 F 8/14/2009 REDNESS AND SWELLING AT INJ
354269 8/14/2009 WI 4 4 M 8/14/2009 Patient developed fever to 102 per m
354270 8/14/2009 VA 11 11 M 8/14/2009 Mother called stating son had Tdap
354271 8/14/2009 PA 4 4 M 8/14/2009 Patient was diagnosed in our office
354272 8/14/2009 MO 5 5 M 8/14/2009 Woke up on 8/13/09 with a temp of
354273 8/14/2009 WI 17 17 M 8/14/2009 Call received from mom 8/13/09, sta
354274 8/14/2009 NC 36 36 F 8/14/2009 Pain in Left arm that began as soon
354275 8/14/2009 FL 4 4 M 8/14/2009 Symptoms: Circular swelling 3"x3",
354276 8/14/2009 TX 1 1 0F 8/14/2009 Pt. developed high fever one day af
354277 8/14/2009 IN 42 42 M 8/14/2009 Localized erythema/edema affecting
354278 8/14/2009 MI 15 15 F 8/14/2009 Mom states that pt had cracked lips
354279 8/14/2009 AL 5 5 F 8/14/2009 Fever of 103 axcillary with 2 minute
354280 8/14/2009 AL 42 41 F 8/14/2009 Swelling of leftside of lower lip occu
354281 8/14/2009 TX 3 3 F 8/14/2009 We think Grace had a seizure that l
354282 8/14/2009 TX 12 12 F 8/14/2009 Mother states that the child began t
354283 8/14/2009 TX 4 4 F 8/14/2009 Swelling, redness, warm and slightly
354284 8/14/2009 CA 5 5 M 8/14/2009 High fever for 6 days, Full body rash
354285 8/14/2009 TX 14 14 M 8/14/2009 12 hours later, fever, headache, nec
354286 8/14/2009 TX 11 11 F 8/14/2009 Redness to vaccine site, tenderness
354287 8/14/2009 IL 3 3 F 8/14/2009 R DELTIOD NOTICE SWELLING, R
354288 8/14/2009 WA 40 40 F 8/14/2009 8/11/00: vaccine (varicella #2). 8/12
354289 8/14/2009 TX 11 11 M 8/14/2009 Redness and swelling to vaccine sit
354290 8/14/2009 AL 4 4 F 8/14/2009 REDNESS AND SWELLING AT INJ
354291 8/14/2009 TX 11 11 M 8/14/2009 Redness and swelling to vaccine sit
354292 8/14/2009 IL 64 64 M 8/14/2009 Single non erythematous raised les
354293 8/14/2009 TX 9 9 F 8/14/2009 PT. RECEIVED HPV AND VARICE
354294 8/14/2009 AR 11 11 F 8/14/2009 Localized redness, edema, and itch
354295 8/14/2009 OH 13 13 M 8/14/2009 Pt developed a red circular rash on
354296 8/14/2009 NC 12 12 M 8/14/2009 15x11 cm area reddness and swelli
354297 8/14/2009 NJ 22 22 F 8/14/2009 After receiving gaurdicil, lauren faint
354305 8/14/2009 OH 5 5 M 8/14/2009 Shortly after receiving vaccines pati
354306 8/14/2009 MN 37 37 M 3-4 hours after taking the Tdap I ha
354307 8/14/2009 WY 83 83 F 8/14/2009 Silver dollar size redness - Site is w
354308 8/14/2009 MT 12 12 F 8/14/2009 Pt reported HR 100, temp. 100 degr
354309 8/14/2009 OR 61 61 F 8/14/2009 Shingles Left herpes zoster ophthal
354310 8/14/2009 CT 4 4 F 8/14/2009 6"x 6" erythema, slight warmth, sligh
354311 8/14/2009 CA 0.5 0 0.5 M 8/14/2009 Was seen at hospital on 8/4/09 for I
354312 8/14/2009 MO 14 14 F 8/13/2009 Approximately 15 minutes after imm
354313 8/14/2009 NY 5 5 F Approx 5am after injection Pt starte
354314 8/14/2009 MI 4 4 M 8/6/2009 Swelling to left deltoid at injection si
354315 8/14/2009 NV 11 11 M 8/13/2009 Redness Swollen Warm to touch } in
354316 8/14/2009 MO 18 18 F 8/14/2009 Client was inadvertently given a Tda
354317 8/14/2009 TX 12 12 F 8/14/2009 Mother states "At 6:30 pm pt c/o nu
354318 8/14/2009 MI 11 11 F 8/14/2009 Mom did Reading on GARDSIL and
354319 8/14/2009 CA 12 11 M 8/15/2009 2 days after MENACTRA L deltoid o
354320 8/14/2009 MN 1 1 0F 8/19/2009 Developed hives 24 hours after MM
354321 8/14/2009 MN 4 4 M 8/14/2009 To ER via ambulance. Got epi pen b
354322 8/14/2009 TX 34 34 F 8/14/2009 EMS notified 7:02 (Numbness in ton
354323 8/14/2009 WY 1.6 1 0.6 F 8/11/2009 Grandmother reports scattered hive
354324 8/14/2009 NC 0.2 0 0.2 F 8/11/2009 Parents state child became very list
354326 8/14/2009 WA 8 8 M 8/13/2009 Rash with papules on erythematous
354298 8/15/2009 PA 1 1 0F 8/15/2009 Rash on right cheek and both upper
354299 8/15/2009 IN 0.2 0 0.2 M 8/15/2009 Pt develop a rash consistent with er
354300 8/15/2009 CA 22 22 F 8/15/2009 Encephalopathy, severe malnutritio
353411 8/16/2009 DC 0.4 F 8/6/2009 None- Vaccine administered @ inap
354301 8/16/2009 UT 15 15 F 8/16/2009 I had the last shot in early Novembe
354303 8/16/2009 MN 25 25 F 8/16/2009 Within one week of receiving the firs
354304 8/16/2009 OR U 8/16/2009 Not feeling well two hours after vacc
354526 8/16/2009 OH 47 47 F 8/18/2009 Right arm cellulitis following ADACE
354346 8/17/2009 IL 1 1 0F 8/14/2009 Information has been received from
354348 8/17/2009 IL 0.2 0 0.2 F 8/14/2009 Information has been received from
354349 8/17/2009 NV 3 M 8/14/2009 Information has been received from
354353 8/17/2009 KY 5 5 F 8/17/2009 This case was reported by a healthc
354358 8/17/2009 NY 45 45 F Dizziness, chronic flu like symptoms
354359 8/17/2009 FL 20 20 F 8/10/2009 Pt. presented to clinic Aug. 04/09 - S
354360 8/17/2009 FL 12 12 F 8/12/2009 After receiving Tdap, VZV, MENACT
354361 8/17/2009 MA 0.4 0 0.4 M 8/17/2009 Quarter size lump R. leg sm Lump o
354362 8/17/2009 MA 0.1 0 0.1 M 8/6/2009 Pt received TDAP 8/4/09 @ 3:50 PM
354363 8/17/2009 CA 17 17 F 8/12/2009 Started feeling dizzy, ears felt plugg
354364 8/17/2009 CA 11 11 F 8/10/2009 Mom and daughter back today. Pati
354365 8/17/2009 VA 46 46 F 8/12/2009 Left upper arm swollen, redness, wa
354366 8/17/2009 NJ 11 11 M 8/11/2009 Painful 4.5 cm X 4.5 cm Red Raised
354367 8/17/2009 MN 0.5 0 0.5 F 8/13/2009 4 x 3 cm Reddened with lump unde
354368 8/17/2009 PA 4 4 F 8/13/2009 Red, scabbed dots upper R arm.
354369 8/17/2009 MA 65 65 M 8/12/2009 Received vaccine 2/1/8 but develop
354370 8/17/2009 NC 41 41 F 8/12/2009 6/12 by history hives like rash, fever
354371 8/17/2009 MA 1.3 1 0.3 F 8/13/2009 Irritable leg pain, limping, unsteady
354372 8/17/2009 AZ 10 10 F 8/10/2009 Swelling, warm. TX: KEFLEX, BEN
354373 8/17/2009 AR 1.3 1 0.3 F 7/31/2009 Pt. ran fever 6 hours after vaccines
354374 8/17/2009 LA 11 11 M 8/3/2009 Presents to clinic today, 8/3/09, c/o
354375 8/17/2009 LA 13 13 M 7/23/2009 Client reports left arm started swellin
354376 8/17/2009 GA 2 2 0M 8/12/2009 Lesions noted 2 days prior to visit -
354377 8/17/2009 GA 1 1 0F 8/13/2009 3 days ago developed rashes with d
354378 8/17/2009 GA 1 1 0F 8/12/2009 Vesicular lesions together w/crusted
354379 8/17/2009 NH 15 15 F 8/12/2009 Pt vaccinated 8-5-09. Onset 8-6-09
354380 8/17/2009 PA 65 65 F 19th July, Fever, unable to swallow
354381 8/17/2009 OR 65 65 F 8/10/2009 26 hrs. later I got the chills (6pm) by
354382 8/17/2009 TX 60 60 F 8/9/2009 Redness, great deal of swelling (righ
354383 8/17/2009 NV 37 37 F 8/11/2009 Pt reported swelling in same side up
354384 8/17/2009 KS 1.3 1 0.3 F 8/5/2009 No known adverse reaction. Tdap a
354385 8/17/2009 OH 18 18 F 8/10/2009 12 minutes after injection patient go
354386 8/17/2009 CA 0.2 M 8/11/2009 Excessive diarrhea - watery. X 2/ 8-
354387 8/17/2009 OH 18 18 F 8/11/2009 8/7/09. c/o redness. Swelling and so
354388 8/17/2009 CT 11 11 U Varicella vaccine administered 8/7/0
354389 8/17/2009 GA 4 4 F 8/17/2009 COUGH(WHOOPING COUGH LIKE
354390 8/17/2009 FL 31 31 F 8/17/2009 Difused rash, erythemaos, macular,
354391 8/17/2009 FL 83 83 M 8/17/2009 TD vaccine ordered and TDAP give
354392 8/17/2009 MI 18 18 M 8/17/2009 Patient became light headed, dizzy
354393 8/17/2009 TX 12 12 F 8/11/2009 Fever of 102. Body aches. Both sta
354394 8/17/2009 TX 13 13 M 8/17/2009 After completion of vaccinations pat
354395 8/17/2009 IA 29 29 F 8/17/2009 3x5 inch area in SQ tissue on back
354396 8/17/2009 TX 2 M 8/22/2009 HIB dilute with wrong solution. No a
354397 8/17/2009 CO 59 59 M 8/17/2009 At approximately 2100, Pt complain
354398 8/17/2009 GA 0.3 0 0.3 F 8/17/2009 Child developed fever with 24 hours
354399 8/17/2009 MI 81 81 F 8/17/2009 Significant skin reaction at site of in
354400 8/17/2009 AR 16 16 F 8/17/2009 Ongoing chest pain intermittently sin
354401 8/17/2009 AK 4 4 M 8/17/2009 Localized - Red, swelling, warmth to
354402 8/17/2009 PA 65 75 F 8/17/2009 Patient has a reddened area at injec
354403 8/17/2009 TX 31 31 M 8/17/2009 Patien developed rash approximate
354404 8/17/2009 FL 49 49 F 8/17/2009 Patient states that she suffered from
354405 8/17/2009 OR 15 15 M 8/17/2009 After receiving 2nd injection (MMR)
354406 8/17/2009 NY 12 12 F 8/17/2009 Redness, painful hard lump with Pn
354407 8/17/2009 VA 13 13 F 8/17/2009 AFTER RECEIVING 1ST GARDAS
354408 8/17/2009 MI 5 5 M 8/17/2009 Patient developed a fever, headach
354409 8/17/2009 FL 4 4 M 8/7/2009 URTICARIAL LESIONS ON FACE,
354411 8/17/2009 MO 4 4 M 8/17/2009 Left lateral thigh was swollen, red, f
354413 8/17/2009 OK 1.3 1 0.3 M 8/17/2009 On 8/15/09 about 6:00pm child deve
354414 8/17/2009 CA 2 2 1F 8/17/2009 Localized inflammatory reaction of s
354415 8/17/2009 KS 19 19 F 8/17/2009 None reported
354416 8/17/2009 PA 81 81 F 8/17/2009 1 week after receiving Zostavax, on
354417 8/17/2009 IL 0.3 0 0.3 M 8/17/2009 THE PATIENT PRESENTED WITH
354418 8/17/2009 TX 11 11 M 8/17/2009 R arm 7.0 x 6.0 cm wider.
354419 8/17/2009 PA 61 61 F 8/17/2009 Raised red blotchy rash at site of in
354420 8/17/2009 TX 11 11 M 8/17/2009 Swollen and red left arm.
354421 8/17/2009 MT 18 18 F 8/15/2009 Vaccine on 8-7-09. 8-10-09 elevate
354422 8/17/2009 OH 13 13 F 8/17/2009 20 m after given GARDASIL, had 20
354423 8/17/2009 TX 13 13 F 8/15/2009 Pts arm got swollen up and pt had a
354424 8/17/2009 OH 17 17 F 8/17/2009 Fever of 102 or above and headach
354425 8/17/2009 NC 14 14 F 8/11/2009 2-3 min after immunization of HPV g
354426 8/17/2009 CO 4 4 F 8/12/2009 Morning after receiving vaccines aw
354427 8/17/2009 NJ 24 24 M 7/8/2009 Non stated. 8/18/09 spoke w/pt say
354428 8/17/2009 LA 11 11 M 8/7/2009 Approx. 30 min after administration
354429 8/17/2009 NC 10 10 F 8/11/2009 HPV injection given IM in R deltoid.
354430 8/17/2009 MD 19 19 F 8/12/2009 Immediately became pale and fainte
354431 8/17/2009 TX 34 34 M 7/27/2009 Tdap, red hard tricep, inflamed large
354432 8/17/2009 IL 5 5 M 7/31/09, left leg is swollen, red, and
354433 8/17/2009 FL 27 27 F 8/7/2009 2:30pm Nausea / emesis shaking h
354434 8/17/2009 MN 12 12 M 8/7/2009 Less than 24 hours post imm starte
354435 8/17/2009 LA 11 11 F 8/10/2009 Reported both cheeks, chin and fore
354436 8/17/2009 NV 4 4 F 8/17/2009 Child received DTAP, VARAIVAX va
354437 8/17/2009 AZ 4 4 M 8/17/2009 Redness to R deltoid area.
354438 8/17/2009 CA 59 59 F 8/17/2009 Employee received MMR vaccine 5
354439 8/17/2009 MD 22 22 F 7/16/2009 Episode of tremors X approx. 30 se
354440 8/17/2009 WA 8 8 M 8/17/2009 Redness and rash.
354441 8/17/2009 AL 32 32 F 8/17/2009 LEFT UPPER ARM REDNESS WIH
354442 8/17/2009 IL 9 9 M 8/14/2009 Talked to mom 9:00 am- completely
354443 8/17/2009 CO 32 32 M 8/17/2009 None stated.
354444 8/17/2009 IL 9 9 F 8/17/2009 Allergic reaction from the chicken po
354445 8/17/2009 SC 1 1 0M 8/10/2009 Febrile seizure on evening.
354446 8/17/2009 SD 5 5 F 8/10/2009 Rash and bruise on leg Rt red
354447 8/17/2009 CA 67 67 F 8/10/2009 Local skin reaction large 12cm x 9cm
354448 8/17/2009 0 0 0M Coatinous breakouts hives, rashes,
354457 8/18/2009 ND 0 0 0M 8/17/2009 Information has been received from
354469 8/18/2009 OK F 8/14/2009 Initial report was received on 07 Au
354470 8/18/2009 FL 0.5 0 0.5 M 8/13/2009 2-23-09 Office visit vomiting, diarrhe
354471 8/18/2009 NJ 17 17 M 8/12/2009 Shortly after receiving Hepatitis A an
354472 8/18/2009 NC 12 12 F 7/28/2009 Severe headaches, belly pain, bilate
354473 8/18/2009 NC 12 12 M 8/17/2009 (Rt) Deltoid vaccine site swollen, ery
354474 8/18/2009 TX 0.5 0 0.5 M 8/12/2009 Mom describes child as "limp" "wea
354475 8/18/2009 MO 11 11 F 8/13/2009 Fever - Nausea x 2 days - vomiting
354476 8/18/2009 FL 38 38 F 8/12/2009 8-12-09 Am RN Supervisor received
354477 8/18/2009 TX 4 4 F 8/11/2009 X1 Hive on site of administration 18
354478 8/18/2009 GA 9 9 F 8/5/2009 Pt given TDaP < 10 yrs of age. No
354479 8/18/2009 OR 66 66 F 8/13/2009 Redness, soreness, swelling and itc
354480 8/18/2009 VA 68 68 F 8/14/2009 Typical. Redness, soreness -swellin
354481 8/18/2009 KY 4 4 M 8/13/2009 7"x5" red area, swelling, 8/13/09 8:0
354482 8/18/2009 OR 16 16 F 8/12/2009 About 5 min after receiving the belo
354483 8/18/2009 NC 11 11 M 6/29/2009 Hep A #1 given 6-26-2009 - Also giv
354484 8/18/2009 NE 19 19 F 8/13/2009 11:30pm 8-11-2009 vomited, upset
354485 8/18/2009 VA 15 15 F 8/4/2009 7/29/09 - Client called Health Depar
354486 8/18/2009 VA 4 4 F 8/13/2009 @ site of injection- large area of ery
354487 8/18/2009 WI 18 18 F 8/7/2009 About 12 hours after HPV & HEP A
354488 8/18/2009 AZ 1.1 1 0.1 M 8/12/2009 Child received MMR and VARIVAX
354489 8/18/2009 VT 11 11 M 8/12/2009 5 inch by 3 3/4 red raised area at si
354490 8/18/2009 PA 5 5 F 8/12/2009 Pt's mother, called this RN at 12:15
354491 8/18/2009 PA 5 5 F 8/12/2009 Pt's mother called RN at 12:15 pm a
354492 8/18/2009 CA 67 67 F Vesicular eruption c/u varicella Zost
354493 8/18/2009 OR 4 4 F 8/12/2009 Hives on torso- anterior ! Posterior !
354494 8/18/2009 WI 5 5 M L rash, hematoma approximately 2
354495 8/18/2009 NY 11 11 F 8/12/2009 Patient became light headed and m
354496 8/18/2009 AZ 14 14 F 8/12/2009 Gave HAVRIX #1 in (L) arm and pa
354497 8/18/2009 WA 12 12 F 8/8/2009 5:00 am following day awoke with b
354498 8/18/2009 VA 42 42 M 8/12/2009 While at son's football game pt start
354499 8/18/2009 WI 15 15 F 8/12/2009 08/10/09 - @ approximately 3:15 pm
354500 8/18/2009 NV 6 6 M 8/12/2009 L shoulder area is erythematous, m
354501 8/18/2009 TX 19 19 F 8/12/2009 Received GARDASIL 6/4/2007, 7/3
354502 8/18/2009 TX 12 12 F 8/17/2009 Itching swelling to vaccine site. ABX
354503 8/18/2009 IA 60 F 8/18/2009 round faint red rash around injection
354504 8/18/2009 IA 29 29 M 8/18/2009 Pt called the following day with c/o f
354505 8/18/2009 SD 5 5 M 8/18/2009 Pt. was given a DTaP on August 6th
354506 8/18/2009 GA 39 39 F 8/18/2009 Varicella Vaccine received 08/13/20
354507 8/18/2009 NC 12 1 0M 8/18/2009 fever of 103 for 28 hours, with conti
354509 8/18/2009 TX 14 14 M 8/18/2009 5-6 hours following vaccination, pat
354510 8/18/2009 MT 57 56 F 8/18/2009 Within 24 hours of the vaccination h
354511 8/18/2009 MA 33 33 F 8/18/2009 Noted rash on arms and chest 24 h
354512 8/18/2009 NJ 5 5 M 8/18/2009 Patient received MMR and Varivax
354513 8/18/2009 VA 5 5 M 8/18/2009 Brysen is here because he had his
354514 8/18/2009 CO 11 11 U 8/18/2009 Syncopal episode following Tdap va
354515 8/18/2009 FL 25 25 F 8/18/2009 Within 10 seconds of vaccine, I got
354516 8/18/2009 MO 0.3 0 0.3 M 8/18/2009 RECEIVED 4 MO SHOTS 1PM @ H
354517 8/18/2009 KS 13 13 M 8/18/2009 Pt received varicella vaccine 08/17/
354519 8/18/2009 CA 1.2 1 0.2 F 8/18/2009 New onset generalized tonic-clonic
354520 8/18/2009 NY 16 16 F 8/18/2009 My daughter had been suffering from
354521 8/18/2009 AL 36 35 M 8/18/2009 mild fever of 100 degrees F.; heada
354522 8/18/2009 TX 4 4 F 8/18/2009 Patient was found walking outside r
354524 8/18/2009 TN 11 11 F 8/17/2009 12cm area of erythema at site of ME
354525 8/18/2009 OK 4 4 F 8/13/2009 Local reaction to left shoulder/deltoi
354527 8/18/2009 IL 5 5 F 8/18/2009 Left upper arm redness and swelling
354528 8/18/2009 OR 5 5 M 8/19/2009 Parent reports 7pm Pt C/o throat dis
354529 8/18/2009 OR 1.2 1 0.2 M 8/18/2009 R Thigh, indurated, erythematous, s
354530 8/18/2009 VA 11 11 F 8/18/2009 Child has fever to 103.5 headache "
354531 8/18/2009 NY 11 11 M 8/18/2009 Swelling upper arm c/erythema - las
354532 8/18/2009 NC 13 13 M 8/17/2009 Day after vaccines, woke up feeling
354533 8/18/2009 VT 11 11 M Temp 104 degrees & some delirium
354534 8/18/2009 CA 1.1 1 0.1 M 8/18/2009 Child right away react w/ hives.
354535 8/18/2009 LA 9 9 M 8/18/2009 Pt Rcvd vaccine @ 11am - went ho
354536 8/18/2009 GA 61 F 8/11/2009 4/29/09 Pt. given Tdap injection dur
354537 8/18/2009 FL 1 1 0F 8/13/2009 Crying hysterically. Lips and hands
354538 8/18/2009 MI 1.6 1 0.6 F 8/13/2009 Shots done on Tuesday August 11,
354539 8/18/2009 CA 4 4 M 8/10/2009 Red area of warmth and itching on R
354540 8/18/2009 OH 1.8 1 0.8 U 3-5 days after the Hib vaccine my so
354542 8/18/2009 ME 71 71 M Site was "hot and red to the touch. A
354543 8/18/2009 KY 46 46 F 8/12/2009 Approx. 1 minute after inj. patient st
354545 8/18/2009 GA 10.5 10 F 8/7/2009 Pt had swelling, erythema and bruis
354546 8/18/2009 MS 16 16 F 8/3/2009 Itchy rash - of neck, trunk, arms.
354547 8/18/2009 GA 31 32 F 8/17/2009 Swelling at injection site, red with fe
354548 8/18/2009 OH 4 4 M 8/18/2009 High Fever, bellyache, tired with MO
354549 8/18/2009 PA 8 8 F 8/18/2009 About 5min after receiving Hep A va
354553 8/18/2009 WI 22 22 F 8/18/2009 This case was reported by a healthc
354523 8/19/2009 KY 22 22 F 8/19/2009 I received the 1st round of Gardasil
354570 8/19/2009 WI 12 11 F 8/14/2009 Nausea, vomiting, low grade fever x
354571 8/19/2009 NJ 1 1 0M 8/18/2009 InformationYregarding PREVNAR wa
354579 8/19/2009 TN 14 M 8/17/2009 This case was received from a heal
354583 8/19/2009 NY 54 54 F 8/10/2009 Body aches and temp. 99 started 8/
354584 8/19/2009 NY 44 43 F 8/12/2009 Burning sensation and pain in shou
354585 8/19/2009 TX 27 27 F 8/13/2009 Pt. felt light headed & weak at 01:00
354586 8/19/2009 MI 42 42 F 8/19/2009 Received flu vaccine Nov. 2008 - wi
354587 8/19/2009 PA 20 20 F 8/19/2009 08.17.09 - R arm soreness, immed.
354588 8/19/2009 NC 44 44 F 7/30/2009 Arm swollen, itching in arm, warm to
354589 8/19/2009 NC 13 13 M 8/13/2009 Vaccine were given, pt tolerated we
354590 8/19/2009 DC 65 65 F 8/13/2009 Patient was given PNEUMOVAX mo
354591 8/19/2009 NC 1.2 1 0.2 F 7/31/2009 Red area a site of injection - dime s
354608 8/19/2009 CA 4 4 F 7/21/2009 A serious report of lymphadenitis ha
354609 8/19/2009 CA 3 3 F 7/21/2009 A serious report of septic arthritis ha
354610 8/19/2009 CA 4 4 M 7/21/2009 A serious report of hearing loss/dea
354611 8/19/2009 CA 4 4 F 7/21/2009 A serious report of trauma has been
354612 8/19/2009 CA 3 3 M 7/21/2009 A serious report of urinary tract infec
354613 8/19/2009 CA 3 3 M 7/21/2009 A serious report of trauma has been
354614 8/19/2009 CA 3 3 F 7/21/2009 A serious report of nail disorder has
354615 8/19/2009 CA 3 3 M 7/21/2009 A serious report of trauma has been
354616 8/19/2009 CA 3 3 F 7/21/2009 A serious report of sleep apnea and
354617 8/19/2009 CA 3 3 M 7/21/2009 A serious report of congenital anom
354618 8/19/2009 CA 4 4 F 7/21/2009 A serious report of sleep apnea and
354619 8/19/2009 CA 4 4 M 7/21/2009 A serious report of encopresis has b
354620 8/19/2009 CA 4 4 F 7/21/2009 A serious report of congenital anom
354621 8/19/2009 CA 4 4 F 7/21/2009 A serious report of abscess and pos
354622 8/19/2009 CA 2 2 0.1 F 7/21/2009 A serious report of congenital anom
354623 8/19/2009 CA 2 2 0.5 M 7/21/2009 A serious report of abdominal pain a
354624 8/19/2009 CA 3 3 F 7/21/2009 A serious report of trauma has been
354629 8/19/2009 FL 11 11 F 8/19/2009 Patient was in waiting room about 1
354630 8/19/2009 VA 22 22 F 8/19/2009 Pt. had seizure like activity after the
354631 8/19/2009 MD 14 14 F 8/19/2009 First injection of Garadsil was given
354632 8/19/2009 TX 13 14 F 8/19/2009 Near Fainting Heart rate 52 pale
354633 8/19/2009 IN 12 12 M 8/19/2009 On 7-18-07, DTaP vaccine was give
354634 8/19/2009 NC 8 8 M 8/19/2009 circular red edematous area at site
354635 8/19/2009 FL 66 66 M 8/19/2009 The patient came in to see the doct
354636 8/19/2009 MI 12 12 M 8/19/2009 PATIENT'S MOTHER STATES THA
354637 8/19/2009 CT 14 14 M 8/19/2009 Approx 5 hours after receiving vacc
354638 8/19/2009 FL 16 16 F 8/19/2009 acute idiopathic autoimmune hemol
354639 8/19/2009 CA 17 17 F 8/1/2009 Fatigue, dry skin, extreme fatigue, li
354640 8/19/2009 AL 4 4 M 8/17/2009 Lip swelling, earlobe swelling and e
354641 8/19/2009 CA 0.4 0 0.4 F 8/19/2009 Patient had sudden onset of rolling
354642 8/19/2009 AZ 0.2 0 0.2 F 8/19/2009 Seizure.
354643 8/19/2009 CA 4 4 M 8/18/2009 (L) lateral upperarm onset redness 1
354644 8/19/2009 MN 19 19 F 8/19/2009 Patient Reported intermittent hives
354645 8/19/2009 PA 70 70 F 8/19/2009 Developed ocular viral, herpes infec
354646 8/19/2009 MO 77 77 F 8/19/2009 Patient stated she received the ZOS
354647 8/19/2009 PA 1 1 0F 8/19/2009 Mother stated first vesicle rash on a
354648 8/19/2009 MI 24 24 F 8/19/2009 Pt observed following inj./ After 15 m
354649 8/19/2009 HI 9 11 F 7/22/2009 Erythema, slight tenderness @ injec
354650 8/19/2009 NC 30 30 F 8/19/2009 30 year old female complains of fac
354651 8/19/2009 NE 5 5 F 8/19/2009 Allergic Rx -Mod/Severe local with o
354652 8/19/2009 MN 66 66 F 8/19/2009 Swollen, erythematous, indurated a
354653 8/19/2009 CA 0.6 0 0.6 M Low grade temp (<105 degrees F),
354654 8/19/2009 CA 15 15 F 8/19/2009 stood up after injection and had pro
354655 8/19/2009 LA 11 11 F 8/19/2009 Had seizure 7/25/09. Had Mri & Ct s
354656 8/19/2009 UT 11 11 F 8/19/2009 My daughter is going into junior high
354657 8/19/2009 TX 11 11 F 8/19/2009 Severe headaches that come on su
354658 8/19/2009 WA 55 55 F 8/19/2009 Arm very sore, headache, fever/chil
354659 8/19/2009 CA 1 0 0F 8/19/2009 10 days after receiving her MMR va
354660 8/19/2009 FL 38 38 F 8/19/2009 Client stated that she felt a tingling f
354661 8/19/2009 NY 42 F 8/19/2009 BELL'S PALSY DIAGNOSED BY P
354662 8/19/2009 IN 54 54 F 8/19/2009 6 hours following vaccine administra
354663 8/19/2009 AR 11 11 F 8/19/2009 Sine the shot was given, pt. has had
354664 8/19/2009 PA 1.1 1 0.1 F 8/19/2009 Vomiting, Fever, Seizure. 8/25/09 H
354665 8/19/2009 IN 14 14 F 8/19/2009 Administered four vaccines during im
354666 8/19/2009 NH 18 18 M 8/19/2009 large hives all over body appeared d
354667 8/19/2009 MO 14 14 M 8/19/2009 Hives on chin, arms, legs, caps of s
354668 8/19/2009 2 2 0M 8/19/2009 Child's father reported that the fever
354669 8/19/2009 CA 12 12 F 8/19/2009 bad muscle pain, severe headache,
354670 8/19/2009 9 9 F 8/20/2009 PT COMPLAINED THAT INJECTIO
354671 8/19/2009 CA 14 14 F 8/19/2009 Pt received the Gardasil series of sh
354672 8/20/2009 5 5 F 8/20/2009 ON 19 AUG 09, PT COMPLAINED
354737 8/20/2009 ME 57 57 F 8/13/2009 Jan 2008 diagnosed Sensory Guilla
354738 8/20/2009 CO 0.5 0 0.5 M 8/14/2009 Pt had vomiting, bloody diarrhea. Se
354739 8/20/2009 NJ 0 0 0M 8/7/2009 Anaphylaxis, admitted to hospital. B
354740 8/20/2009 KY 9 9 F 6/10/2009 Approx. 1 1/2 weeks after receiving
354741 8/20/2009 KY 11 11 M 8/19/2009 Hives, rash, swelling of most of arm
354742 8/20/2009 MN 21 21 F 8/20/2009 Had 2nd HPV vaccine 2/10/09; star
354743 8/20/2009 NY 14 14 F 8/17/2009 Pt felt lightheaded/dizzy - No LOC,
354744 8/20/2009 IL 5 5 F 8/10/2009 Pt was ok day of injections, got low
354745 8/20/2009 TX 4 4 M 8/17/2009 6X8 cm area with redness - 3X3 cen
354746 8/20/2009 IL 5 5 M 8/12/2009 4cm Red-firm-warm to touch Rx for
354747 8/20/2009 NE 12 12 F 8/13/2009 Left deltoid warm, red, swollen, pain
354748 8/20/2009 GA 56 56 F ### Approx. 1 hour post injection, pt. ca
354749 8/20/2009 MI 46 46 F 8/14/2009 6-8-09 Presented to our ER with an
354750 8/20/2009 TN 12 12 F 8/14/2009 VARIVAX vaccine given in right arm
354751 8/20/2009 IL 0.3 0 0.3 F 8/17/2009 Awoke early morning with shallow b
354752 8/20/2009 NV 4 4 F 8/5/2009 Inappropriate DTAP given (extra) an
354753 8/20/2009 NV 16 16 F 8/14/2009 Mom states pt felt tired yesterday, li
354754 8/20/2009 CO 21 F A couple of hours after first shot, my
354755 8/20/2009 15 15 F 8/18/2009 Took my three daughters to their do
354767 8/20/2009 VI 10 10 F 8/20/2009 8/19/09 mother called clinic stating
354768 8/20/2009 SC 39 39 M 8/20/2009 LOCAL REACTION, FEVER, CHILL
354770 8/20/2009 NM 5 5 M 8/20/2009 While administering MMR vaccine p
354771 8/20/2009 PA 12 12 F 8/20/2009 Initially loss of hair. Then dizziness
354772 8/20/2009 IL 11 11 F 8/20/2009 Local reaction within 24hrs. But las
354773 8/20/2009 NY 58 58 F 8/20/2009 About two weeks after I received the
354774 8/20/2009 KS 18 18 F 8/20/2009 Patient started vomiting and having
354775 8/20/2009 TN 14 14 F 8/20/2009 1st vaccination was on 07/15/08, sh
354776 8/20/2009 MI 4 4 M 8/20/2009 Client developed fever of 100, vomi
354777 8/20/2009 AZ 11 11 F 8/20/2009 Red area to back of left arm the size
354778 8/20/2009 AZ 4 4 F 8/20/2009 LEFT SQ AREA LARGE SWELLING
354779 8/20/2009 WI 1 1 0F 8/20/2009 Cranky overnight after receiving vac
354780 8/20/2009 NY 35 35 M 8/20/2009 Patient had Vaccinations at 8 am w
354782 8/20/2009 MO 1.3 1 0.3 M 8/20/2009 Increased temperature leading to se
354783 8/20/2009 MI 1.9 1 0.9 M 8/20/2009 started with a fever on 8/13/09 rash
354784 8/20/2009 WA 17 17 F 8/20/2009 Patient had first Gardisil injection at
354785 8/20/2009 NC 0.3 0 0.3 F 8/20/2009 HAD 1ST ROTATEQ 06/25/2009 AN
354786 8/20/2009 NM 13 13 M 8/20/2009 Less than 24 hours after vaccine ad
354787 8/20/2009 VA 0.6 0 0.6 M 8/20/2009 About 72 hours after DtaP vaccinati
354791 8/20/2009 UT 20 20 F 8/20/2009 She started having "seizures" or "st
354792 8/20/2009 CA 0.2 0 0.1 F 8/20/2009 Patient vomited and then became le
354793 8/20/2009 NH 13 13 M 8/20/2009 Swelling, tenderness at the injection
354794 8/20/2009 SC 32 32 F 8/20/2009 Cluster of itchy read rash on face, a
354795 8/20/2009 GA 16 16 F 8/20/2009 Received varicella, TDAP, MCV4 on
354796 8/20/2009 FL 0 0.5 M 8/20/2009 FEVER OF 105 ON 8/8/09 WENT T
354797 8/20/2009 NH 10 10 F 8/20/2009 Developed itchy scattered vesicles 7
354798 8/20/2009 ND 15 15 F 8/20/2009 ON July 21 had shot. On July 26 pa
354799 8/20/2009 ND 10 10 F 8/20/2009 patient developed a hive appearanc
354800 8/20/2009 OH 20 20 F 8/20/2009 FAINTING, DIZZYNESS HEADACH
354801 8/20/2009 PA 15 15 F 8/20/2009 - approx 2 minutes post-vaccination
354802 8/20/2009 IL 11 11 F 8/20/2009 Convulsive syncope 5min post vacc
354803 8/20/2009 IL 11 11 F 8/20/2009 Client was given Tdap, Hep A, Men
354804 8/20/2009 OK 0.1 0 0.1 F 8/20/2009 blood in stool
354805 8/20/2009 GA 45 45 F 8/20/2009 Onset of flu-like symptoms ~4 hours
354806 8/20/2009 CA 13 13 F 8/20/2009 RAISED AREA LOA, APPROX.70M
354807 8/20/2009 MD 1.8 1 0.8 F 8/20/2009 01/30/09 with diarrhea (day 0 only);
354808 8/20/2009 NE 18 18 F 8/20/2009 Large local reaction noted 2 days af
354809 8/20/2009 27 27 M 8/20/2009 Pain and redness X 1 day
354810 8/20/2009 MA 18 F 8/20/2009 Shortly after receiving third dose of
354811 8/20/2009 NC 23 23 F 8/20/2009 Within seconds of receiving vaccine
354812 8/20/2009 NC 15 15 F 8/20/2009 Prompted seizures to reappeared. H
354813 8/20/2009 54 54 F 8/17/2009 This report might have been reporte
354814 8/20/2009 20 20 F 8/15/2009 I've had the same reaction to GARD
354815 8/20/2009 WA 54 54 F 8/19/2009 The day after the vaccination, she d
354816 8/20/2009 KY 70 70 F 8/20/2009 Herpes Zoster, R side breast (under
354817 8/20/2009 TX 4 4 F 8/20/2009 Patient presented with vesicular les
354818 8/20/2009 NC 5 5 F 8/20/2009 Left deltoid swelling & redness. 3 X
354819 8/20/2009 CA 8 8 F 8/20/2009 On Aug. 18, 2009, patient came for
354820 8/20/2009 VA 24 24 U 8/20/2009 Pt received Hep B #1 in her left arm
354821 8/20/2009 NE 15 M 7/30/2009 15 yo developed herpes zoster in T
354823 8/20/2009 CA 65 65 F 8/16/2009 Throat swelled/ made swallowing di
354824 8/20/2009 0 0 0F 8/14/2009 Baby received varicella vaccination
354825 8/20/2009 30 30 F 8/10/2009 Date of inj 7/16/09, Date of event 7/
354830 8/20/2009 CO 4 4 M 8/20/2009 R upper arm significant edema, redn
354831 8/20/2009 AZ 11 11 F 8/20/2009 c/o Headaches, Right arm numbnes
354832 8/20/2009 WA 10 10 F 8/20/2009 TDAP given left deltoid about 11:30
354834 8/20/2009 IL 26 26 M 8/20/2009 ADACEL administered (L) deltoid 8/
354835 8/20/2009 MN 12 12 M 8/20/2009 Pt. has fever 99.0 - C/o SA last nigh
354836 8/20/2009 MN 66 66 F 8/20/2009 Redness spreading into armpit/brea
354837 8/20/2009 AZ 12 12 F 8/20/2009 Sudden onset left sided chest pain a
354840 8/20/2009 PA 11 11 F 8/19/2009 Left arm swelling one day after vacc
354842 8/20/2009 PA 5 5 M 8/20/2009 98 degrees - not noticed until visit 4
354843 8/20/2009 VA 10 10 F 8/20/2009 Tues PM 8/18/09 left arm red swolle
354844 8/20/2009 OH 5 5 M 8/20/2009 After vaccination mom reports the p
354846 8/20/2009 NC 74 F 8/20/2009 Patient presented to Doctor 8/20/20
354847 8/20/2009 OR 4 4 M 8/20/2009 Left thigh 20 X 18 cm swelling / war
354848 8/20/2009 KS 11 11 M 8/20/2009 08/20/2009 Other Red raised rash.
354853 8/20/2009 TX 11 11 F 8/13/2009 L Deltoid erythematous wheal
354854 8/20/2009 NC 11 11 F 8/20/2009 TDAP injection site left deltoid. Are
354856 8/20/2009 IL 0.3 0 0.3 M 8/20/2009 Blood in stool no Tx given. 1 wk po
354858 8/20/2009 AR 1.1 1 0.1 M 8/20/2009 2 days w/ rash, Dx: chickenpox .
354859 8/20/2009 MO 26 26 F 8/13/2009 Swollen glands on side shot admini
354860 8/20/2009 IA 1 1 0M 8/20/2009 103.4 temp
354861 8/20/2009 CA 9 9 M 8/20/2009 Reaction at the injection site. Lump
354862 8/20/2009 NM 1.3 1 0.3 F 8/20/2009 - Fever up to 101 x 72 degrees - Sw
354863 8/20/2009 OH 1.3 1 0.3 M 8/17/2009 Mother called stating son broke out
354917 8/21/2009 MI 46 46 F 8/19/2009 Initial report received on 17 August
354919 8/21/2009 MI 0.4 0 0.4 F 8/6/2009 None. I gave Pentacel inadvertently
354920 8/21/2009 RI 1.3 1 0.3 F 8/18/2009 15 days after varicella vaccine deve
354921 8/21/2009 OH 5 5 M 8/12/2009 From knee up on left leg swollen. A
354922 8/21/2009 LA 0.7 0 0.7 F 8/14/2009 Redness to thigh quarter sz. 8/13/09
354923 8/21/2009 MD 14 14 F Within 10 minutes of receiving vacc
354924 8/21/2009 NH 4 4 F 8/17/2009 None stated.
354925 8/21/2009 AZ 26 26 F 8/17/2009 Patient received MMR injection left
354926 8/21/2009 TX 12 12 M 8/13/2009 High fever, nausea, stiff neck 103 d
354927 8/21/2009 WA 12 12 F 8/17/2009 5 min after rec GARDASIL, HAVRIX
354928 8/21/2009 IN 74 74 F 8/12/2009 Itching - mostly on chest - arm and h
354929 8/21/2009 IL 0.2 0 0.2 F 8/12/2009 Pt noticed right eyelid swollen. No o
354930 8/21/2009 IL 5 5 F Extreme redness, warmth of left arm
354931 8/21/2009 NC 71 71 F 8/20/2009 Injection site swollen and warm to to
354932 8/21/2009 SC 18 18 F 8/20/2009 Dizzy, headache, increased heart ra
354933 8/21/2009 NE 41 41 F 8/21/2009 Pain in chest and along shoulder bla
354934 8/21/2009 RI 11 11 F 8/19/2009 Vasovagal syncope w/in 2 minutes
354936 8/21/2009 PA 15 15 M 8/17/2009 Pain behind eye vomiting, nausea; p
354937 8/21/2009 AZ 0.1 F 8/11/2009 Patient was crying for about 6hrs; R
354938 8/21/2009 FL 3 3 F 7/31/2009 5x7cm red area noted to LT injectio
354939 8/21/2009 IN 48 48 M 8/18/2009 Rash (localized)
354940 8/21/2009 CO 15 15 F 8/14/2009 Has large lump - tennis ball size at s
354942 8/21/2009 MA 75 75 M 8/21/2009 Pt received PPV23 in his right arm o
354944 8/21/2009 FL 24 24 F 8/21/2009 Patient noted a history of eczema o
354945 8/21/2009 OH 54 54 F 8/21/2009 Two days of wide spread urticarial e
354946 8/21/2009 PA 31 31 F 8/21/2009 Following my fourth rabies booster s
354947 8/21/2009 OH 53 53 M 8/21/2009 Wide spread urticarial pruitic rash. N
354948 8/21/2009 AL 0.2 0 0.2 M 8/21/2009 had seizure 3 days after vaccines g
354949 8/21/2009 WA 20 20 M 8/21/2009 MULTIPLE SATELLITE LESIONS O
354950 8/21/2009 CA 14 14 F 8/21/2009 She got very dizzy immediately afte
354951 8/21/2009 CA 14 14 F 8/21/2009 Pt had Tdap and varicella shots 6/1
354952 8/21/2009 CA 0.2 0 0.2 F 8/21/2009 Patients mother reports that at 2:00
354954 8/21/2009 CA 53 53 F 8/21/2009 8-18-09 Pt with severe left arm indu
354955 8/21/2009 WA 39 39 M 8/21/2009 Pt was initially vaccinated for smallp
354956 8/21/2009 OH 4 4 F 8/21/2009 Was informed child was on Zithroma
354957 8/21/2009 WI 11 11 F 8/21/2009 Arm where Tdap and varicella vacci
354958 8/21/2009 MT 5 5 M 8/21/2009 8-20-09--Pt. came to medical center
354959 8/21/2009 KS 14 14 F 8/21/2009 rapid heart beat,weakness of the lef
354960 8/21/2009 NC 0.2 0 0.2 M 8/21/2009 PT WAS GIVEN THIRD HEP B TO
354961 8/21/2009 PA 39 39 F 8/21/2009 Left deltoid swelling, pain, erythema
354962 8/21/2009 VA 14 14 F 8/21/2009 Dizziness, nausea, vomiting starting
354963 8/21/2009 NC 39 39 F 8/21/2009 Received vaccines at 4:30 pm. At 1
354964 8/21/2009 FL 10 10 M 8/21/2009 Pt. was given the vaccine at 4:00 PM
354965 8/21/2009 WI 4 4 M 8/21/2009 Arm swelling from elbow to shoulde
354966 8/21/2009 AZ 71 71 M 8/21/2009 Within a day after Shingles shot, I d
354967 8/21/2009 WI 18 18 F 8/21/2009 Light-headed, dizzy, and nauseous
354968 8/21/2009 MN 82 82 F 8/21/2009 Redness and swelling from site of in
354986 8/21/2009 MN -1 0.7 M 8/21/2009 This case was reported by a healthc
354989 8/21/2009 52 F 8/21/2009 This case was reported and describ
354990 8/21/2009 52 F 8/21/2009 This case was reported in a literatur
354991 8/21/2009 1.4 1 0.4 F 8/21/2009 This female subject was enrolled in
354992 8/21/2009 GA 71 71 M 8/22/2009 Noticed when went to bed last night
354993 8/21/2009 PA 7 7 M 8/22/2009 Right deltoid area was a little pale 8
354994 8/21/2009 M 8/22/2009 Patient report soreness to right delto
354995 8/21/2009 TX U Fell to floor - pale, fainted. V/S take
354996 8/21/2009 CA 12 12 F 8/21/2009 Pt. received (1) Tdap in (L) arm then
354997 8/21/2009 TX 4 4 F 8/21/2009 Local reaction (L) upper arm/tricep a
354998 8/21/2009 TX 12 12 M 8/21/2009 Varicella vaccine reaction started 24
354999 8/21/2009 IL 55 55 F 8/21/2009 Pt given vaccine about 11 o'clock, A
355000 8/21/2009 NC 11 11 M 8/21/2009 Knot in (L) arm 1 1/2 inch circle.
355001 8/21/2009 KS 11 11 F 8/21/2009 Parent of client called reporting that
355002 8/21/2009 MA 5 5 M 8/21/2009 Pt. had IZS 8-20-09, began wheezin
355003 8/21/2009 TX 14 F 8/21/2009 Rec'd HPV #1 12-16-08- No reactio
355004 8/21/2009 NH 72 72 F 8/21/2009 At 3:30 pm pt developed swelling sl
355005 8/21/2009 AL 1 1 0M 8/21/2009 Left thigh, red swollen warm to touc
355006 8/21/2009 MN 23 23 F 8/21/2009 Developed fever, pain, redness & sw
355007 8/21/2009 MO 4 4 M 8/21/2009 None Stated
354969 8/22/2009 CA 17 17 F 8/20/2009 From the time of vaccination until ab
354970 8/22/2009 CA 55 55 F 8/22/2009 fever
354971 8/22/2009 TX 2 2 0.1 M 8/22/2009 A few days after the shot, he started
354972 8/22/2009 MD 40 40 M 8/22/2009 My husband received the vaccinatio
354973 8/22/2009 CA 14 14 M 8/22/2009 approx 12 hours after the shots my
354974 8/22/2009 FL 16 16 M 8/22/2009 Pt was given shot on 08/18/09 in Le
354975 8/22/2009 TX 14 14 F 8/22/2009 8 hours after shot: Tremors,vertigo,h
354976 8/22/2009 MD 4 4 M 8/22/2009 Fever of 103, complaint of headach
354977 8/22/2009 OH 53 53 F 8/22/2009 Arm soreness never went away afte
354978 8/22/2009 WA 22 22 F 8/22/2009 Patient given vaccin afternoon of 8/
354979 8/23/2009 MD 38 38 F 8/23/2009 severe hives, itching, wheezing with
354980 8/23/2009 NY 45 45 F 8/23/2009 Severe dizziness cuasing inability to
354981 8/23/2009 WI 67 67 M 8/23/2009 Administered just prior to discharge
354982 8/23/2009 FL 1.5 1 0.5 F 8/23/2009 Pt had a fever of 102.7 F taken und
354983 8/23/2009 IN 40 40 F 8/23/2009 injection @ 2130--urticaria bilat han
355009 8/24/2009 AZ 14 14 F 8/18/2009 Diagnosed with Type 1 Diabetes Me
355010 8/24/2009 WV 0.4 0 0.4 F 8/17/2009 Hypoxic brain injury after a possible
355012 8/24/2009 PA 1.8 1 0.8 M 8/18/2009 Child received both vaccines in righ
355013 8/24/2009 FL 67 67 F 8/17/2009 Received Shingles Vaccine ZOSTA
355014 8/24/2009 OH 74 74 F 8/19/2009 Outbreak of shingles Post Vaccine R
355015 8/24/2009 MD 2 2 0M 8/23/2009 I saw him for well check up at 09:30
355016 8/24/2009 LA 16 16 F 8/14/2009 Immediately following vaccine (abou
355017 8/24/2009 MN 27 27 U Left shoulder pain, decrease ROM a
355018 8/24/2009 TN 11 11 F 8/14/2009 Pain- redness - firm - Golf ball size t
355019 8/24/2009 IL 18 18 F 8/19/2009 Right leg had no feeling/wd not sup
355020 8/24/2009 NC 0.2 0 0.2 M 8/19/2009 12 noon approx Received Pentacel
355021 8/24/2009 KS 33 33 F 8/20/2009 7" length x 6" width. Redness, with
355022 8/24/2009 MA 19 F Fainting and dizzy 1 hour after shot
355028 8/24/2009 WY 13 13 F 8/21/2009 Information has been received from
355032 8/24/2009 VA 13 13 F 8/12/2009 arm pain - severe fatigue, lethargy,
355034 8/24/2009 CT F 8/4/2009 Right arm injection site with large X
355035 8/24/2009 KY 4 4 M 8/21/2009 Localized reaction to left thigh.
355036 8/24/2009 LA 11 11 M 8/19/2009 Vaccines given on 8/11/09 (Tdap, M
355037 8/24/2009 LA 33 33 M 8/11/2009 Patient states he developed a rash
355038 8/24/2009 CT 13 13 M 8/21/2009 9:35AM pt. returns with c/o malaise,
355039 8/24/2009 CA 0.5 0 0.5 F 8/21/2009 No adverse reaction noted to extra
355040 8/24/2009 TX 23 23 F 8/17/2009 Client going into nursing school, rec
355041 8/24/2009 VA 39 39 F 8/18/2009 Febrile illness t max 103. Severe my
355042 8/24/2009 OH 5 5 F 8/20/2009 Area of induration & erythema at sit
355043 8/24/2009 CA 4 4 M 8/19/2009 Redness & swollen where immuniza
355044 8/24/2009 WI 10 10 F Local reaction: red, swollen, hard to
355045 8/24/2009 CA 3 3 M 8/20/2009 Father states child began favoring le
355046 8/24/2009 NY 11 11 F 8/22/2009 Patient had syncopal episode & fell
355047 8/24/2009 MI 44 44 F 8/20/2009 Rt upper arm 2in x 2in reddened ha
355048 8/24/2009 CO 11 11 M 8/24/2009 This case was reported by a healthc
355049 8/24/2009 TN 0.5 0 0.5 M 8/24/2009 This case was reported by a healthc
355050 8/24/2009 MN 63 63 F 8/24/2009 initial small erythema for 2 days, res
355051 8/24/2009 TX 12 12 M 8/24/2009 Received vaccinations around 12:30
355052 8/24/2009 MT 12 12 M 8/24/2009 Extensive Left Deltoid swelling, eryt
355053 8/24/2009 MN 9 9 F 8/24/2009 Pt given outside of FDA approved a
355054 8/24/2009 MI 5 5 F 8/24/2009 Vaccine administered 08/20/2009. C
355055 8/24/2009 TX 6 6 M 8/24/2009 After patient received the immuniza
355056 8/24/2009 FL 50 50 M 8/24/2009 anaphylaxisY(immediate)
355057 8/24/2009 TX 15 15 M 8/24/2009 some temp, difficulty breathing, tired
355058 8/24/2009 SC 13 13 F 8/24/2009 Mother reports fatigue and complain
355059 8/24/2009 SC 4 4 F 8/24/2009 Received 4 year vaccines on 8-20-0
355060 8/24/2009 TX 5 5 F 8/24/2009 Within a few days of the vaccination
355061 8/24/2009 VA 37 37 F 8/24/2009 Recieved first hep b shot and IPV s
355062 8/24/2009 MI 18 18 F 8/24/2009 Gave vaccines to pt while she was l
355063 8/24/2009 PA 73 73 F 8/24/2009 Injection given on 08/20. Approx 3"
355064 8/24/2009 NC 16 16 F 8/24/2009 Pt became dizzy 20 min. after first G
355065 8/24/2009 MO 1 1 0M 8/14/2009 Broke out with rash all over extremit
355066 8/24/2009 MO 78 79 M 8/17/2009 8-14-09 Ball of left foot extremely so
355067 8/24/2009 VA 59 59 F 8/24/2009 20 MINUTES AFTER RECEIVING H
355068 8/24/2009 FL 58 58 M 8/24/2009 Patient complained of continued mu
355069 8/24/2009 MD 65 65 M 8/24/2009 8/21/09 Received phone call from p
355070 8/24/2009 KS 18 18 M 8/24/2009 Sean is complaining of muscle fatig
355071 8/24/2009 OH 27 11 F 8/24/2009 Developed an increased heart rate
355072 8/24/2009 TX 13 13 F 8/24/2009 SWELLING AND REDNESS TO LE
355073 8/24/2009 AL 11 11 F 8/24/2009 Long-term chronic nausea, chronic
355074 8/24/2009 TX 40 40 M 8/24/2009 Reoccurring headaches, chronic fat
355075 8/24/2009 VA 2 2 0.2 M 8/24/2009 loss of appetite & 102 degree fever;
355078 8/24/2009 DC 4 4 F 8/24/2009 8/7/09- 4 y.o. Received immunizatio
355079 8/24/2009 12 12 M Swelling, redness, and itching of the
355080 8/24/2009 UT 1 1 0M 8/24/2009 On 9/28/08 he developed a tremor a
355081 8/24/2009 MO 15 15 M 8/24/2009 8/10/09: Rash (small) on the tummy
355083 8/24/2009 MI 63 63 F 8/24/2009 Shot given 8/19/09 -Weds- Onset o
355084 8/24/2009 TX 14 14 F 8/24/2009 Report by parent of "nodule" develo
355085 8/24/2009 CO 14 14 F 8/19/2009 4 days after HPV #3 and MENACTR
355086 8/24/2009 VA 1 1 0M 8/24/2009 Fever-developed 8 days after vaccin
355087 8/24/2009 CA 4 4 M 8/24/2009 (R) deltoid reddened - size 8cm x 4c
355088 8/24/2009 AZ 12 12 F 8/20/2009 Sudden onset left sided chest pain a
355089 8/24/2009 WI 5 5 F 8/21/2009 Began with true urticarial rash on 8/
355090 8/24/2009 CA 12 12 M 8/21/2009 Swollen, red, hard, hot.
355091 8/24/2009 PA 11 11 F 8/20/2009 10 minutes following shot pt becam
355092 8/24/2009 MI 19 19 F 8/24/2009 - Had rash and soreness developed
355093 8/24/2009 PA 4 4 F 8/24/2009 8-19 developed swelling of face/han
355094 8/24/2009 CA 4 4 F 8/24/2009 3.5cm indurated dark red. 6cm total
355095 8/24/2009 MO 4 4 M 8/24/2009 Approx 2 1/2 cm x 3 cm area of red
355096 8/24/2009 VA 11 11 F Erythema circumferentially 2/3, leng
355097 8/24/2009 OH 9 9 F 8/24/2009 Child rec'd VARIVAX and HAV; left
355098 8/24/2009 MI 3 3 F 8/29/2009 None
355099 8/24/2009 TX 13 13 F 8/24/2009 Reports "feeling bad" about an hour
355100 8/24/2009 SD 35 35 F 8/24/2009 8/13 - Vaccine given at 11 am - 8/14
355101 8/24/2009 CA 0.6 0 0.6 M 9/19/2009 Low grade temp (100 degrees F) an
355102 8/24/2009 TX 4 4 M 8/24/2009 Rash on upper thigh. Red and raise
355103 8/24/2009 MD 11 11 F 8/24/2009 Pt received #2 varicella on 7/28/09.
355111 8/25/2009 NC 5 5 F 8/20/2009 2 1cm. Blisters above sight where I
355112 8/25/2009 NC 12 12 F 8/12/2009 Rash on legs. One leg shape of a tr
355113 8/25/2009 TX 34 34 M 8/25/2009 Received booster dose of AVA 18 A
355131 8/25/2009 WA 0.3 0 0.3 F 8/21/2009 Pt found dead
Y in crib on 8/14/09. Pr
355132 8/25/2009 OH 1.1 1 0.1 M 8/8/2009 2 days after my son received MMR
355133 8/25/2009 FL 4 4 F 8/20/2009 Immediately after vaccines started t
355134 8/25/2009 TN 0.4 0 0.4 M 8/21/2009 Intussusception 2 wks after receivin
355136 8/25/2009 NC 12 12 F 8/14/2009 She was seeing black shapes, said
355137 8/25/2009 WI 11 11 M 5/4/2009 This patient has been diagnosed wi
355139 8/25/2009 LA 13 13 F 8/21/2009 Daughter was given two injections o
355140 8/25/2009 AL 18 F 8/20/2009 This year my daughter and two of m
355148 8/25/2009 AR 4 4 M 8/19/2009 Red swollen area (Lt) thigh, no feve
355149 8/25/2009 CA 13 13 F 8/17/2009 Approximately 38 hrs after administ
355150 8/25/2009 KS 14 14 F 8/20/2009 Vaccinations given on 8-10-09, scre
355198 8/25/2009 NC 11 11 M 8/21/2009 Acute onset hives about 40-44 hrs a
355199 8/25/2009 GA 68 68 M 8/20/2009 Received ZOSTAVAX (shingles vac
355200 8/25/2009 OR 75 75 F 8/21/2009 "Quarter-sized" lump at injection site
355201 8/25/2009 OR 64 45 M Has bitterness in mouth, unable to e
355202 8/25/2009 MN 36 36 F 8/20/2009 Gradual onset pain, redness swellin
355203 8/25/2009 OH 36 M 8/4/2009 Temperature of 103 F and fever like
355204 8/25/2009 MN 11 11 F 8/19/2009 Bump at injection site - difficulty bre
355205 8/25/2009 MA 25 25 F 8/14/2009 Erythema induration right deltoid. M
355206 8/25/2009 MA 36 36 F 8/20/2009 Pt complained of "mild" shortness o
355207 8/25/2009 OK 7 7 F 8/25/2009 Pt received varicella vaccination on
355208 8/25/2009 PA 10 10 F 8/25/2009 Pt received varicella vaccine sub-Q
355209 8/25/2009 AZ 65 65 M 8/25/2009 S: pt returned to clinic 2 days after v
355210 8/25/2009 AR 72 72 M 8/25/2009 Severe flushing, back pain, shortne
355211 8/25/2009 AR 41 41 F 8/25/2009 Reaction started on July 31 - had so
355212 8/25/2009 FL 49 50 F 8/25/2009 Pt's left arm began to swell x 3 days
355213 8/25/2009 PA 68 68 M 8/25/2009 Sub normal temperature, Headache
355214 8/25/2009 KS 17 17 M 8/25/2009 2 days after getting vaccine, arm be
355215 8/25/2009 MO 65 65 F 8/25/2009 CELLULITIS, BUTTOCKS AT INJEC
355216 8/25/2009 OH 14 14 F 8/25/2009 Patient received Menactra vaccine i
355217 8/25/2009 MI 17 17 F 8/25/2009 3 minutes after client received5 vac
355218 8/25/2009 AL 67 67 F 8/25/2009 Shingles vaccine received on 08/11
355219 8/25/2009 TX 0 0 0F 8/25/2009 Decedent isYa 7 day old neonate wh
355221 8/25/2009 MI 8 8 F 8/25/2009 Child in for vaccinations, she had 2
355222 8/25/2009 CA 64 64 M 8/25/2009 Patient with moderate to severe pai
355223 8/25/2009 MO 37 37 F 8/25/2009 Received vaccine on 9/5/08. On 10
355224 8/25/2009 PA 4 4 M 8/25/2009 Call from mother on 8/25/09. States
355225 8/25/2009 VA 11 11 F 8/25/2009 Pt. received her Adacel booster and
355226 8/25/2009 IL 57 57 F 8/25/2009 Client called on 8/24/09 that she ha
355227 8/25/2009 MI 0.2 0 0.2 F 8/25/2009 2.5 mo Female received the Oral Ro
355228 8/25/2009 CA 11 11 F 8/25/2009 redness, swelling and tenderness o
355229 8/25/2009 FL 15 15 F 8/25/2009 Severe Gastritis, weakness, wt. loss
355231 8/25/2009 TX 5 M 8/18/2009 Pt started sneezing, and eyes got v
355232 8/25/2009 MI 14 14 F 8/25/2009 Received vaccine 08-24 PM. C/O di
355233 8/25/2009 MA 11 11 M 8/25/2009 11 year old generally healthy male w
355234 8/25/2009 AZ 66 66 U 8/25/2009 Got slight rash on inner upper thigh
355235 8/25/2009 CA 17 17 F 8/25/2009 24 hours post injection, high fever (m
355236 8/25/2009 CA 15 15 F 8/25/2009 24 hours after injection had fever re
355237 8/25/2009 MS 3 3 F 8/14/2009 Local reddness, warmth and swellin
355238 8/25/2009 MN 62 62 F 8/17/2009 On 8/14 local reaction - red firm are
355239 8/25/2009 CA 70 70 F 8/19/2009 Within 5 minutes of injection of ZOS
355240 8/25/2009 CA 16 16 F 8/19/2009 Pt had reaction after giving HPV vac
355241 8/25/2009 ID 0.5 0 0.5 M 8/19/2009 Within a couple of minutes of giving
355242 8/25/2009 TX U 8/14/2009 None.
355243 8/25/2009 WA 16 16 M 8/18/2009 After receiving MENACTRA and He
355244 8/25/2009 WA 5 5 M 8/18/2009 (L) arm swollen and red from elbow
355245 8/25/2009 DE 69 69 F 8/17/2009 I had the vaccination for the shingle
355246 8/25/2009 ID 27 27 M 8/19/2009 TWINRIX give IM in the dorsoglutea
355248 8/25/2009 NY 11 11 M 8/19/2009 Itching at and around injection site a
355250 8/25/2009 CA 59 59 F Inflammation at injection site - Eye a
355252 8/25/2009 AR 28 28 F 8/12/2009 Developed hives 2 days after shot t
355253 8/25/2009 CA 71 71 M 8/21/2009 Developed shingles L facial (V- 1 n
355254 8/25/2009 FL 15 15 F 8/25/2009 As per patient - 2hrs after vaccines
355256 8/25/2009 IN 14 14 M 8/25/2009 Received call from mother. Says ab
355257 8/25/2009 PA 15 15 M 8/25/2009 Had flu vaccine - shortly after got lig
355258 8/25/2009 MA 8 8 M 8/27/2009 Mother states after receiving vaccin
355259 8/25/2009 WA 11 11 M 8/19/2009 Child had generalized non-febrile se
355260 8/25/2009 MI 1.6 1 0.6 M 8/19/2009 DTAP given on 8-11-09 Hives on 8-
355261 8/25/2009 CA 60 60 F 8/25/2009 Mondays night noticed a red/pink kn
355262 8/25/2009 72 72 F Small raised red rash at site of injec
355263 8/25/2009 OH 48 48 M 8/21/2009 Vaccine (TWINRIX #3) Administere
355264 8/25/2009 MN 8 8 M 8/19/2009 Developed a lump Rt upper arm. It
355265 8/25/2009 TX 1.3 1 0.3 F 8/19/2009 Developed blister link rash over both
355266 8/25/2009 TX 0.9 0 0.9 M 8/25/2009 Rash all over body.
355268 8/25/2009 PA 3 F 8/25/2009 Attended facility on 8-15-07. Rash e
355269 8/25/2009 GA 66 66 M 8/19/2009 Patient noticed stinging during injec
355270 8/25/2009 NC 5 5 F 8/24/2009 Within 30 minutes of injection of all
355271 8/25/2009 NC 5 5 F 8/24/2009 Pt. returned to office approximately
355272 8/25/2009 WA 50 50 F 8/14/2009 Received Hepatitis B vaccination (E
355273 8/25/2009 NY 25 25 M 6/10/2009 Pt became pale approx 1/2 min afte
355274 8/25/2009 IA 5 5 F 8/25/2009 Fever 103.0 8/22/09
355275 8/25/2009 NC M 8/14/2009 Information has been received from
355276 8/25/2009 VT 15 15 M 8/25/2009 Syncope x 2
355277 8/25/2009 WI 12 12 F 8/25/2009 Patient experienced fainting, and na
355278 8/25/2009 LA M 6/4/2009 Vesicular, blanching rash with pruiri
355280 8/25/2009 WA 11 11 M 8/20/2009 Left deltoid red, swollen and painful
355281 8/25/2009 OH 4 4 M 8/25/2009 Erythema multiforme, seen on 8/24/
355282 8/25/2009 TX 24 24 M 8/24/2009 10 Minutes after shot pt. complained
355283 8/25/2009 SC 1.1 1 0.1 M 8/21/2009 Pt given shot Sat 830A. Returns at
355285 8/25/2009 IN 11 11 M 8/25/2009 Following vaccination, pt. and his m
355288 8/25/2009 TX 12 U Redness, warmth, firmness to uppe
355289 8/25/2009 CA 49 49 F 8/21/2009 Facial edema ("puffy eyelids"). Incre
355291 8/25/2009 77 77 F 8/25/2009 3 days after vaccines patient develo
355293 8/25/2009 MA 5 5 M 8/12/2009 Received DTaP, IPV in left arm 8/5/
355295 8/25/2009 CT 4 4 M 8/25/2009 6 d after DTaP given, patient recove
355296 8/25/2009 NC 1.7 1 0.7 F 8/25/2009 Fever began a few hours after vacc
355562 8/25/2009 SC 6 F ### A spontaneous non-serious report o
355590 8/25/2009 CA 9 F 8/18/2009 Hive broke out on her body - Hypera
355591 8/25/2009 CA 0.2 0 0.2 F 8/18/2009 Respiratory alway clearing her nose
355592 8/25/2009 CA 2 2 0.1 M 9/25/2008 Flu like symptoms every time. Folde
355593 8/25/2009 CA F 9/25/2008 Vomiting, diarrhea, rocking back an
355595 8/25/2009 CA F 9/25/2008 Folded bowel movement, vomiting a
355621 8/25/2009 CA 0.2 0 0.2 F 9/25/2008 Flu like symptoms, picky skin, thinni
355396 8/26/2009 KY 63 63 M 8/25/2009 On 10-01-08 Y he complained of sore
355397 8/26/2009 ID 85 F 8/20/2009 Shortly after vaccinated: broke out o
355398 8/26/2009 MN 5 5 M 8/21/2009 Night tremors; upset agitated; not q
355399 8/26/2009 CA 19 19 M 8/18/2009 Pt vaccinated smallpox 8/8/09; left a
355400 8/26/2009 MO 4 4 F 8/19/2009 Swelling of arm at injection site with
355401 8/26/2009 AL 1 1 0M 8/3/2009 Had fever for 1st 2 sets of shots for
355402 8/26/2009 PA 1.3 1 0.3 F 8/20/2009 Shot RXN left thigh red, sore, fever.
355403 8/26/2009 GA 1 1 0F 7/24/2009 Within 48 hours: High fever, irritabili
355404 8/26/2009 GA 10 10 M 8/25/2009 Injection site is warm to touch, red &
355405 8/26/2009 TX 13 13 F 8/26/2009 Morbilliform rash of trunk.
355406 8/26/2009 KS 11 11 M 8/26/2009 Pt passed out after receiving vaccin
355407 8/26/2009 TN 11 11 M 7/21/2009 Approx 5 min post vaccine became
355408 8/26/2009 UT 4 4 M 8/26/2009 Pain in leg with TETNUS shot, fever
355411 8/26/2009 MI 33 33 F 8/25/2009 Initial report received on 13 August
355413 8/26/2009 IL 72 F 8/24/2009 Initial report received on 14 August
355468 8/26/2009 GA 61 61 F 8/26/2009 BREAKOUT IN OOZING SENSITIV
355469 8/26/2009 NC 11 11 M 8/26/2009 Pt developed swelling and itching a
355470 8/26/2009 AR 4 4 M 8/26/2009 Had Gma Seizures starting at 10pm
355471 8/26/2009 MN 33 33 M 8/26/2009 This individual received the flu shot
355472 8/26/2009 MI 12 12 F 8/26/2009 Multiple Uriticariae Shoulders. Raise
355473 8/26/2009 VA 20 20 F 8/26/2009 Pt became pale,weak c/o dizziness
355474 8/26/2009 GA 18 18 F 8/26/2009 Adverse event onset was 8-08-09 -
355475 8/26/2009 NY 54 54 F 8/26/2009 Within a few days I became ill with a
355476 8/26/2009 MI 59 M 8/26/2009 Subject in pneumococcal vaccine tr
355477 8/26/2009 MN 4 4 M 8/26/2009 By 5:30 on the night of his immuniza
355478 8/26/2009 MI 5 5 M 8/26/2009 pulled up mcir the night before didn
355480 8/26/2009 IL 74 74 M 8/26/2009 4 days after vaccination I experienc
355481 8/26/2009 TN 0.2 0 0.2 F 8/26/2009 Patient received Rotarix oral vaccin
355482 8/26/2009 VA 16 16 F 8/26/2009 Initial near syncopal episode at time
355483 8/26/2009 ND 14 14 F 8/26/2009 Severe headaches/migraines which
355484 8/26/2009 NY 1.3 1 0.3 M 8/26/2009 7/30/09 temp 101, febrile sz, seen b
355485 8/26/2009 VI 11 11 F 8/26/2009 mother and client report at this vist (
355486 8/26/2009 CO 11 11 M 8/26/2009 Developed dizziness, high-fever (10
355487 8/26/2009 VI 44 44 F 8/26/2009 Patient had swelling in the back of t
355488 8/26/2009 MI 75 75 M 8/26/2009 Pt has been on Humira and methotr
355489 8/26/2009 IN 17 17 F 8/26/2009 After a few minutes patient lost cons
355490 8/26/2009 OH 63 63 F 8/26/2009 Local reaction to LT posterior upper
355491 8/26/2009 IL 1.1 1 0.1 M 8/26/2009 Pt. vaccinated 7/31/09, His mother,
355492 8/26/2009 MO 10 10 M 8/26/2009 Within 15 minutes of vaccination, pt
355493 8/26/2009 NE 31 31 F 8/26/2009 The patient received the Tdap vacc
355494 8/26/2009 CT 19 19 F 8/26/2009 First acute schizophrenic episode (d
355495 8/26/2009 CO 65 65 F 8/26/2009 Patient developed 2 inch red circle a
355496 8/26/2009 TX 8 8 U 8/26/2009 Varicella vaccine administered to rig
355497 8/26/2009 SC 13 13 M 8/26/2009 pt recieved vaccine on 8/24/09. Pt s
355498 8/26/2009 IA 31 30 F 8/26/2009 PATIENT RECEIVED THIS VACCIN
355499 8/26/2009 MN 51 51 F 8/26/2009 She recieved the flu vaccine on 8-1
355500 8/26/2009 WA 18 18 F 8/26/2009 Redness and swelling, the size of g
355501 8/26/2009 CA 1.4 1 0.4 M 8/26/2009 Extensive local reaction
355502 8/26/2009 RI 48 48 F 8/26/2009 Had vaccine at approx 9:30am felt s
355503 8/26/2009 OR 66 66 F 8/26/2009 Large red and swollen area around
355504 8/26/2009 AZ 13 13 F 8/26/2009 1515: Client c/o nuasea after vaccin
355505 8/26/2009 TX 67 67 F 8/26/2009 Developed shingles in nose the nex
355506 8/26/2009 MN 41 41 F 8/26/2009 Deltoid muscle weakness. Pain in d
355507 8/26/2009 OH 2 2 0.1 M 8/25/2009 21 days after primary Varicella vacc
355513 8/26/2009 NV 11 11 F 8/26/2009 MENACTRA shot given in LD Wedn
355514 8/26/2009 CA 4 4 M 8/26/2009 Redness with swelling to R Deltoid.
355516 8/26/2009 TX 44 44 F 8/26/2009 Itching, redness, warmth, swelling.
355517 8/26/2009 NC 0.1 0 0.1 M 8/25/2009 Excessive prolonged crying, rednes
355518 8/26/2009 MN 37 37 M 8/26/2009 Pt feels fine- When I called to his ho
355519 8/26/2009 MN 12 12 M 8/26/2009 Pt feels fine - when I called to his ho
355520 8/26/2009 IL 4 4 F 8/26/2009 Develop rash that resembles Rubell
355521 8/26/2009 MN 11 11 M 8/24/2009 Seen 2 days after vaccine with prog
355522 8/26/2009 TX 0.6 0 0.6 M 8/26/2009 "none reported by parent".
355523 8/26/2009 MI 4 4 F 8/26/2009 Lt leg (anterior thigh) 10 x 10 cm ery
355524 8/26/2009 KS 5 5 M 8/25/2009 Minor hives, swelling around eye. N
355525 8/26/2009 AZ 31 31 M 8/26/2009 Pt received shot 8pm on 8/24/09. A
355526 8/26/2009 TX 13 F 8/26/2009 Red, swollen X 4 days.
355527 8/26/2009 TX 16 16 F 8/22/2009 Headache. Momentarily passed out
355528 8/26/2009 CA 4 4 F 8/26/2009 Redness swollen to (L) deltoid.
355529 8/26/2009 IL 4 4 M 8/26/2009 Erythema & mild pain at site of DTa
355530 8/26/2009 TX 1.5 1 0.5 M 8/24/2009 None provided.
356153 8/26/2009 OH 0.2 M 8/27/2008 Initial report received on 21 August
356154 8/26/2009 CA 28 28 M ### This non-serious case was received
356155 8/26/2009 VA 61 61 F 2/17/2009 Initial report received from a health
356156 8/26/2009 CA 5 5 F 5/26/2009 This non serious case was received
356157 8/26/2009 IL 1.6 1 0.6 M 4/13/2009 Case is linked with case 2009-0055
356158 8/26/2009 TX 4 4 F 3/6/2009 This event was received from a hea
356159 8/26/2009 FL 4 4 F 5/11/2009 This non serious case was received
356160 8/26/2009 NY 0.2 U 6/19/2009 Initial report was received 16 June 2
356161 8/26/2009 TX 4 4 M 6/26/2009 This case was received from a heal
356162 8/26/2009 PA 28 28 F 7/31/2008 Initial report was received 18 July 20
356163 8/26/2009 WV 4 4 F 10/7/2008 Initial report received on 25 August
356164 8/26/2009 PA 4 4 M 9/30/2008 This case was received from a heal
356165 8/26/2009 PA 0.2 0 0.2 F 9/29/2008 This case was received from a heal
356166 8/26/2009 FL 0.4 0 0.3 F 9/18/2008 Initial information was received from
356167 8/26/2009 FL 0.2 0 0.2 F 9/18/2008 Initial information was received from
356168 8/26/2009 CA 4 4 F 12/8/2008 Initial non-serious report received fr
356169 8/26/2009 WA 0.5 0 0.5 M ### Initial report was received 19 Novem
356170 8/26/2009 MA 5 5 M 1/6/2009 Initial report was received 17 Decem
356299 8/26/2009 NY 1.4 1 0.4 M 6/2/2009 A 17 months old male patient receiv
355251 8/27/2009 SD 12 12 F 8/19/2009 CNP present after incident. 1550- B
355629 8/27/2009 14 14 F 8/26/2009 Initial and follow-up information was
355630 8/27/2009 WA M 8/26/2009 Information has been received from
355634 8/27/2009 GA 52 52 F 8/21/2009 Initial report received on 17 August
355641 8/27/2009 PA 13 13 F 8/25/2009 Initial report received on 21 August
355647 8/27/2009 IL 13 13 F 8/21/2009 Developed Hodgkins lymphoma. We
355663 8/27/2009 CA 11 11 M 8/19/2009 About 3-4 hours after vaccine admin
355665 8/27/2009 CA 4 4 F 8/7/2009 L humeral area 5x5cm red in duratio
355673 8/27/2009 IN 5 5 F 8/21/2009 9 cm across, redness, warm to the t
355674 8/27/2009 MI 49 49 F 8/20/2009 Report of muscle ache throughout e
355675 8/27/2009 SC 53 53 F 8/21/2009 Severe pain at injection site & arm (
355676 8/27/2009 4 4 F 8/19/2009 Localized erythema & swelling of De
355677 8/27/2009 VA 11 11 F 8/20/2009 18-20 hrs after injection, pt develop
355678 8/27/2009 MI 31 31 F 8/19/2009 L deltoid soft tissue abscess.
355679 8/27/2009 TN 44 44 M 7/23/2009 "I wake up at 4:30 AM with my Rt ja
355680 8/27/2009 TN 4 4 F 7/29/2009 (1) 4 + Local reaction (L) arm (2) C/
355681 8/27/2009 VA 12 12 F 8/27/2009 Received 1st GARDASIL 8/13/09; m
355682 8/27/2009 PA 20 20 F 8/27/2009 Few minutes after shots, patient had
355683 8/27/2009 TX 65 65 F 8/27/2009 Reports a lump as large as a baseb
355684 8/27/2009 MN 5 5 F 8/19/2009 On 8/18/09, day following vaccinatio
355685 8/27/2009 TX 12 12 M 8/26/2009 9x10 cm warm\pink\non-tender; 2x3
355686 8/27/2009 TX 16 16 M 8/25/2009 30min after shot-BOOSTRIX mom r
355687 8/27/2009 FL 18 18 F 8/26/2009 Patient had Tdap and GARDASIL th
355688 8/27/2009 NH 18 18 M 8/21/2009 Patient started to experience warmt
355689 8/27/2009 NH 9 9 M 8/21/2009 Patient developed tenderness, redn
355690 8/27/2009 NY 16 16 F 8/21/2009 Injection site shows a swollen lump
355691 8/27/2009 NH 11 11 M 8/21/2009 Redness, swelling, and tenderness
355692 8/27/2009 VA 8 8 F 8/24/2009 8-10-09 Received varicella vaccine.
355694 8/27/2009 CT 33 33 M 8/27/2009 Approximately 20 hrs after administ
355696 8/27/2009 MD 44 47 M 8/27/2009 knots on arm at vaccine site that did
355697 8/27/2009 NY 22 22 F 8/27/2009 Pt. was a 22 yr old Female, inproce
355698 8/27/2009 0.3 0 0.3 M 8/27/2009 Rotavirus Vaccine administered on
355699 8/27/2009 IL 72 72 M 8/27/2009 Pt was due to be discharged after u
355700 8/27/2009 LA 60 60 F 8/27/2009 80mm red circle
355701 8/27/2009 PR 16 16 F 8/27/2009 MOTHER REFERS THE PATIENT
355702 8/27/2009 NJ 15 15 F 8/27/2009 APPROX. 20 SECONDS AFTER RE
355703 8/27/2009 NC 65 65 F 8/27/2009 Hives developed on face and neck w
355704 8/27/2009 TX 10 10 M 8/27/2009 Vomitting; Loss Consciousness with
355705 8/27/2009 MI 0.2 0 0.2 F 8/27/2009 Pentacel along with IPV was admin
355706 8/27/2009 CA 0.3 0 0.4 M 8/27/2009 HAIR FALLING OUT
355707 8/27/2009 TX 4 4 F 8/27/2009 Patient left clinic after vaccinations a
355708 8/27/2009 WI 12 12 M 8/27/2009 redness, hardness & swelling, mildly
355709 8/27/2009 FL 4 4 M 8/27/2009 CLIENT COMPLAINING OF PAIN A
355710 8/27/2009 11 11 M 8/27/2009 mild localized erythema 7 X 5.5 cm
355711 8/27/2009 CA 68 68 F 8/27/2009 DAY 2 - SORE, TENDER, ITCHING
355712 8/27/2009 FL 40 40 F 8/27/2009 REC'D FLU VACCINE @9AM. @ 1
355713 8/27/2009 MI 11 11 M 8/27/2009 Rt Deltoid swollen, red, hot,itchy an
355714 8/27/2009 NJ 53 F 8/27/2009 developed fever 101 degrees 12 hr
355715 8/27/2009 CA 66 66 F 8/27/2009 Zostavax administered on 8/10/200
355716 8/27/2009 MD 6 6 F 8/27/2009 PT LEFT ARM (DELTOID AREA) B
355717 8/27/2009 DE 27 27 F 8/27/2009 Patient has had moderate to severe
355718 8/27/2009 MO 1 0 0M 8/27/2009 Febrile seizure, temp 104.3(tempora
355719 8/27/2009 WA 1 1 0F 8/27/2009 High fever (102.2) and Fever Seizur
355720 8/27/2009 CO 40 40 F 8/27/2009 After about 10 minutes after receivin
355721 8/27/2009 CA 38 29 F 8/27/2009 VET CALLED BACK REPORTING P
355722 8/27/2009 NC 28 18 F 8/27/2009 Pt. presented to clinic for second M
355723 8/27/2009 NM 24 24 M 8/27/2009 RASH AND ITCHING COVERING W
355724 8/27/2009 CA 65 65 F 8/27/2009 65 y/o female/employee who presen
355725 8/27/2009 CA 42 42 M 8/27/2009 Vet reporting tender, warm and sligh
355726 8/27/2009 CA 5 5 M 8/27/2009 RIGHT THIGH RED, SWOLLEN AN
355727 8/27/2009 CA 72 72 F 8/27/2009 4 episodes of atrial fibrillation (new o
355728 8/27/2009 IL 19 18 F 8/27/2009 1st vaccine: 11/28/08; Rash on han
355729 8/27/2009 CA 0.9 M 8/27/2009 SWELLING AND REDNESS WITH
355734 8/27/2009 MI 59 59 M 8/27/2009 Shoulders, hips, neck weakness, m
355735 8/27/2009 NC 5 5 M 8/27/2009 (L) lateral upper thigh 13x13 cm, lig
355736 8/27/2009 SD 69 69 M 8/27/2009 Patient has a rash at rt side T5 & T1
355737 8/27/2009 MA 48 48 F 8/27/2009 Pt received ADACEL vaccine on 8/2
355738 8/27/2009 VT 4 4 F 8/27/2009 Upper arm redness, swelling & disc
355739 8/27/2009 NE 12 12 M 8/27/2009 Upper L) arm red swollen, itchy area
355740 8/27/2009 MT 12 12 M 8/27/2009 10 x 7 cm red erythema. Decreased
355741 8/27/2009 NJ 16 16 F 8/27/2009 Induration of 1 cm diameter at site o
355742 8/27/2009 CA 8 8 M 8/26/2009 Erythema, swelling, pain to site of in
355743 8/27/2009 PA 16 16 F 8/25/2009 1118AM 3 minutes after shots were
355744 8/27/2009 WI 12 12 F 8/27/2009 Pt fainted, subsequent headache di
355745 8/27/2009 NY 5 5 F 8/27/2009 none
355746 8/27/2009 IA 12 12 M 8/27/2009 Patient received MENACTRA and V
355747 8/27/2009 WA 11 11 F 8/26/2009 Redness, slight swelling, hot to touc
355748 8/27/2009 NM 9 9 M 8/27/2009 None stated.
355749 8/27/2009 PA 1 1 0M 8/27/2009 8/28/09 Was shaking and off balanc
355750 8/27/2009 CA 4 4 F 8/27/2009 1 d after immunization; pt developed
355751 8/27/2009 MA 21 21 F 8/27/2009 Reported local redness and pruritis.
355752 8/27/2009 WA 10 10 F 8/26/2009 Redness, slight swelling, hot to touc
355753 8/27/2009 MA 54 54 M 8/27/2009 Administered DTAP instead of inten
355840 8/27/2009 HI 10 10 M 8/27/2009 4:55 p: Decreased O2 saturation, 70
355844 8/27/2009 MI 0.6 0 0.6 F 7/17/2009 Fever. Hive type rash widespread.
355845 8/27/2009 KS 5 5 M 8/27/2009 Rash slight warm area to left leg.
355846 8/27/2009 WI 11 11 F Ashley received MENACTRA & TDA
355847 8/27/2009 WI 15 15 M Patient received Tdap and MENACT
355730 8/28/2009 KY 1.3 0 0.2 F 8/28/2009 Fever that was 103.5, Vomiting, Ra
355829 8/28/2009 TN 0.2 0 0.2 M 8/27/2009 Information has been received from
355841 8/28/2009 NC 0.2 0 0.2 M 8/25/2009 Fever 103.8 later on day of vaccine
355842 8/28/2009 VA 31 31 F 8/28/2009 "Trouble breathing & getting air" R e
355843 8/28/2009 VA 28 28 F 8/28/2009 Started with hives on wrist, itching a
355848 8/28/2009 CT 18 18 F 8/24/2009 Second dose of GARDASIL given to
355849 8/28/2009 NY M 8/26/2009 Syncopal episode after receiving TD
355850 8/28/2009 ME 18 F 8/25/2009 8/24/09 around 1:30pm after I gave
355851 8/28/2009 MI 52 52 F 8/28/2009 Red, Rash on left upper arm, warm
355852 8/28/2009 WI 17 17 F 8/28/2009 11:30am-Pt was given Tdap, HPV,
355853 8/28/2009 GA 26 26 F 8/28/2009 Patient received FLu Mist on 25Aug
355854 8/28/2009 WI 1 1 0M 8/28/2009 The pt developed fever later in the d
355855 8/28/2009 VA 11 11 F 8/28/2009 Mother called stating child had red s
355856 8/28/2009 VA 34 34 F 8/28/2009 7/9/2009 Associate reports cold sx ,
355857 8/28/2009 VA 20 20 F 8/28/2009 Pt's mom called and says that expi
355858 8/28/2009 IL 11 11 M 8/28/2009 Pt presented to clinic 2 days after a
355859 8/28/2009 IN 64 64 M 8/28/2009 Chills, sweats, body aches, light-hea
355861 8/28/2009 PA 72 72 F 8/28/2009 Received pneumovax at about 10am
355862 8/28/2009 IA 24 24 F 8/28/2009 Patient developed hives and itching
355863 8/28/2009 AR 6 6 M 8/28/2009 No adverse events noted to date.
355864 8/28/2009 TX 3 3 F 8/28/2009 None noted at present. But client go
355865 8/28/2009 AR 10 10 F 8/28/2009 NO Adverse Events to date.
355867 8/28/2009 VA 5 5 F 8/28/2009 Tired, sleepy after vaccines. 2 am -
355868 8/28/2009 KY 4 4 F 8/28/2009 Patient presented on 8/27/09 with re
355869 8/28/2009 AR 4 4 F 8/28/2009 NO ADVERSE EVENTS TO DATE
355870 8/28/2009 MI 8 8 M 8/28/2009 Patient left the office and came imm
355871 8/28/2009 VA 4 4 F 8/28/2009 Swelling of Left arm & shoulder and
355872 8/28/2009 IL 76 76 F 8/28/2009 Client recieved Pnuemovax 23 Rt a
355873 8/28/2009 WA 82 82 F 8/28/2009 Patient took 2nd dose of Vivotif on e
355874 8/28/2009 WI 17 17 M 8/28/2009 Fainting on and off for about 20 min
355875 8/28/2009 WI 35 35 F 8/28/2009 8/19 2:30 noticed itching, 3:00 notic
355876 8/28/2009 NC 5 5 M 8/28/2009 2 TO 3 MINUTES AFTER RECEIVI
355877 8/28/2009 CA 63 63 F 8/28/2009 Pox-like structure on the arm where
355878 8/28/2009 OK 16 16 F 8/28/2009 None noted
355879 8/28/2009 UT 28 28 F 8/28/2009 The pneumvax vaccine was adminis
355880 8/28/2009 NY 63 63 F 8/28/2009 Tenderness, pruitic, macular rash a
355881 8/28/2009 AZ 11 11 M 8/28/2009 After vaccination parent and child le
355882 8/28/2009 ID 71 71 F 8/28/2009 Client called EIPHD on 8/27/09 repo
355883 8/28/2009 TX 14 14 F 8/28/2009 8/25/2009: VZV#2 given SQ to Righ
355884 8/28/2009 AK 25 25 F 8/28/2009 Pt had a left leg pain withing hours a
355885 8/28/2009 OH 15 15 F 8/28/2009 between shot 2 and 3 started having
355886 8/28/2009 TX 6 6 M 8/28/2009 The patient was seen 2 days after th
355887 8/28/2009 MO 17 17 F 8/28/2009 Developed migrane headache
355901 8/28/2009 CA 10 10 M 8/27/2009 1605 Administered Hep A and VZV
355902 8/28/2009 WA 0.5 0 0.5 M 8/28/2009 10/31/08 Pt seen in office for vomiti
355903 8/28/2009 PA 5 5 F 8/28/2009 TC received by grandmother; states
355904 8/28/2009 WA 19 19 F 8/20/2009 Patient developed ASCUS PAP and
355905 8/28/2009 ND 51 51 M 8/28/2009 Child broke out with pox-like rash a
355906 8/28/2009 IA 12 12 F 8/27/2009 Patient was given ADACEL first with
355910 8/28/2009 MA 15 15 F 8/28/2009 8/24 afternoon- pt received vaccine
355911 8/28/2009 OH 12 12 F 8/27/2009 Patient had low grade fever and hea
355913 8/28/2009 NE 12 12 M 8/28/2009 Large welt measuring 4x3 on back o
355914 8/28/2009 MI 17 17 F 8/27/2009 Joint swelling to include digits, knee
355916 8/28/2009 NY 11 11 F 8/27/2009 When child woke up next morning a
355917 8/28/2009 NM 73 73 M 8/28/2009 Stated the night of 25 Aug 09 she d
355919 8/28/2009 GA 3 3 F (L) thigh erythematous w/ clearing p
355934 8/28/2009 MA 13 13 F 8/28/2009 Pt. had nasal flu mist. Fell back in w
355935 8/28/2009 AZ 11 11 F 8/28/2009 Patient received MENACTRA 0.5cc
355936 8/28/2009 OR 11 11 M 8/28/2009 11x18 cm area of well demarcated e
355937 8/28/2009 AZ 5 5 F 8/28/2009 Left deltoid swelling, red, hot touch.
355938 8/28/2009 NC 63 63 M 8/28/2009 About 2 hrs following vaccine he aw
355939 8/28/2009 MA 90 90 F 8/28/2009 full blown case of Zost 2 wks after -
355941 8/28/2009 CO 15 15 F 8/28/2009 After administration GARDASIL pt w
355942 8/28/2009 MA 11 11 F Tdap expired on 5/2/09 and was ad
355943 8/28/2009 MA 11 11 M Tdap expired 5/2/09 and was admin
355944 8/28/2009 MA 12 12 M Tdap expired on 5/2/09 and was ad
355945 8/28/2009 PA 69 69 F 8/24/2009 Pt had herpes zoster outbreak.
355946 8/28/2009 WA 48 48 F 8/27/2009 Swollen lymph nodes under right ar
355947 8/28/2009 4 4 F 8/28/2009 Pt. given vaccines on 8/24/2009; ca
355948 8/28/2009 MN 68 68 F 8/28/2009 Severe swelling and redness down
355949 8/28/2009 TX 17 17 F 8/28/2009 Collar bone sore. Bump on left side
355950 8/28/2009 IN 5 5 M 8/21/2009 Large amt swelling next AM redness
355951 8/28/2009 MA 11 11 M 8/28/2009 Pt. Received vaccines in office. Whe
355952 8/28/2009 VA 5 5 M 8/29/2009 8-18-09 Erythema, swelling at site. T
355888 8/29/2009 NY 5 4 M 8/29/2009 24 hours after vaccination the patien
355889 8/29/2009 NY 11 11 M 8/29/2009 Pt. complained that he wasn't feelin
355892 8/29/2009 PA 65 65 F 8/29/2009 Patient received the vaccine today a
355893 8/29/2009 CA 0.5 0 0.5 F 8/29/2009 Fever to 103 degrees
355894 8/29/2009 CA 15 15 F 8/29/2009 fatigue, fainting, dizziness and seizu
355912 8/29/2009 NE 5 5 M 8/28/2009 (L) upper thigh swollen to softball si
355896 8/30/2009 OH 21 21 M 8/30/2009 Constant tingling in right hand. Red
355897 8/30/2009 LA 8 8 M 8/30/2009 Hives. Received Dexamethasone IM
355898 8/30/2009 CA 62 62 F 8/30/2009 Week of NOv. 24th did not have ene
355899 8/30/2009 AZ 32 32 M 8/30/2009 Vaccine was given on a Wednesday
355900 8/30/2009 CA 62 62 M 8/30/2009 Vaccinated 8/28/09 about 4 p.m. Fi
355971 8/31/2009 NJ M 5/12/2009 Expired vaccine used (expired drug
355976 8/31/2009 NJ 31 31 M 5/12/2009 Expired vaccine used (Expired drug
356000 8/31/2009 OH 70 70 F 8/26/2009 This case was received from a heal
356001 8/31/2009 F 8/27/2009 Initial report received on 18 August
356002 8/31/2009 IN M 8/27/2009 Initial information received on 19 Au
356003 8/31/2009 IN U 8/27/2009 Initial report was received 19 Augus
356005 8/31/2009 OH 12 F 8/27/2009 Initial report was received 24 Augus
356010 8/31/2009 16 F 8/28/2009 Information has been received via in
356029 8/31/2009 AZ 7 7 M 8/23/2009 Daily intermittent headaches, fatigu
356030 8/31/2009 OH 4 4 M 8/25/2009 Received vaccines and left office to
356031 8/31/2009 OH 18 18 F 8/27/2009 My daughter had the series of GAR
356032 8/31/2009 13 13 F 8/25/2009 My daughter received all three injec
356033 8/31/2009 LA 17 17 F 8/20/2009 See copies of pt's record 7/31/09. 8
356034 8/31/2009 NE 12 12 F 8/26/2009 Local redness & swelling at injection
356035 8/31/2009 LA 5 5 F 8/26/2009 Rash 5 days after shot around site r
356036 8/31/2009 IL 77 77 F 8/27/2009 Headache started shortly after injec
356037 8/31/2009 CA 4 4 M 8/27/2009 Pt began to swell on (LF) leg.
356038 8/31/2009 WI 17 17 M 8/26/2009 Client received MCV4 and TDAP. A
356039 8/31/2009 TX 4 M TM 101 at 50 + hrs after injection w
356040 8/31/2009 MO 3 3 M 8/28/2009 Gave client TD by mistake. Should
356041 8/31/2009 AZ 16 16 F 8/27/2009 Developed fever of 100 last night an
356042 8/31/2009 OR 53 53 M 8/21/2009 Pt reported "rash on abd and groin a
356043 8/31/2009 MI 18 18 F 8/25/2009 Urticaria. Rx BENADRYL 25 mg P.
356044 8/31/2009 ID 5 5 M 8/28/2009 Swelling in R thigh, redness - tende
356046 8/31/2009 FL 4 4 F 8/28/2009 Guillan - Barre syndrome. Respirat
356047 8/31/2009 TX 26 26 M 8/31/2009 Onset of pruritic and painful papular
356048 8/31/2009 NY 3 3 M 8/28/2009 Large area of erythema and blisters
356049 8/31/2009 MI 14 14 F 8/31/2009 Patient presented in the office on 8/
356050 8/31/2009 GA 19 19 M 8/31/2009 large erythematous edematous patc
356051 8/31/2009 FL 74 73 F 8/31/2009 Headache, Fever, Facial Swelling, H
356052 8/31/2009 MI 35 35 F 8/31/2009 Inflammation a few days after vaccin
356053 8/31/2009 MN 37 37 F 8/31/2009 Redness with orange peel texture, s
356054 8/31/2009 TX 4 4 M 8/31/2009 Swollen red left arm. hot sensation
356055 8/31/2009 IL 15 15 M 8/31/2009 Approx. 10 minutes after receiving T
356056 8/31/2009 GA 39 39 F 8/31/2009 Toxic Drug reaction; Severe dehydr
356057 8/31/2009 NY 31 31 F 8/31/2009 Sore and numbness in arm 8 hours
356058 8/31/2009 MI 15 15 F 8/31/2009 Client became lightheaded, pale an
356059 8/31/2009 MO 48 48 F 8/31/2009 Patient received vaccination at prim
356060 8/31/2009 CA 61 61 M 8/31/2009 Adverse reaction to Shingles vaccin
356061 8/31/2009 MO 15 15 M 8/24/2009 Reaction started 45 minutes after T
356062 8/31/2009 MI 9 9 F 8/31/2009 24 HOURS AFTER SHOTS SHE BR
356063 8/31/2009 MI 61 61 F 8/31/2009 24 hours after vaccination patient de
356064 8/31/2009 AR 6 6 M 8/31/2009 Within an hour after receiving immu
356065 8/31/2009 VA 4 4 F 8/31/2009 6 days after vaccines were given pa
356066 8/31/2009 MN 36 36 F 8/31/2009 Flu shot received 08/24/09 @ 10:30
356067 8/31/2009 MO 32 32 M 8/31/2009 Shortly after receivcing vaccinations
356068 8/31/2009 TN 32 32 M 8/31/2009 swelling of lower lip, soreness of thr
356069 8/31/2009 OR 2 3 M 8/31/2009 Redness, heat, swelling and discom
356070 8/31/2009 GA 13 13 F 8/31/2009 Patient received vaccine on 8/17/09
356071 8/31/2009 CA 4 4 M 8/31/2009 CELLULITIS RIGHT THIGH. KEFLE
356072 8/31/2009 WA 82 82 F 8/31/2009 redness at the site of injection. the r
356073 8/31/2009 WA 70 70 M 8/31/2009 Maculopapular rash of trunk and ex
356074 8/31/2009 OH 0.3 0 0.4 M 8/31/2009 urticarial rash 5 minutes following P
356075 8/31/2009 IN 1 1 0M 8/31/2009 <20 red papules on trunk, not itchy,
356076 8/31/2009 CA 4 5 M 8/31/2009 none
356078 8/31/2009 IN 14 14 F 8/31/2009 MOTHER REPORTED CHILD HAD
356079 8/31/2009 IN 29 29 F 8/31/2009 Patient complains of severe pain in
356080 8/31/2009 IN 62 62 F 8/31/2009 chills, sweats, body ache, difficulty s
356081 8/31/2009 AZ 15 15 F 8/31/2009 After receiving vaccine daughter c/o
356083 8/31/2009 WI 14 14 F 8/27/2009 N, stomach, dizzy, HA, backache, c
356084 8/31/2009 OH 34 34 M 8/31/2009 Headache, tiredness, nausea, diarrh
356085 8/31/2009 NE 12 12 F 8/31/2009 Area around injection site red & bum
356086 8/31/2009 FL 4 4 F 8/31/2009 8-31-09 mother phoned, client ok ev
356087 8/31/2009 IA 31 31 F 8/31/2009 Severe myalgia - fatigue - started 8/
356088 8/31/2009 CA 4 4 F 8/28/2009 Pt received vaccine on 8-26-09 on 8
356089 8/31/2009 CA 63 63 M 8/31/2009 Fever to 103 F with shaking chills da
356090 8/31/2009 CA 4 4 F 8/31/2009 None Stated
356091 8/31/2009 CA 0.5 0 0.5 F 8/31/2009 Infant developed edema, redness/p
356092 8/31/2009 CO 9 9 F 8/31/2009 VARIVAX administered 8/28/09 to R
356093 8/31/2009 IL 5 5 F 8/28/2009 Redness, swelling & induration at in
356094 8/31/2009 PA 61 61 F 8/31/2009 Injection site reaction (redness; abo
356095 8/31/2009 VA 5 5 F 8/14/2009 Approximately 36 hours after vax ad
356096 8/31/2009 IA 4 4 M 8/28/2009 Pt began having rash on leg admini
356097 8/31/2009 NJ 16 16 F 8/31/2009 Headache, fatigue. Local swelling, r
356098 8/31/2009 MT 5 5 M 8/21/2009 Pt. returned to clinic 20 minutes afte
356099 8/31/2009 MA 5 5 F 6/25/2009 See attached
356100 8/31/2009 IN 20 20 F 8/25/2009 Fever 100.4, chills, H/A, swollen lips
356101 8/31/2009 NH 0.4 0 0.4 F 8/24/2009 Post vaccine fever. Temperature ele
356102 8/31/2009 NC 16 16 F 8/25/2009 Per pts. mother, pt. started experien
356103 8/31/2009 NC 38 38 F 8/26/2009 Shots given and instructed to use co
356104 8/31/2009 IN 1.9 F 8/24/2009 Mild case of chicken pox.
356105 8/31/2009 WI 5 5 M 8/5/2009 Noted orange sized, red, hard, warm
356106 8/31/2009 SC 0.4 0 0.4 F 8/24/2009 Diarrhea/ Hematocrit leading to sev
356107 8/31/2009 VA 44 44 F Pt received TDAP (BOOSTRIX) on
356108 8/31/2009 OH 19 19 F 8/25/2009 Patient called our office 4 hours afte
356109 8/31/2009 TX 15 15 F 8/12/2009 Jerking, shaking, "locked up" (2 min
356110 8/31/2009 AZ 52 52 F 8/24/2009 By 08/22/09 around 3:30 pm there w
356111 8/31/2009 IN 0.6 0 0.6 F 8/21/2009 Temp up to 105 degrees duration 2
356112 8/31/2009 OR 17 17 F 8/24/2009 Pt had HPV, Hep A, & Verasella. S
356113 8/31/2009 8 8 U Swelling of LA, red, hot.
356114 8/31/2009 IL 2 2 0F 8/31/2009 Presented to office with rash - Bega
356115 8/31/2009 OH 9 9 F 8/28/2009 Erythema & swelling upper arm (16
356116 8/31/2009 CA 4 4 F 8/28/2009 Skin rash & swelling 6x7 cm. Requir
356117 8/31/2009 MD 65 65 F 8/24/2009 PNEUMOVAX 8/17/09 developed h
356118 8/31/2009 WV 5 5 M 8/26/2009 Pt received Hep A vaccine on 8/25/
356119 8/31/2009 37 37 F 8/26/2009 Developed suddenly around 21 May
356120 8/31/2009 AZ 8 8 M 8/24/2009 Left arm 6 inch erythematous area.
356121 8/31/2009 OR 1.1 1 0.1 M 8/21/2009 Fever, vomiting. 5 cm swelling and e
356122 8/31/2009 OR 1.1 1 0.1 M 8/21/2009 Fever, vomiting, diarrhea, and fussin
356123 8/31/2009 AZ 4 4 M 8/26/2009 Slight swelling and redness to inject
356125 8/31/2009 MN 11 11 M 8/31/2009 Rash, low grade fever, fatigue, head
356130 8/31/2009 LA 0.5 0 0.5 M 8/21/2009 Fever 103 degrees. Lt thigh swollen
356132 8/31/2009 FL 30 30 M 8/26/2009 2-3 day after flu like symptoms, leth
356133 8/31/2009 NC 15 15 F 8/24/2009 After administration of GARDASIL v
356134 8/31/2009 MS 5 5 F 8/19/2009 Pt. displayed redness at the site of i
356135 8/31/2009 CA 20 20 M 12 days following vaccination pt dev
356136 8/31/2009 LA 1.1 1 0.1 F 8/12/2009 Rash. Fussiness.
356145 8/31/2009 OR 55 55 F 8/10/2009 8/10/09 - Pt in for HEP B #3 - Repo
356149 8/31/2009 OR 10 10 M 8/18/2009 Pt was given MENACTRA before he
356150 8/31/2009 IL 80 80 F 8/31/2009 Back & thigh pain within 24 hrs afte
356151 8/31/2009 71 71 F 8/31/2009 Cold sores
356152 8/31/2009 FL 2 2 0.4 M 8/27/2009 Parent reported increased swelling
356082 9/1/2009 TX 54 54 F 9/1/2009 Shingles Vaccine on Left arm: 1st d
356171 9/1/2009 ME F 8/26/2009 Was admin. 8/21/09. Noticed reactio
356172 9/1/2009 PA 1.7 1 0.7 M 8/27/2009 Left thigh became red and swollen o
356173 9/1/2009 MI 18 18 M 8/21/2009 24 hours after vaccine broke out in
356175 9/1/2009 MS 5 5 F 8/25/2009 Rash - red, raised - to chest, back, s
356176 9/1/2009 TN 0.2 0 0.2 F 8/26/2009 See attached sheets.
356177 9/1/2009 FL 48 48 F 8/27/2009 This spontaneous case was receive
356179 9/1/2009 MD 7 7 M 8/31/2009 Swelling in (L) arm - site of where va
356181 9/1/2009 OH 49 49 M 8/24/2009 Approx 9-10:00pm on day of immun
356182 9/1/2009 TX 11 11 F 8/24/2009 Both vaccines administered in same
356183 9/1/2009 WA 12 12 F 8/24/2009 Presented to clinic 4/30/07 with 2d m
356184 9/1/2009 NJ 6 6 F 8/29/2009 Mother states patient ran a fever of
356188 9/1/2009 OK 0.6 0 0.6 M 8/20/2009 Stop sleeping nights, fever, irritabilit
356190 9/1/2009 TX F 8/24/2009 None
356191 9/1/2009 AZ 17 17 M 8/28/2009 Patient had Varicella vaccination ab
356197 9/1/2009 MT 18 18 F 8/27/2009 Pt. given Hep A VFC, instead of He
356198 9/1/2009 CA 1.7 1 0.7 F 8/26/2009 Pt received vaccine on 8/14/09. Pt
356200 9/1/2009 OH 5 5 M 8/25/2009 Pt. broke out in a rash, swelling, vom
356201 9/1/2009 HI 12 12 F 8/28/2009 Fever to 102, night of GARDASIL #
356203 9/1/2009 HI 11 11 F 8/28/2009 Fever to 102, night of GARDASIL a
356204 9/1/2009 LA 56 56 F None.
356205 9/1/2009 OK 10 M 8/26/2009 None stated.
356206 9/1/2009 ID 11 11 F Pt received hep A (L deltoid) and AD
356207 9/1/2009 WA 54 54 F 8/26/2009 Redness and swelling of injection si
356208 9/1/2009 TX 12 12 F 8/24/2009 Both arms between shoulders and e
356209 9/1/2009 GA F 7/21/2009 I received the shingles vaccine on 2
356210 9/1/2009 11 11 F 8/30/2009 Female vaccinated with GARDASIL
356211 9/1/2009 IL 68 F 8/30/2009 Vaccinated with ZOSTAVAX for shin
356212 9/1/2009 WV 14 14 F 8/20/2009 Fainting/feeling hot. Placed patient
356213 9/1/2009 NC 46 46 F 9/1/2009 Received ADACEL 8/27/09 - 8/28/0
356214 9/1/2009 FL 15 15 F 8/21/2009 On 8/10/09 - 7 pm client taken to ER
356215 9/1/2009 34 34 M 8/31/2009 On 27 April 2009 he received AVA #
356216 9/1/2009 VA 37 37 M 8/27/2009 This 37 year old AD US Navy office
356217 9/1/2009 NC 4 4 F 9/1/2009 No adverse symptoms noted.
356218 9/1/2009 NC 10 10 M 9/1/2009 Swelling redness pain warmth of lef
356219 9/1/2009 NJ 11 11 M 8/28/2009 Within 1 hour child developed angry
356220 9/1/2009 NY 21 21 F 8/26/2009 Pt. developed chills, fever, SOB afte
356221 9/1/2009 WA 11 11 M 8/27/2009 Telephone call from parent reporting
356222 9/1/2009 VA 60 60 F 8/26/2009 24 hours after receiving vaccine, be
356223 9/1/2009 CO 4 4 M 8/26/2009 Erythema and inflammation onset a
356224 9/1/2009 LA 12 12 M 8/17/2009 About 30 min - 1 hr after vaccines p
356225 9/1/2009 WI 12 12 M 8/27/2009 Passed out. Stomach pain.
356226 9/1/2009 MA 17 17 F 8/27/2009 Near syncope - some chest pain & d
356227 9/1/2009 VT 46 46 F 8/25/2009 HA, neck stiffness, myalgias and pa
356228 9/1/2009 MA 1 1 0M 8/26/2009 Developed <12 erythematous papul
356229 9/1/2009 PA 0.2 0 0.2 F 8/27/2009 Hep B-dose #3 given at age 8 wks b
356230 9/1/2009 GA 4 4 M 8/27/2009 Swelling, inflammation, bruising, wa
356231 9/1/2009 MN 5 5 F 8/27/2009 Redness, warmth, slight bruising to
356232 9/1/2009 PA 12 12 F 8/27/2009 Left deltoid area redness, itching wi
356233 9/1/2009 WI 12 12 M 8/27/2009 Passed out. Stomach pain.
356234 9/1/2009 WI 1 1 0M 8/26/2009 Local hypersensitivity reaction to MM
356235 9/1/2009 OK 25 25 M 8/20/2009 Isolated pox developed on right foot
356236 9/1/2009 MS 17 17 F 7/23/2009 Severe headache with fever 100 de
356237 9/1/2009 TX 77 77 F 8/28/2009 Shot on 8/19/09. Next day large red
356240 9/1/2009 GA 20 20 F 9/1/2009 This case was reported by a healthc
356241 9/1/2009 IL 14 14 F 9/1/2009 Patient received HPV #3 on 07/13/0
356242 9/1/2009 MD 73 73 F Dizziness (within 10 minutes of FLU
356243 9/1/2009 NE 5 5 M 9/1/2009 Erythema multiforme within 24 hour
356244 9/1/2009 ID 11 11 M 9/1/2009 A couple hours after vaccines L side
356245 9/1/2009 MS 0.1 0 0.1 F 9/1/2009 Student Nurse gave vaccines to you
356246 9/1/2009 KY 14 14 F 8/20/2009 Extreme fatigue- persistent, precede
356247 9/1/2009 TX 1 1 0M 9/1/2009 Net like rash, itching, 12 days after
356248 9/1/2009 DE 4 4 F 9/1/2009 Mother reported high fever and fron
356249 9/1/2009 MI 3 3 M 8/31/2009 Approx. 10-20 minutes after receivin
356250 9/1/2009 AZ 48 48 F 8/31/2009 Persistent pain; numbness in injecti
356251 9/1/2009 IL 32 32 F 9/1/2009 Symptoms of feeling overheated, ta
356252 9/1/2009 IL 78 78 F 9/1/2009 After receiving her shots pt c/o shor
356253 9/1/2009 GA 13 M 9/1/2009 Within 2-4 days of receiveing menac
356254 9/1/2009 NH 12 12 M 9/1/2009 Per patient and mother, Shad felt "fu
356255 9/1/2009 PA 1 1 0M 9/1/2009 Ryan (22 pounds, 7 oz; 31 inches) h
356256 9/1/2009 NY 0.3 0 0.3 F 9/1/2009 Intussusception. Failed reduction. R
356257 9/1/2009 KY 5 5 M 9/1/2009 Patient had high fever spikes of 104
356259 9/1/2009 OH 1 1 0.1 F 8/31/2009 Within three days had head to toe ra
356260 9/1/2009 MI 7 7 F 9/1/2009 According to mom approximately 5-
356261 9/1/2009 OH 6 6 M 9/1/2009 Developed hives around injection si
356262 9/1/2009 MA 4 4 M 9/1/2009 Varicella and MMR vaccines given o
356263 9/1/2009 IA 0.3 0 0.4 F 9/1/2009 After my daughter's 4mo check up a
356264 9/1/2009 IL 0.5 0 0.5 F 9/1/2009 received vaccineson 8/4/09. On 8/6
356265 9/1/2009 FL 16 16 F 9/1/2009 Bell's palsy (unilateral). 9/2/09 Cons
356266 9/1/2009 KS 18 18 F 9/1/2009 Patient fainted and fell to floor hittin
356267 9/1/2009 VA 8 8 F 9/1/2009 Received Hep A and Flumist, left ro
356268 9/1/2009 PA 9 9 F 9/1/2009 Child received TD, IPV,HEP A,MMR
356269 9/1/2009 NJ 11 11 M 8/31/2009 syncope, occured about 2 min after
356271 9/1/2009 OH 20 20 F 9/1/2009 Severe leg cramps in the calves
356273 9/1/2009 NC 72 72 F 9/1/2009 Patient reports a rash, fever and he
356274 9/1/2009 AL 5 5 F 9/1/2009 Had a rash with blisters over some p
356275 9/1/2009 UT 5 5 F 9/1/2009 Patient came to clinic on 8-17-09 co
356276 9/1/2009 AL 10 10 F 9/1/2009 On 8/21/09 Mother reported child ha
356277 9/1/2009 CA 70 70 F 9/1/2009 10 cm x 6.5cm mild erythema left ar
356278 9/1/2009 IL 8 8 M 9/1/2009 1 day following varicella administrat
356279 9/1/2009 MD 56 56 F 9/1/2009 client had twinrix vaccine (3rd dose)
356280 9/1/2009 IL 12 12 M 9/1/2009 4 cm erythematous oval shaped are
356281 9/1/2009 CO 16 16 F 9/1/2009 Patient administered Hep A and HP
356283 9/1/2009 NC 48 48 F 9/1/2009 Approximately 10-12 hours after rec
356284 9/1/2009 WA 24 24 M 9/1/2009 Pt had satellite lesions 1/2 an inch t
356285 9/1/2009 LA 13 13 F 9/1/2009 Stiffening and aching muscles, ches
356286 9/1/2009 UT 15 15 M 9/1/2009 HIGH FEVER 102.4, HEADACHE
356287 9/1/2009 CA 74 74 F 9/1/2009 pt recevied flu shot on left arm,and
356288 9/1/2009 VA 61 61 F 9/1/2009 Her whole arm(on which vaccine wa
356289 9/1/2009 GA 1 1 0F 9/1/2009 Approx. 4 hours after receiving MMR
356290 9/1/2009 CA 30 30 M 9/1/2009 Vertigo and stomach cramps beginn
356291 9/1/2009 NY 1.8 1 0.8 M 9/1/2009 Superficial skin reaction occurred th
356292 9/1/2009 AL 61 61 F 9/1/2009 Zoster L chest
356294 9/1/2009 TX 0 0 0F 9/1/2009 Dr. went did physical & came out th
356295 9/1/2009 NE 2 M 8/18/2009 A serious, spontaneous report of me
356300 9/2/2009 WI 15 15 F 8/27/2009 Lg reddened area - Warm & itchy rt
356322 9/2/2009 OH 50 50 F 8/11/2008 I received 2 of the 3 HEPATITIS B V
356323 9/2/2009 NM 13 13 F 8/25/2009 Aggression, seizures, rapid heart ra
356324 9/2/2009 TX 4 4 M 8/27/2009 Swelling and erythema to site; exten
356325 9/2/2009 PA 14 14 M 8/28/2009 After receiving immunizations at offi
356326 9/2/2009 PA 14 14 M 8/26/2009 None stated
356327 9/2/2009 NC 43 43 F 8/28/2009 Patient went to ER 8/13/09 with com
356328 9/2/2009 IN 17 17 F 8/25/2009 Bradycardia, arrythmias, heart block
356329 9/2/2009 IL 25 25 F 8/28/2009 More than normal bleeding at time o
356330 9/2/2009 NC 12 12 F 8/25/2009 Angioedema 8 cm on right posterior
356331 9/2/2009 NC 16 16 M 8/25/2009 Angioedema noted in right posterior
356332 9/2/2009 NC 5 5 F 8/25/2009 Erythema on right arm - posterior 3
356333 9/2/2009 VA 55 55 F 8/25/2009 Fever, chill, muscle pain all over, bo
356334 9/2/2009 LA 13 13 F 8/27/2009 Severe hair loss. Headaches. 10/14
356335 9/2/2009 ID 12 12 U Broke out in rash on 8/18/09, seen i
356336 9/2/2009 VA 11 11 M 8/29/2009 Pt developed chickenpox 10 days a
356337 9/2/2009 AZ 93 93 F 9/2/2009 Face swollen, eyes swollen, itching
356338 9/2/2009 WA 0.3 0 0.3 F 8/28/2009 Day of vaccine administration, patie
356339 9/2/2009 KY 4 4 F 8/27/2009 Localized reaction at site of injection
356340 9/2/2009 VA 0.8 0 0.8 M 8/28/2009 Approx < 2 hrs after HEP B vaccine
356350 9/2/2009 CO 56 U Reported general malaise - Temp u
356351 9/2/2009 CO 80 U Reported: Didn't feel good, shaky, a
356352 9/2/2009 MI 8 8 F 9/1/2009 Behavior changes with in 1-2 days.
356353 9/2/2009 IL 34 34 M 9/2/2009 PAIN, ITCHING, REDNESS AND S
356354 9/2/2009 TX 4 4 M 9/2/2009 Within 12 hours of flu shot injection
356355 9/2/2009 NJ 73 F 9/2/2009 nausea, Vomiting, throat tightness w
356356 9/2/2009 MN 56 56 F 9/2/2009 At the time of the vaccination, she fe
356357 9/2/2009 NV 17 17 F 9/2/2009 Sore arm evening of vaccination. W
356358 9/2/2009 AL 59 59 F 9/2/2009 Employee developed large welped,
356359 9/2/2009 MO 47 47 F 9/2/2009 The day after vaccine was administe
356360 9/2/2009 IA 0.2 0 0.2 F 9/2/2009 Generalized tonic clonic seizure as
356361 9/2/2009 IN 43 43 F 9/2/2009 Received shot in clinic around 2:00
356362 9/2/2009 VA 41 41 F 9/1/2009 Patient experienced wheezing and c
356363 9/2/2009 TN 4 4 M 9/2/2009 Administered PENTACEL vaccine in
356364 9/2/2009 MI 32 31 F 9/2/2009 8/5/2009 Soreness of Right upper a
356365 9/2/2009 TX 6 6 M 9/2/2009 SITE OF INJECTION IS SWOLLEN
356366 9/2/2009 WA 31 31 M 9/2/2009 Patient inadvertantly innoculated sp
356368 9/2/2009 SC 46 46 F 9/2/2009 Recieved Tdap in L deltoid on 08/29
356369 9/2/2009 MI 54 54 F 9/2/2009 Induration and redness/swelling in a
356370 9/2/2009 OR 1.3 1 0.3 F 9/2/2009 Diffuse urticaria after receiving DTa
356371 9/2/2009 WA 32 32 M 9/2/2009 Patient with pustular lesions on eryt
356372 9/2/2009 MA 1.3 1 0.3 M 9/2/2009 My child suffered severe reactions t
356373 9/2/2009 NJ 13 13 F 9/2/2009 About 5 minutes after receiving Gar
356374 9/2/2009 VA 12 12 F 9/2/2009 Outbreak of pruritic small papules o
356375 9/2/2009 NV 0.6 0 0.6 M 9/2/2009 Vaccines were given and we left Dr
356376 9/2/2009 WA 62 62 F 9/2/2009 Patient reports that she had a Shing
356377 9/2/2009 CA 61 61 F 9/2/2009 developed "headache,chills, fever o
356378 9/2/2009 OK 61 60 F 9/2/2009 Pt developed 5 painful, fever blister
356379 9/2/2009 NJ 65 65 M 9/2/2009 Patient had pneumovax 9 am on 8/2
356381 9/2/2009 NC 0.2 0 0.2 F 9/2/2009 Patient developed fever of 104 in th
356382 9/2/2009 PA 0.3 0 0.3 M 8/24/2009 Patient developed abdominal disten
356383 9/2/2009 PA 0.2 0 0.2 M 8/24/2009 Increased number of apneic and bra
356384 9/2/2009 WA 11 M 9/2/2009 Swelling & redness in right arm.
356385 9/2/2009 AK 56 56 F 9/1/2009 Patient was given 0.5 mL of flu vacc
356386 9/2/2009 CO 12 12 F 9/12/2009 Pt given flu shot (told to hang aroun
356387 9/2/2009 TX 76 76 F 9/2/2009 Patient developed large rash that sh
356388 9/2/2009 OH 11 11 M 9/1/2009 11 am 8/31/09 vaccines administere
356389 9/2/2009 OR 51 51 F 9/2/2009 Redness, warmth in shoulder and s
356390 9/2/2009 CA U Redness, swollen tender to touch.
356391 9/2/2009 NM 17 17 F 9/2/2009 Pt had nausea & vomiting after GAR
356392 9/2/2009 NM 12 12 F 9/2/2009 Right arm red, swollen.
356394 9/2/2009 OH 17 17 F 9/1/2009 Pt got GARDASIL # 3 given as injec
356395 9/2/2009 CA 3 3 M 9/2/2009 Erythema, edema, hyperemia meas
356396 9/2/2009 TX 7 7 F 9/2/2009 Cough, runny nose congestion snee
356397 9/2/2009 ME 13 13 F Imm Friday- Saturday had fever 10
356398 9/2/2009 NY 10 10 F 9/2/2009 FEVER ONSET 9/1 at 9PM,CHILLS
356399 9/2/2009 IL 0.3 0 0.3 F 9/2/2009 7/2/09 irritable since 7/01/09 noc ; d
356400 9/2/2009 SC 1.3 1 0.3 M 9/2/2009 Patient administered PCV, Hep A, a
356401 9/2/2009 IN 62 62 M Rash, hives, tongue swelling, itching
356402 9/2/2009 WI 2 2 0.2 M 9/2/2009 Approximately 1/2 hr. after receiving
356403 9/2/2009 TX 14 14 F 8/31/2009 Redness and swollen right arm. AU
356404 9/2/2009 WA 19 19 M 9/2/2009 19 y/o male, US Army AD PFC, dev
356405 9/2/2009 NC 11 11 M 9/2/2009 Pt presented. Was given TDAP. W
356406 9/2/2009 TN 15 15 M 8/19/2009 Arthalgia of joints. Stiffness of extre
356407 9/2/2009 WA 47 47 F 9/2/2009 Severe Bruising.
356408 9/2/2009 OR 46 46 F 9/2/2009 Severe GI, vomiting, diarrhea. Neg
356409 9/2/2009 IL 33 F 9/6/2009 Received Hep B vaccine IM @ 08:3
356380 9/3/2009 HI 21 21 M 9/3/2009 The patient was febrile to 102.1 with
356410 9/3/2009 OR 18 18 M 8/28/2009 Edema of lips, red eyes, hives on ar
356422 9/3/2009 18 F 9/2/2009 This case was received from a heal
356434 9/3/2009 KY 0.2 0 0.2 M 9/3/2009 No known adverse
Y reactions. Aunt r
356440 9/3/2009 NC 11 11 F 9/3/2009 CHILD RETURNED WITH MOTHER
356441 9/3/2009 MI 65 65 F 9/3/2009 Received Influenza and PPV23 vac
356442 9/3/2009 KY 17 17 F 9/3/2009 Recieved menactra on june 24 2009
356443 9/3/2009 IN 0.7 0 0.7 F 9/3/2009 That evening the child became cong
356444 9/3/2009 FL 20 20 M 9/3/2009 After receiving Hepatitis A vaccine p
356445 9/3/2009 PA 56 56 F 9/3/2009 began developing symptoms approx
356446 9/3/2009 NJ 4 4 F 9/3/2009 Red, raised and very hot at site of s
356447 9/3/2009 AR 41 41 F 9/3/2009 Tightness in throat, radiating to che
356448 9/3/2009 VA 16 16 F 9/3/2009 Patient claims that she felt lighthead
356449 9/3/2009 ND 35 35 F 9/3/2009 Member was administered the Anth
356450 9/3/2009 PA 65 65 F 9/3/2009 Patient noticed a small red rash aro
356451 9/3/2009 PA 16 16 M 9/3/2009 Fever 104
356452 9/3/2009 NC 18 18 F 9/3/2009 A 3 cm round erythromatous indura
356453 9/3/2009 NY 42 42 F 9/3/2009 The patient received the flu shot on
356454 9/3/2009 IL 16 15 F 9/3/2009 patient lying on exam table. While ly
356455 9/3/2009 OR 62 62 F 9/3/2009 PAINFUL, SWOLLEN, WARM TO T
356456 9/3/2009 CA 11 11 F 9/3/2009 PT BECAME PALE, WEAK AND DI
356457 9/3/2009 NJ 0.8 0 0.8 F 9/3/2009 swelling, red and hot at the site, crie
356458 9/3/2009 TX 65 65 M 9/3/2009 Patient received Pneumovax injectio
356459 9/3/2009 WI 39 39 M 9/3/2009 Warmth, redness, pain at site of vac
356460 9/3/2009 CA 15 15 F 9/3/2009 PT BECAME PALE, WEAK AND DI
356461 9/3/2009 ND 11 11 M 9/3/2009 9/1/2009 Jonathan experienced a ra
356462 9/3/2009 MI 2 1 1M 9/3/2009 Pt developed rash on whole body, it
356463 9/3/2009 17 17 F 9/3/2009 Had seizure aporx 1 month after ha
356464 9/3/2009 NV 15 15 F 9/3/2009 Fever per patient's mother (temp no
356465 9/3/2009 NE 12 12 F 9/3/2009 About 2 weeks after vaccine admini
356466 9/3/2009 CA 3 3 M 9/3/2009 Redness, swelling warmth to L thigh
356467 9/3/2009 CA 4 4 F 9/3/2009 R arm red swollen warm "band" pos
356468 9/3/2009 MI 51 51 F 9/3/2009 Pain in left tricep 1 hour following sh
356469 9/3/2009 TX 72 72 F 9/3/2009 A 72 year old female came in to the
356470 9/3/2009 MA 3 3 M 9/3/2009 The patient developed a headache
356471 9/3/2009 CA 4 4 F 9/3/2009 DTap #5 administered to left Deltoid
356472 9/3/2009 AZ 41 41 F 9/3/2009 R Arm - site of injection swollen red
356473 9/3/2009 WA 0.7 0 0.7 F 9/3/2009 Death. 9/11/09
Y Autopsy received DO
356475 9/3/2009 GU 0.3 0 0.3 M 9/3/2009 Vomiting started within 2hrs after va
356476 9/3/2009 WA 11 11 F 9/3/2009 Redness & swelling around site of in
356477 9/3/2009 CO 57 57 M 9/3/2009 Fever, chills, aches, hard to move, h
356478 9/3/2009 PA 12 12 M 9/2/2009 Fever x 1 day. Itching, vomiting x 1.
356479 9/3/2009 VA 12 12 M 9/3/2009 Received VARIVAX # 2 on 08/31/09
356480 9/3/2009 CA 1.7 1 0.7 F 9/3/2009 skin r thigh Erythemic rash with few
356481 9/3/2009 NC 15 15 M 9/3/2009 Patient presented to office on 9/1/09
356482 9/3/2009 TN 14 14 M 9/3/2009 Pain and soreness to left deltoid on
356483 9/3/2009 IL 5 5 M 9/3/2009 Patient had reaction to shots give o
356484 9/3/2009 DE 60 60 F 9/3/2009 Large rash at injection site, radiating
356485 9/3/2009 CA 5 5 M 9/3/2009 Vaccine 8/27/09 8/29/09 Urticaria sw
356486 9/3/2009 WA 1.1 1 0.1 F 9/3/2009 Quarter size hive at site of VARIVAX
356487 9/3/2009 WA 1.1 1 0.1 M 9/3/2009 Quarter size hive @ site of Varicella
356488 9/3/2009 CA 4 4 M 9/3/2009 Small rash all body with no SOB or
356489 9/3/2009 NV 22 22 F 9/3/2009 Stiffness on left side of neck and the
356490 9/3/2009 AZ 11 11 F 9/3/2009 Patient had syncopal episode after
356491 9/3/2009 IL 62 62 F 9/3/2009 Right arm hurts, patient says can't li
356492 9/3/2009 IN 50 50 F 8/26/2009 Swollen, red, hot area - hard to mov
356493 9/3/2009 KY 1 1 0M 9/3/2009 Non febrile seizure on 9/12/2009. L
356494 9/3/2009 CO 3 3 F 9/3/2009 Fever - 103 degrees, stomach-ache
356495 9/3/2009 CA 11 11 M 9/1/2009 Received phone call from mother, c
356496 9/3/2009 VA 19 19 F 9/3/2009 Pt. had generalized reaction at injec
356497 9/3/2009 OR 51 51 U Pt reports onset of fever, chills & all
356498 9/3/2009 CO 16 16 F 9/2/2009 Youth here today complaining of sw
356500 9/3/2009 NC 1.8 1 0.8 M 9/4/2009 Immunizations were given 8-28-09.
356501 9/3/2009 GA 23 23 F 6/17/2009 No adv s/sx.
356502 9/3/2009 GA 19 19 F 7/1/2009 Client reported feeling weak and un
356503 9/3/2009 GA 11 11 M 7/28/2009 Right arm swollen, red, and warm to
356504 9/3/2009 GA 18 18 F 4/14/2009 MCV given in left deltoid at approxim
356505 9/3/2009 NY 15 15 F 8/31/2009 Local reaction with varicella vaccine
356506 9/3/2009 CA 4 4 M 9/3/2009 Left thigh 10 mm X 8 mm red, inflam
356507 9/3/2009 OR 3 3 M 9/2/2009 Low grade fever started last night re
356508 9/3/2009 WA 0.3 0 0.3 F 9/3/2009 Within day or two of vaccine started
356509 9/3/2009 CA 54 F 9/3/2009 Urticaria around the injection site. P
356510 9/3/2009 GA 11 11 F 8/17/2009 Swollen, red area where varicella va
356511 9/3/2009 KS 66 66 F 9/1/2009 On 8/29/09- morning Pt noticed a sw
356512 9/3/2009 MN 65 65 F 8/29/2009 Upper arm turned black/blue first nig
356513 9/3/2009 VA 49 49 F Swelling erythema warmth around s
356514 9/4/2009 FL 0.2 0 0.2 M 6/8/2009 Fever 101-105 w/in 24hrs of receivin
356515 9/4/2009 NY 13 13 M 8/31/2009 Transverse myelitis of acute onset o
356516 9/4/2009 AR 62 62 F 9/1/2009 Within 24 hrs I had a red rash at the
356517 9/4/2009 FL 26 26 M 8/28/2009 Pt received MMR vaccine on 8/19/0
356518 9/4/2009 CA 4 4 F 8/28/2009 Right deltoid swollen, red, warm to t
356519 9/4/2009 IL 11 11 F 8/27/2009 By the evening. Child had redness,
356520 9/4/2009 MO 11 11 F 8/27/2009 None stated. 9/15/09 PCP Medical
356521 9/4/2009 MO 68 68 U With erythema, redness to (L) latera
356522 9/4/2009 OR 15 15 F 8/29/2009 Within 1 hour of receiving the injecti
356523 9/4/2009 FL 12 12 F 8/31/2009 Pt passed out while in hall after rece
356524 9/4/2009 CT 71 71 F 9/1/2009 Pt diagnosed with shingles 9-1-09.
356525 9/4/2009 OH 5 5 M 9/1/2009 Soon after vaccines petechial rash n
356526 9/4/2009 PA 69 69 F 8/31/2009 Patient had redness and itching at t
356528 9/4/2009 WI 45 45 F 8/31/2009 Urticarial rash beginning 2 days afte
356529 9/4/2009 NM 13 13 F 8/31/2009 Mother reported hive-like eruption a
356530 9/4/2009 MD 8 8 F 9/2/2009 Erythema of upper arm & few vesicl
356531 9/4/2009 MS 3 3 F 4/24/2009 Hives and slight shortness of breath
356532 9/4/2009 OH 21 21 F 8/31/2009 Given Td on 8/28/09 along with PPD
356533 9/4/2009 NC 12 12 M 8/31/2009 Vesicular rash - 17 days post vaccin
356534 9/4/2009 NC 1 1 0F 9/4/2009 Received 12 month immunizations o
356535 9/4/2009 OH 20 20 F 8/19/2009 8-14-09 - 8-19-09 pt c/o eye lids bei
356536 9/4/2009 MN 15 15 F 8/28/2009 Large area of redness surrounding
356537 9/4/2009 KY 1 0 1F 8/31/2009 Hoarseness, diarrhea - 24 hours aft
356538 9/4/2009 MS 30 30 F 9/3/2009 7/27 = vaccine. 8/3 = swollen lymph
356550 9/4/2009 WI 11 11 M 9/4/2009 Travis received Intranasal Influenza
356551 9/4/2009 CA 51 51 F 9/4/2009 patient experienced a deep aching p
356552 9/4/2009 WI 13 13 M 9/4/2009 After receiving the Hepatitis A vacci
356553 9/4/2009 MI 4 4 M 9/4/2009 RIGHT UPPER THIGH ERYTHEMA
356554 9/4/2009 VA 65 65 F 9/4/2009 Patient reported a 2 inch area surro
356555 9/4/2009 NY 29 29 M 9/4/2009 Patient was given Day 14 HDCV 1c
356556 9/4/2009 GA 11 11 M 9/4/2009 ADVERSE ONSET WAS ON 9/2/20
356557 9/4/2009 NY 45 45 F 9/4/2009 Patient received Day 14 HDCV 1cc
356558 9/4/2009 TN 66 66 M 9/4/2009 Patient called on 09/04/09 to report
356559 9/4/2009 CA 57 56 F 9/4/2009 Contracted Shingles about 9 month
356562 9/4/2009 OH 4 4 M 9/4/2009 Right arem very swollen, red and ho
356563 9/4/2009 CA 26 26 F 9/4/2009 Patient called this am c/o pain and r
356564 9/4/2009 CA 0.5 0 0F 9/4/2009 12 hours after the injection my son h
356565 9/4/2009 NJ 10 10 M 9/4/2009 Clear or white areas on fingertips an
356566 9/4/2009 MI 15 15 F 9/4/2009 Patient received Gardasil HPV vacc
356567 9/4/2009 MO 74 74 M 9/4/2009 Received vaccine at primary care ph
356568 9/4/2009 AK 15 15 F 9/4/2009 Received Tdap on 8/28/09. Reports
356569 9/4/2009 MD 19 19 M 9/4/2009 Rash/Itching following FLUMIST (Fl
356570 9/4/2009 VA 14 14 M 9/4/2009 Following Tdap and Hepatitis A vac
356571 9/4/2009 VA 1.3 1 0.3 M 9/4/2009 developed pustules/papules differen
356572 9/4/2009 IL 0.3 0 0.4 F 9/4/2009 Diarrhea 6 times a day for 2 weeks
356573 9/4/2009 KY 12 12 F 9/4/2009 Gardasil #1, Hep A #1, Menactra an
356574 9/4/2009 TX 27 27 F 9/4/2009 SITE RXN 2.5-3 INCH DIAMETER,
356575 9/4/2009 CO 14 14 F 9/4/2009 Father states that his daughter beca
356576 9/4/2009 TX 76 76 F 9/4/2009 Patient received Flulaval Vaccine IM
356577 9/4/2009 KS 50 50 M 9/4/2009 Vaccine administered 8/19/09 at 09
356578 9/4/2009 IA 37 37 F 9/4/2009 Pneumonia vaccine received this m
356579 9/4/2009 IL 82 82 F 9/4/2009 Patient started to feel numbness in
356603 9/4/2009 ND 66 66 F 9/4/2009 Shortness ofY breath, initially with ex
356607 9/4/2009 TX 4 4 M 9/3/2009 Patient returned to office on 9/2/09
356608 9/4/2009 TX 4 M 9/4/2009 Patient came in to office on 9/2/09.
356609 9/4/2009 WY 65 65 F 9/3/2009 Swelling (local), pain, fever. Husba
356610 9/4/2009 WA 11 11 F 8/31/2009 Local reaction (R) arm, red, swollen
356611 9/4/2009 IN 13 13 M 9/4/2009 Woke up at 3AM on 9/2/09 & felt ve
356612 9/4/2009 GA 1.3 1 0.3 M 9/3/2009 MMR given 8/25/09. Taken to ER o
356613 9/4/2009 IA 13 13 F 9/4/2009 Pt's parent reports pt fainted while a
356614 9/4/2009 GA 11 11 F 9/4/2009 Pt. complains of pain and swelling in
356615 9/4/2009 TX 48 48 F 9/7/2009 She received vaccine on Friday 9-4
356616 9/4/2009 KS 75 75 F 9/7/2009 Patient called in. Itchy rash to upper
356617 9/4/2009 TX 69 69 F 9/6/2009 Patient received vaccines (FLUVIRI
356618 9/4/2009 CT 57 57 F 9/5/2009 Shortly after FLUVIRIN administere
356619 9/4/2009 TX 65 65 F 9/6/2009 5 minutes after receiving PNEUMOV
356620 9/4/2009 CA 32 32 F 9/5/2009 Reports of soreness in the whole ar
356621 9/4/2009 FL 68 68 F 9/6/2009 Pt came to pharmacy states she wo
356622 9/4/2009 CA 53 53 M 9/4/2009 Right arm had vaccine injected was
356623 9/4/2009 CA 72 72 M 9/5/2009 9/2 at noon receive influenza, pneum
356624 9/4/2009 MD 64 64 F 9/5/2009 2"-3" flat red rash now itching at inje
356625 9/4/2009 KY 51 51 F 9/5/2009 Redness at injection site - swelling f
356626 9/4/2009 TX 67 67 F 9/5/2009 Swelling - warm. Aches - all over es
356627 9/4/2009 WI 5 5 M 9/4/2009 Pt developed chicken pox after havi
356628 9/4/2009 CO 36 36 M 9/4/2009 Patient appeared okay after flu vacc
356629 9/4/2009 TN 55 55 F 9/4/2009 Administered vaccine at 1:15pm on
356630 9/4/2009 WI 17 17 F 9/4/2009 10:05A - received vaccines shortly a
356631 9/4/2009 MN 12 12 M 9/3/2009 1 day after vaccine had area at site
356632 9/4/2009 NY 17 17 M 9/3/2009 Red face & eyes after vaccine - sne
356633 9/4/2009 SC 13 13 F 9/4/2009 Where VARIVAX was given (subcut
356634 9/4/2009 NH 11 11 F 9/4/2009 Pt presented with large red area sur
356635 9/4/2009 NY 4 4 F 9/4/2009 Swelling of her thigh.
356636 9/4/2009 TX 12 12 U 9/3/2009 Patient had vaccines on 8/31/09. Pa
356637 9/4/2009 NY 9 9 M 9/2/2009 He has a "dent" on his upper arm -
356638 9/4/2009 OR 4 4 M 9/4/2009 Pt received immunization 8/27, 8/30
356639 9/4/2009 NC 1.6 1 0.6 M 9/6/2009 Low grade fever. Multiple bumps bil
356640 9/4/2009 PA 15 15 F 9/5/2009 Seen @ 48 hours ago - got 3 shots
356641 9/4/2009 NC 38 38 F 9/4/2009 Nummular induration 2-3 cm X 3-4 d
356642 9/4/2009 IN 84 84 F 9/4/2009 Pt stated that was very sore on 9-3-
356580 9/5/2009 TX 13 13 M 9/5/2009 Patient was ordered to get meningo
356581 9/5/2009 TX 2 2 0.8 M 9/5/2009 none
356582 9/5/2009 FL 12 12 F 9/5/2009 After recieving the Gardasil vaccine
356583 9/5/2009 CO 60 60 M 9/5/2009 Swelling from ankles to knees, wors
356584 9/5/2009 WA 58 58 F 9/5/2009 At approximately 9:00 pm, my left a
356585 9/5/2009 CA 1.3 1 0.2 M 9/5/2009 Vaccines Administered 08/26/09. H
356586 9/5/2009 AL 0.3 0 0.3 F 9/5/2009 extreme irritability for 6 days. chron
356587 9/5/2009 TX 2 2 0.7 F 9/5/2009 left leg swollen,stiff and really red at
356588 9/5/2009 TX 4 4 F 9/5/2009 had a fever redness and now has a
356589 9/6/2009 MD 66 66 F 9/6/2009 local site or injection became inflam
356590 9/6/2009 13 13 F 9/6/2009 My daughter was adminstered GAR
356591 9/6/2009 TX 65 65 F 9/6/2009 Next day after receiving Zostavax va
356592 9/6/2009 OH 35 35 U 9/6/2009 pneumonia shot given while patient
356593 9/6/2009 TX 68 68 F 9/6/2009 WITHIN 24 HOURS PATIENT DEV
356594 9/6/2009 MI 61 61 M 9/6/2009 Difficult Breathing. Rapid Heart Rat
356595 9/6/2009 OH 66 66 F 9/6/2009 Received pneumovax and influenza
356596 9/6/2009 AZ 1.1 1 0.1 M 9/6/2009 DIARHHEA AND FEVER BEGINNIN
356597 9/7/2009 VA 49 49 F 9/7/2009 Redness, pain, extreme swelling & b
356598 9/7/2009 OH 43 43 F 9/7/2009 Administered 8/11/09 for pre-emplo
356599 9/7/2009 GU 71 72 F 9/7/2009 Patient phoned the pharmacy to com
356600 9/7/2009 NC 0.6 0 0.6 F 9/7/2009 Gardasil vaccinations administered
356601 9/7/2009 WV 4 4 M 9/7/2009 self injurous behavior, tantrums, reg
356602 9/7/2009 TX 65 65 F 9/7/2009 neuropathic pain (tingling, numbnes
356656 9/8/2009 AZ M 9/4/2009 Information has been received from
356661 9/8/2009 VA 56 56 F 9/3/2009 Started hurting and then swelling. P
356662 9/8/2009 PA 15 15 F 9/4/2009 Onset of chest pain, SOB, cough - 2
356666 9/8/2009 U 9/8/2009 This case was Y reported by a physici
356672 9/8/2009 NY 31 31 F 9/8/2009 Chest tightness - monitored a little li
356673 9/8/2009 MN 5 5 F 9/8/2009 Extensive swelling, redness and ind
356674 9/8/2009 NM 12 12 F 9/8/2009 Developed severe and prolonged al
356675 9/8/2009 VA 18 18 F 9/14/2009 (L) Deltoid Cellulitis after MENACTR
356676 9/8/2009 NJ 24 24 F 9/8/2009 Hives
356677 9/8/2009 MN 3 3 M 9/8/2009 Flu mist administered 8/27/2009, On
356678 9/8/2009 WV 4 4 M 9/3/2009 Immunization 9-1-09 and on 9-2-09
356679 9/8/2009 MI 4 4 M 9/4/2009 Generalized swelling to L thigh from
356680 9/8/2009 CA 34 34 F 8/31/2009 LA subcutaneous nodule noted app
356681 9/8/2009 MA 67 67 F 9/1/2009 Patient complained of dizziness, ligh
356682 9/8/2009 CA 47 47 F 9/1/2009 Patient stated that on Saturday (8-2
356683 9/8/2009 NY 16 16 F 9/2/2009 Pt was given GARDASIL and ADAC
356684 9/8/2009 OR 4 4 M 8/11/2009 Shots given on 8-10-09. Mom notic
356685 9/8/2009 CA 4 4 F 8/31/2009 Redness, edema induration is warm
356686 9/8/2009 OR 11 11 M 8/25/2009 12:54 pm pt arms and legs retracted
356687 9/8/2009 AZ 4 F 8/17/2009 Rt posterior arm reddened.
356688 9/8/2009 MI 70 70 F 8/20/2009 On 8/17/09 on right arm injection sit
356689 9/8/2009 MI 40 40 F 8/14/2009 8/9/09 rash started on lower buttock
356690 9/8/2009 PR 18 18 F 9/3/2009 Swelling eyes and lips, and all over
356691 9/8/2009 CA 39 39 F 7/15/2009 Employee agreed to receive the HE
356692 9/8/2009 CA 3 3 F 9/3/2009 Pt woke up 9/1 - clingy, didn't eat, li
356693 9/8/2009 MD 31 31 M 9/8/2009 Developed type 1 diabetes. 9/16/09
356695 9/8/2009 VA 11 11 M 9/8/2009 5 hrs after vaccination, arm sore, m
356696 9/8/2009 OH 13 13 M 9/8/2009 5-6 Minutes after varicella vaccine w
356697 9/8/2009 AR 1.3 1 0.3 M 9/8/2009 NO ADVERSE EVENTS NOTED AT
356698 9/8/2009 OR 35 35 M 9/8/2009 Redness, warmth, swelling, left delt
356699 9/8/2009 OH 13 13 F 9/8/2009 9-3-09 Rec'd T/C from MGM, advise
356700 9/8/2009 NC 64 64 F 9/8/2009 Pt. received vaccine on 8/17/09 11:
356701 9/8/2009 WA 9 9 M 9/8/2009 Swelling and itchiness at injection s
356702 9/8/2009 AR 52 52 F 9/8/2009 headache, difficulty breathing, ches
356703 9/8/2009 NY 34 M 9/8/2009 Pt woke up 3days post flu mist adm
356704 9/8/2009 NC 54 54 F 9/8/2009 Patient was administered Pneumov
356705 9/8/2009 OH 4 4 F 9/8/2009 Localized reddened area left anterio
356706 9/8/2009 CA 51 52 M 9/8/2009 patient reported low grade fever, ac
356707 9/8/2009 WA 1.1 1 0.1 M 9/8/2009 Developed rash 3 days after recievi
356708 9/8/2009 CA 5 5 M 9/8/2009 Pt's R. arm at inj. site became swoll
356709 9/8/2009 CT 9 9 F 9/8/2009 Cellulitis at vaccine site. Seen at ER
356710 9/8/2009 VA 10 10 F 9/8/2009 RASH, ITCHING, BLEEDING AT IN
356711 9/8/2009 WA 65 65 F 9/8/2009 Pt presented to facility after recievin
356713 9/8/2009 NY 0.3 0 0.3 M 9/3/2009 Pt had episodes on significant cryin
356714 9/8/2009 OH 31 31 F 9/8/2009 Flu shot administered about 5:30 PM
356715 9/8/2009 CO 50 50 F 9/8/2009 Patient described "pain in arm with
356716 9/8/2009 CO 25 25 F 9/8/2009 Headache, dizziness and shortness
356717 9/8/2009 IA 37 37 F 9/4/2009 Had "asthma-like" attack, body ache
356718 9/8/2009 IL 52 52 F 9/8/2009 Pt experienced "heart racing" follow
356719 9/8/2009 WA 4 4 M 9/8/2009 6.5 x 4.5 cm raised erythematous d
356720 9/8/2009 CO 45 45 F 9/8/2009 Myalgia, muscle joint pain, fatigue, n
356721 9/8/2009 MO 5 5 M 9/8/2009 Child received vaccine on 9/1/09. A
356722 9/8/2009 TX 38 38 F 9/7/2009 Pt only reported sharp pain in left ar
356723 9/8/2009 MI 16 16 M 9/8/2009 Erythema and pain in upper deltoid
356724 9/8/2009 SC 75 75 F 9/8/2009 15 minutes after patient received inj
356725 9/8/2009 MA 38 38 M 9/1/2009 T 97.2 - loss of appetite, fatigue, va
356726 9/8/2009 KY 32 32 F 9/4/2009 Hoarseness, wheezing, weakness,
356727 9/8/2009 AK 60 U Pt developed hives 1 day later on in
356728 9/8/2009 GA 50 50 F 9/4/2009 Circular raised silver-dollar sized are
356729 9/8/2009 PA 2 2 0.2 M 9/8/2009 Developed serum sickness with hive
356730 9/8/2009 CT 11 M 8/31/2009 5cm x 5cm area of redness & swelli
356731 9/8/2009 MA 1.4 1 0.4 M 9/3/2009 At 16 mo visit on 1/23/09, child had
356732 9/8/2009 U Initial report was received 10 Augus
356733 9/8/2009 PA 24 24 M 8/19/2009 Fever, headache, injection site pain
356734 9/8/2009 WA F 8/20/2009 Initial information received on 18 Au
356735 9/8/2009 FL 17 17 F 8/25/2009 Initial report was received 20 Augus
356736 9/8/2009 NE 23 M 8/27/2009 Inappropriate schedule of vaccine a
356712 9/9/2009 CA 74 74 M 9/9/2009 Patient reported that he had not rec
356738 9/9/2009 OH 16 16 F 9/4/2009 None Stated.
356739 9/9/2009 VA 12 12 M 9/8/2009 Hives appeared within 6 hours of va
356741 9/9/2009 MD 63 63 M 9/8/2009 Information has been received from
356763 9/9/2009 CA 46 46 F 9/3/2009 11/27/07 had scratchy throat, cough
356764 9/9/2009 TX 1.3 1 0.3 M 9/3/2009 1412 Shots given PENTACEL, MMR
356765 9/9/2009 VA 0.3 0 0.3 F 9/3/2009 One week after 4 month check, pres
356768 9/9/2009 SD 61 61 F 9/2/2009 Swelling and bruising at injection sit
356769 9/9/2009 MA F 8/28/2009 RN here this AM for flu vaccination.
356770 9/9/2009 VA 4 4 M Pt woke up day after injections with
356771 9/9/2009 OH 5 5 F 9/2/2009 Mom brought in 2 children for vaccin
356772 9/9/2009 NH 5 5 F 9/2/2009 9-1-09 4 P fever 101.7 temp. TYLE
356773 9/9/2009 NH 5 5 F 9/2/2009 9-1-09 2:30 PM fever 100.9 temp - v
356774 9/9/2009 VA 11 11 F 9/3/2004 Generalized urticaria 6 days after re
356775 9/9/2009 GA 77 76 F 9/1/2009 One year after administration of ZO
356776 9/9/2009 OH 2 2 0.1 F 9/2/2009 Mom reported hives over entire bod
356777 9/9/2009 MO 5 5 M 8/26/2009 DTaP & MMR administered approx
356778 9/9/2009 NC 12 12 F 9/1/2009 - Fever x 2-3 days (102.0). - Alterna
356779 9/9/2009 CA 4 4 F 8/31/2009 None reported.
356780 9/9/2009 WA 1.2 1 0.2 F 8/31/2009 Onset of seizures and development
356781 9/9/2009 TX 30 30 F 9/3/2009 Warmth and swelling up left arm, itc
356782 9/9/2009 AZ 8 8 M 9/4/2009 8/27/09 pt came in this morning c/o
356783 9/9/2009 MS 5 5 M 9/4/2009 Mother states fever of 101 degrees
356784 9/9/2009 WA 67 67 F 9/4/2009 Red, hot. Tues evening using ice pa
356786 9/9/2009 IL 19 19 M see attached SF 600
356787 9/9/2009 NY 4 4 M 9/2/2009 After my son received his booster sh
356788 9/9/2009 CO 61 61 F 9/2/2009 Redness and inflammation at the in
356789 9/9/2009 OH 1.4 1 0.4 F 9/1/2009 8-31-09 @ 7:30 pm - lower right thig
356790 9/9/2009 MN 14 14 F 9/3/2009 Postural Syncope immediately follow
356791 9/9/2009 MN 39 39 M 9/2/2009 Developed fever to 103. Painful sw
356792 9/9/2009 AZ 14 14 F 9/1/2009 Patient fainted after administering H
356793 9/9/2009 NH 5 5 M 9/3/2009 12x19 cm, red, swollen, warm to the
356794 9/9/2009 PR 15 15 F 9/3/2009 Patient developed dizziness after ad
356795 9/9/2009 IN 0.6 0 0.6 F 9/3/2009 Localized allergic reaction.
356796 9/9/2009 NY 66 66 F 9/3/2009 Difficulty breathing, rash developme
356797 9/9/2009 NY 11 11 M 9/1/2009 Pt complained of left arm swelling /
356798 9/9/2009 IL 18 18 M See attached.
356800 9/9/2009 IN 58 58 F 9/3/2009 Within 5 mins of receiving flu shot, p
356801 9/9/2009 MD 5 5 F 3/6/2009 (R) arm red 3 X 2 cm.
356802 9/9/2009 TN 66 66 F 9/1/2009 8-29-09 (Mild Fever). 8-30-09 & 8-3
356803 9/9/2009 CO 12 12 F 9/1/2009 Syncopal episode immediately follow
356804 9/9/2009 CT 14 14 F 9/4/2009 Onset of chronic headaches 21/2 m
356805 9/9/2009 CA 55 55 F 8/28/2009 All my muscles are sore. My back h
356806 9/9/2009 CA 39 39 F 8/28/2009 Distinct pain @ injection site within
356807 9/9/2009 FL 12 12 F 8/31/2009 Swelling & Redness 8-6-09 R arm.
356808 9/9/2009 WI 12 12 F 9/1/2009 Received Wed 8/26/09 fever next d
356809 9/9/2009 NC 19 19 F 9/9/2009 -itching of the face, swelling of lips;
356810 9/9/2009 FL 14 14 F 9/9/2009 2 weeks after administration of Gard
356811 9/9/2009 MI 3 3 F 9/9/2009 24 hrs after MMR shot, Patient stop
356812 9/9/2009 NY 4 4 F 9/9/2009 Red raised welts around injection si
356813 9/9/2009 NY 14 14 F 9/9/2009 Pt fainted at about 3:50pm at the wa
356814 9/9/2009 PA 13 13 F 9/9/2009 Pain, swelling, lump on arm at injec
356815 9/9/2009 U 9/9/2009 REACTION NOTED POST VACCIN
356816 9/9/2009 OH 76 76 F 9/8/2009 After receiving vaccine, pt states he
356817 9/9/2009 NY 2 2 0.5 F 9/9/2009 Parent reported 1 day following vac
356818 9/9/2009 NY 47 47 F 9/9/2009 Employee reported progressively wo
356819 9/9/2009 TX 42 42 F 9/9/2009 Clent stated a few days after receiv
356820 9/9/2009 NC 86 86 M 9/9/2009 Left upper arm was very swollen, re
356821 9/9/2009 VA 4 1 0M 9/9/2009 AREA OF ERYTHEMA ON UPPER
356822 9/9/2009 AZ 15 15 F 9/9/2009 Received Tdap & MCV4 9/8/2009 @
356823 9/9/2009 AZ 10 10 M 9/5/2009 Within 2 minutes of vaccination, Pt c
356824 9/9/2009 AL 12 12 M 9/9/2009 Left arm swelling- inflammation arou
356825 9/9/2009 TX 13 13 M 9/9/2009 As per client's mother, he started co
356826 9/9/2009 TX 40 40 F 9/9/2009 I received the seasonal flu shot arou
356827 9/9/2009 MI 0.2 0 0.2 F 9/9/2009 Hives, severe crying and localized R
356828 9/9/2009 OH 42 42 F 9/9/2009 Painful at site when arm moved up
356829 9/9/2009 CO 1 1 0F 9/9/2009 Large localized swelling, urticaria (g
356830 9/9/2009 MO 61 61 M 9/9/2009 While there was no pain when shot
356831 9/9/2009 NH 1 0 1M 9/9/2009 developed fever 103 2 days after
356832 9/9/2009 MI 75 75 F 9/9/2009 Right arm redness(softball size), sw
356833 9/9/2009 FL 0.2 0 0.2 M 9/9/2009 2 days after receiving his scheduled
356834 9/9/2009 TX 39 39 F 9/9/2009 PT COMPLAINED OF HER THROA
356835 9/9/2009 FL 15 15 F 9/9/2009 Evans Syndrome. Autoimmune hem
356836 9/9/2009 NC 40 40 F 9/9/2009 fevers, tmax 100.6 within 12 hrs of a
356837 9/9/2009 SD 61 61 M 9/8/2009 Breathing Difficulty, body ache, chill
356838 9/9/2009 PA 57 57 F 9/9/2009 Noticed mild redness on Saturday. E
356839 9/9/2009 GA 4 4 F 9/9/2009 HOT, RED, SWOLLEN AREA FROM
356840 9/9/2009 AZ 29 29 M 9/9/2009 23 days after vaccination pt. develo
356841 9/9/2009 CA 5 5 F 9/9/2009 Erythema, induration and warmth ov
356842 9/9/2009 CA 52 52 F 9/9/2009 Onset of intense myalgias, fever, di
356843 9/9/2009 IL 55 55 F 9/9/2009 Injection site red & hot inflammation
356844 9/9/2009 PA 63 63 F 9/9/2009 Experienced the expected redness,
356845 9/9/2009 IN 5 5 M 9/8/2009 Pt received KINRIX IM and Varicella
356846 9/9/2009 NJ 13 13 F 9/8/2009 Diagnosed w/ juvenile rheumatoid a
356847 9/9/2009 WA 60 60 F 9/8/2009 Jaw -> eye numbness *Sx's gone @
356848 9/9/2009 CA 1 1 0M 8/31/2009 Onset VARICELLA vesicles sympto
356849 9/9/2009 MS 41 41 F 9/2/2009 Tingling sensation heavily on tongu
356850 9/9/2009 PA 0.8 0 0.8 F 9/1/2009 My baby almost immediately becam
356851 9/9/2009 CO 50 50 M 8/30/2009 2 days post inj pt had large localized
356852 9/9/2009 CA 72 72 F 9/1/2009 Skin, rash and hives.
356853 9/9/2009 AZ 30 30 F 8/17/2009 Reports "cold" with intermittent cong
356854 9/9/2009 IL 31 31 M 9/9/2009 Sweating, Lethargic after 5 minutes
356855 9/9/2009 NY 39 39 F 9/9/2009 1 1/2 hrs after immunization (flu) c/o
356856 9/9/2009 LA 11 11 F 9/9/2009 Patient presented with swollen, infla
356857 9/9/2009 AL 39 39 F 9/9/2009 MMR administered 09/04. Reports
356858 9/9/2009 OR 58 58 F 9/3/2009 Pt arm 4 cm x 3.5 cm red, raised, ho
356859 9/9/2009 PA 13 13 F 9/4/2009 Numbness and paresthesias in arm
356860 9/9/2009 MA 46 46 F 9/9/2009 15 min. post vaccine, reported red b
356861 9/9/2009 VT 15 15 F Syncope several seconds after HPV
356862 9/9/2009 CA 69 69 F 9/9/2009 Swelling of entire left arm. Pressure
356863 9/9/2009 OK 25 25 F 9/2/2009 Rabavert given @ 1635 on 9-1-09.
356864 9/9/2009 CA 21 21 F 9/1/2009 Noted (L) upper arm very sore 8/26/
356865 9/9/2009 TX 0.5 0 0.5 F 9/2/2009 Rash all over legs and arms
356866 9/9/2009 OR 24 24 F 9/4/2009 Client got vaccine 9/3/09 and called
356867 9/9/2009 IL 0.4 0 0.4 F 9/2/2009 Brief seizure following vaccine < 1 m
356868 9/9/2009 NJ 69 69 F 9/4/2009 Tetanus-diphtheria vaccine given 5/
356869 9/9/2009 NH 9 9 M 9/3/2009 Patient has a 5 in. x 4 in. raised, red
356870 9/9/2009 38 38 M 8/20/2009 Approx 12 hrs after receiving vaccin
356871 9/9/2009 AR 1.8 1 0.8 M 8/20/2009 Pruritic rash surrounding polio and h
356872 9/9/2009 OR 69 69 F 8/31/2009 Fever (101 degrees), myalgias, redn
356873 9/9/2009 OH 26 26 M 9/1/2009 Received tetanus injection on 8/28/0
356874 9/9/2009 FL 1.2 1 0.2 F 8/31/2009 Developed rash on L arm & body cl
356876 9/9/2009 AZ 12 12 F 9/5/2009 Had arrived home - made bagel and
356878 9/9/2009 KY 1.3 1 0.3 M 9/9/2009 Immediately after receiving varicella
356879 9/9/2009 MN 2 2 0.9 M 9/9/2009 15-20 small red papulopustules.
356880 9/9/2009 VA 45 45 M 9/9/2009 Pt received AVA in his right arm on
356881 9/9/2009 NY 1.2 1 0.2 F 9/9/2009 104+ fever followed by rash. Platele
356883 9/9/2009 WA 13 13 M 9/8/2009 Generalized varicella-like eruption w
356885 9/9/2009 MN 55 55 F 9/9/2009 Seen in ER. Voice hoarse, throat sw
356893 9/9/2009 IL 4 4 M 9/9/2009 This case was reported by a physici
356894 9/9/2009 AK 4 4 M 9/9/2009 Inflammatory reaction to DTaP in Rt
356895 9/9/2009 MN 4 4 F 9/8/2009 Vesicular rash in S2 dermatome - R
356896 9/9/2009 IL 69 69 M 9/9/2009 Localized reaction to flu shot. 5:25P
356897 9/9/2009 IL 51 51 F 9/9/2009 Patient received influenza vaccinati
356916 9/9/2009 AZ 34 34 F 8/28/2009 Pain in the arm, swelling, itching wa
356905 9/10/2009 NJ 46 46 F 9/4/2009 Initial report was received 26 Augus
356908 9/10/2009 TX 10 10 M Headaches. 9/27/09 Hospital recor
356909 9/10/2009 MD 17 17 F 9/8/2009 Received MENACTRA & Tdap on 6
356910 9/10/2009 VA 44 F With 24 hrs of receiving AFLURIA 0
356911 9/10/2009 NC 58 58 F 8/12/2009 Rash - 8-13-09 - Groups of raised re
356912 9/10/2009 CT 0.3 0 0.3 F 9/3/2009 4 month old given inactivated flu va
356913 9/10/2009 GA 46 46 F 9/3/2009 Eye itch night of day of injection. Fa
356914 9/10/2009 15 F Diffuse myalgias, fatigue, nausea, s
356915 9/10/2009 IA 13 F 8/25/2009 Severe headache and dizziness afte
356917 9/10/2009 MA 24 24 F 9/4/2009 Seizure (unwitnessed). Date. Sever
356918 9/10/2009 MA 17 17 F 9/4/2009 Patient reports feeling nauseated ap
356919 9/10/2009 NJ 1.1 1 0.1 M 9/10/2009 Had syncopal episode at home. Fel
356920 9/10/2009 KY 2 2 0.4 F 9/10/2009 Hives, temp 102.3, fussy-given stero
356921 9/10/2009 WV 4 4 M 9/3/2009 Within 5 minutes developed wheezi
356922 9/10/2009 NC 58 58 F 9/10/2009 Had vaccine at 6p, dry cough and h
356923 9/10/2009 NY 4 4 M 9/10/2009 Mother stated child's Left arm very r
356924 9/10/2009 MD 24 24 F 9/10/2009 Immediately after receiving Gardasi
356925 9/10/2009 NM 39 39 F 9/10/2009 rash/hives rt upper arm and upper b
356926 9/10/2009 WA 55 55 F 9/10/2009 I received a flu shot from walk-in fac
356927 9/10/2009 NE 1.1 1 0.1 F 9/10/2009 Initial low grade temp (99F) treated
356928 9/10/2009 MO 12 12 F 9/10/2009 My daughter has passed out TWICE
356929 9/10/2009 ID 32 32 F 9/10/2009 Flu vaccination was given to me on
356930 9/10/2009 PA 66 66 F 9/10/2009 Patient complained of pain and ting
356931 9/10/2009 NY 74 74 F 9/10/2009 Returned to clinic 9-9-09 with a red
356932 9/10/2009 OR 45 45 F 9/10/2009 10cm localized swelling to left deltoi
356933 9/10/2009 MI 37 37 F 9/10/2009 Pt was given double dose of flu vac
356934 9/10/2009 MI 36 36 F 9/10/2009 Pt given double dose of flu vaccine-
356935 9/10/2009 MI 49 49 F 9/10/2009 Pt given double dose of flu vaccine-
356936 9/10/2009 NC 1.8 1 0.7 M 9/10/2009 WITHIN 48 HOURS FEVER OF 105
356937 9/10/2009 FL 3 4 U 9/10/2009 rt arm swollen,red,hard and hot to to
356938 9/10/2009 OK 19 19 F 9/10/2009 Headache, Y Nausea, dizziness, chilli
356939 9/10/2009 LA 17 17 F 9/10/2009 Mental status changes starting 7 da
356940 9/10/2009 CA 2 2 0.9 F 9/10/2009 Patient ran fever of 100-102 for 3 da
356941 9/10/2009 GA 36 36 F 9/10/2009 Roughly 10 minutes after injection,
356942 9/10/2009 TX 17 17 M 9/10/2009 Approximately 4 hours after vaccine
356943 9/10/2009 ME 20 20 M 9/10/2009 Patient was sitting receiving vaccina
356944 9/10/2009 TX 32 32 F 9/10/2009 Itchy arms and chest. No hives or b
356945 9/10/2009 PA 24 24 F 9/10/2009 Pt received TDaP and varicella in L
356947 9/10/2009 IN 46 46 F 9/10/2009 Influenza shot was received at 3:25
356948 9/10/2009 NC 68 68 F 9/10/2009 Redness and soreness at site
356949 9/10/2009 CO 62 62 F 9/10/2009 vomiting, nausea, diarehha, chills, b
356950 9/10/2009 ND 18 18 F 9/10/2009 Symptoms began with hair loss two
356956 9/10/2009 ID U 9/10/2009 This case was reported by a pharma
356957 9/10/2009 CA 76 76 F 9/10/2009 Patient was given 0.5ml of Influenza
356958 9/10/2009 NY 20 20 F 9/6/2009 1 minute after administering FLUEN
356959 9/10/2009 OR 26 26 F 9/10/2009 Raised, red, warm to touch bilateral
356960 9/10/2009 KS 9 9 F 9/10/2009 Mother presented child for flu vaccin
356961 9/10/2009 AZ 56 56 M 9/14/2009 Left deltoid region became erythem
356962 9/10/2009 AZ 17 17 F 9/10/2009 Severe pain 2 days after injection- n
356963 9/10/2009 CA 1 1 0F 9/10/2009 Left thigh with 3 areas of raised pink
356964 9/10/2009 AK 16 16 F 9/10/2009 6x7 cm erythema at injection site lef
356965 9/10/2009 GA 11 11 F 9/10/2009 Client c/o swelling, soreness bilatera
356966 9/10/2009 NC 76 76 M 9/10/2009 Once I gave shot, his arm immediat
356967 9/10/2009 NE 66 66 F 9/10/2009 In ER 1 am had a fever 103. Diagn
356968 9/10/2009 VA 47 47 U 9/10/2009 The pt states in approx. 2005 while
356969 9/10/2009 MN 58 58 F 9/10/2009 Sore Throat, swollen tonsils, T 100.
356970 9/10/2009 OR 43 43 M 9/10/2009 Raised red area silver dollar size ho
356971 9/10/2009 PA 2 2 0.1 F 9/18/2009 Hives on both arms within 5 minutes
356972 9/10/2009 NV 3.8 F 9/10/2009 FOC called 9/2/09. States child had
356988 9/11/2009 MD 43 0 0.5 F 9/11/2009 Body itching, eyes swollen shut, red
356989 9/11/2009 GA 55 54 M 9/11/2009 Inability to concentrate, cognitive dif
356990 9/11/2009 MD 20 20 M 9/11/2009 Generalized rash and puritis develo
356991 9/11/2009 KY 16 16 F 9/11/2009 patient recieved Gardasil on 12/19/0
356992 9/11/2009 NY 0.5 0 0.5 F 9/11/2009 Patient received vaccine on 8/25/09
356993 9/11/2009 NC 6 6 F 9/11/2009 Pt left office, vomit x1 on the way ho
356994 9/11/2009 PA 24 24 F 9/11/2009 Patient developed redness, swelling
356995 9/11/2009 MI 33 33 M 9/11/2009 pt states arm was swollen whole bic
356996 9/11/2009 AR 5 5 F 9/11/2009 LEFT ARM RED,WARM TO TOUCH
356997 9/11/2009 MI 48 48 F 9/11/2009 Pt.states that her left arm started hu
356998 9/11/2009 TX 29 29 M 9/11/2009 Complete loss of appetite. Body chi
356999 9/11/2009 OH 1.5 1 0.5 M 9/11/2009 9/9/09 at 6 PM started screaming an
357000 9/11/2009 TX 54 54 M 9/11/2009 Patient first experienced headache
357001 9/11/2009 AK 52 52 F 9/11/2009 2 inch diameter redness, slight swel
357002 9/11/2009 MT 60 60 F 9/11/2009 Pt received Flu vaccine and pneum
357003 9/11/2009 OH 78 78 F 9/11/2009 Right arm (inside bicep) was slightly
357004 9/11/2009 OR 40 40 F 9/11/2009 Labrynthitis diagnosed after second
357005 9/11/2009 PA 1.5 1 0.6 M 9/11/2009 My son had fever 99.1 degree last n
357006 9/11/2009 MI 15 U 9/11/2009 Pt did not have any reaction to the v
357007 9/11/2009 TX 1.6 1 0.4 M 9/11/2009 Severe swelling and fever at injectio
357008 9/11/2009 AZ 36 36 F 9/11/2009 REDNESS,SWELLING, INDURATIO
357009 9/11/2009 MI 35 35 F 9/11/2009 Tingling in Right arm from deltoid to
357012 9/11/2009 M 9/10/2009 This case was considered medically
357014 9/11/2009 MA 3 M 9/9/2009 Initial information received on 31 Au
357015 9/11/2009 WA 29 29 F 9/8/2009 This spontaneous case was receive
357018 9/11/2009 OH 53 53 F 9/7/2009 Pt. presented to E.R. on 7/27/09 aft
357019 9/11/2009 NV 71 71 F 9/3/2009 Guillain-Barre Syndrome - LE Weak
357020 9/11/2009 OH 2 2 0M 9/4/2009 Febrile seizure 7 days after HIB and
357021 9/11/2009 NV 12 F 8/14/2009 3rd Varicella given accidentally. Pre
357022 9/11/2009 IN 56 56 F 9/4/2009 Received shot around 2pm 9/2. App
357023 9/11/2009 CA 15 15 F 9/4/2009 Pt came back on 9/3 (1 day later) w
357024 9/11/2009 PA 4 4 F 9/4/2009 9-1-09 DTAP in R thigh. 9-3-09 mo
357025 9/11/2009 VA 5 5 M 9/3/2009 Tongue swelling, hives, itching, flus
357026 9/11/2009 MA 5 5 M 9/3/2009 Pt noticed "rash" on trunk that sprea
357027 9/11/2009 NM 72 72 F 9/3/2009 Gave too low - fluid went into tissue
357028 9/11/2009 GA 4 4 M 9/3/2009 Fever x3 day 102 & increasing. Loc
357029 9/11/2009 VA 25 25 F 7/30/2009 On 7-28-09 Patient received TDAP
357030 9/11/2009 DE 71 71 F 9/2/2009 Received pneumonia shot at 3:30 p
357031 9/11/2009 GA 10 10 F 9/3/2009 Redness & Warmth 2-3 hours after
357032 9/11/2009 GA 17 17 F 9/3/2009 Localized swelling (quarter size), re
357033 9/11/2009 IL 3 3 F 9/11/2009 Swallowing dysfxn and annuciation
357034 9/11/2009 SD 90 90 F 9/4/2009 Received ZOSTAVAX vaccine 8/28
357035 9/11/2009 TX 14 14 U Rash at site developed 28 hours sp
357036 9/11/2009 CT 0.4 0 0.4 M 9/10/2009 Very fussy- inconsolable through mo
357037 9/11/2009 CA 10 10 F 9/3/2009 Tingling sensation of (L) arm lasted
357038 9/11/2009 WV 0.4 0 0.4 M 9/11/2009 Hives/urticaria
357039 9/11/2009 TX 2 2 0.1 F Redness and swelling of entire (R) t
357040 9/11/2009 PA 15 15 F 9/3/2009 Patient developed urticaria/lesions f
357041 9/11/2009 WA 0.2 0 0.2 M 9/6/2009 Coded. Former 28 wk gest infant wa
357043 9/11/2009 CO 53 53 F 9/11/2009 Feeling disoriented and dizzy within
357045 9/11/2009 UT 55 F 9/11/2009 Severe sore throat, extreme red eye
357046 9/11/2009 CA 61 61 F 9/11/2009 Zoster vaccine was given after stro
357047 9/11/2009 TN 21 21 F 9/11/2009 PT. EXPERIENCED PAIN,REDNES
357048 9/11/2009 MT 26 26 M 9/11/2009 At 5:30 pm,William came in with a re
357049 9/11/2009 MN 37 37 F 9/11/2009 Patient reports feeling "fine" after in
357050 9/11/2009 GA 29 29 F 9/11/2009 redness, swelling, and warmth at sit
357051 9/11/2009 SC 1.6 1 0.6 F 9/11/2009 MOTHER STATES CHILD "NOT AC
357052 9/11/2009 MI 11 11 M 9/11/2009 Large red swollen area on right arm
357053 9/11/2009 TN 31 28 F 9/11/2009 Onset of weakness and tingling in L
357054 9/11/2009 MA 39 39 F 9/11/2009 Immediately after receiving the Td v
357055 9/11/2009 MA 25 25 M 9/11/2009 Reports feeling dizzy right after adm
357056 9/11/2009 MA 50 50 F 9/11/2009 At the time of administrtion, patient
357057 9/11/2009 TX 76 76 F 9/11/2009 patient experience swelling/warmne
357058 9/11/2009 CA 23 23 F 9/11/2009 Pt noted pruritis in the area 9/10/09
357060 9/11/2009 MN 25 M 9/11/2009 Coughing. Troubles breathing. Sw
357074 9/11/2009 IL 61 61 F 9/11/2009 Patient not feeling well after receivin
357075 9/11/2009 WA 25 25 F 9/8/2009 Rashes on face and legs and gener
357076 9/11/2009 CA 75 75 F 9/9/2009 C/o rash forming a ring approximate
357077 9/11/2009 OH 55 55 U Patient claims her blood pressure h
357078 9/11/2009 OR 81 81 M 9/12/2009 Vaccine on 8/13/09 rash on lower to
357079 9/11/2009 IL 33 33 M 9/12/2009 Patient reported diaphoresis, tachyc
357080 9/11/2009 GA 9 9 F 9/13/09 - 3PM - Patient received ina
357081 9/11/2009 OH 1.2 1 0.2 F 9/11/2009 Local redness, warmth & tendernes
357082 9/11/2009 MO 1 1 0M Patient has a localized reaction also
357083 9/11/2009 MN 4 4 F 9/10/2009 Rt thigh redness and swelling devel
357084 9/11/2009 WI 0.2 0 0.2 M 9/10/2009 Rash following immunization, not ut
357085 9/11/2009 CA 66 66 M 9/13/2009 Patient received FLUVIRIN flu shot
357086 9/11/2009 AL 56 56 F 9/13/2009 Day following immunization, patient
357087 9/11/2009 OR 83 83 M 9/12/2009 Painful injection site followed with a
357088 9/11/2009 CA 4 4 F 9/12/2009 Swelling, erythema, pruritus (L) delt
357089 9/11/2009 NY 16 16 F 9/11/2009 Fainting, feeling of coldness and we
357090 9/11/2009 NY 67 67 M 9/10/2009 Vaccine administered 09/01/09; On
357091 9/11/2009 OH 13 13 F 9/11/2009 Urticaria on face, legs, torso - impro
357092 9/11/2009 WI 20 20 F 9/11/2009 Patient had hotflush, passed out an
357093 9/11/2009 PA 66 66 M 9/11/2009 Pt got a flu shot in the pharmacy at
357095 9/11/2009 NE 76 76 M 9/11/2009 Err:508
357096 9/11/2009 MN 5 5 F 9/11/2009 Immunization on 9/9/09. Mom noted
357097 9/11/2009 CA 26 26 M 9/11/2009 Pt said he got some itchy hives dev
357098 9/11/2009 IL 17 17 F 9/11/2009 Miscarriage Pt was not aware she w
357100 9/11/2009 AR 4 4 F 9/10/2009 Fever, swelling in L upper arm.
357102 9/11/2009 KS 66 66 M Reaction to pneumonia vaccine -arm
357103 9/11/2009 MO 11 11 F 9/4/2009 Pt. rec'd VARIVAX injection subcuta
357105 9/11/2009 PA 18 18 F 9/10/2009 10 mins after vaccine admin. pt c/o
357107 9/11/2009 NY 15 15 M 9/11/2009 Per mother pt. experienced hallucin
357108 9/11/2009 RI 30 30 M 9/10/2009 Patient very apprehensive re flu vac
357109 9/11/2009 NY 2 2 1M 9/11/2009 Pt sneezing, face red, no breathing
357110 9/11/2009 TX 34 34 F 9/11/2009 States that about 30 minutes after s
357111 9/11/2009 NC 65 65 F 9/11/2009 Chills, tired all over, tenderness + p
357112 9/11/2009 GA 1.5 1 0.5 F 9/10/2009 Fever 105.9, no appetite.
357113 9/11/2009 CA 54 54 F 9/13/2009 Patient received PNEUMOVAX on 9
357114 9/11/2009 MO 12 12 F 9/4/2009 None stated.
357115 9/11/2009 PA 86 86 F 9/11/2009 Fever 101- injection site red and sw
357116 9/11/2009 TX 4 4 M 9/11/2009 Swelling, redness, tenderness, to le
357119 9/11/2009 CO 76 76 F 9/11/2009 Reported to Dr's office on 9-4 arm w
357120 9/11/2009 SC 18 18 M 9/14/2009 Pt received immunizations (FLUMIS
357042 9/12/2009 WA 49 49 F 9/12/2009 redness, warmth, soreness at swelli
357061 9/12/2009 WI 4 4 M 9/12/2009 Significant irritability, back pain, mus
357062 9/12/2009 WI 10 10 F 9/12/2009 Shot given under the arm, odd spot
357063 9/12/2009 VA 39 39 F 9/12/2009 Numbness and tingling in arm wher
357064 9/12/2009 OR 27 27 M 9/12/2009 Red bumps on upper left chest and
357065 9/12/2009 SC 73 72 F 9/12/2009 Patient was given vaccination at ab
357066 9/12/2009 FL 19 19 M 9/12/2009 pt described numbness in arm wher
357067 9/12/2009 CA 85 85 F 9/12/2009 Left arm red, swollen, and hot from
357068 9/12/2009 IN 21 21 F 9/12/2009 Had dizziness after first shot on 5/1
357069 9/13/2009 GA 3 3 F 9/13/2009 MY Daughter received the "MIST" in
357070 9/13/2009 OH 42 42 M 9/13/2009 Got shot at 1:00 pm on thursday se
357071 9/13/2009 DE 38 38 M 9/13/2009 Muscle and joint pain all over, fatigu
357072 9/13/2009 NY 39 39 F 9/13/2009 Began to feel dizzy and light headed
357073 9/13/2009 OR 68 68 F 9/13/2009 8/21 Zoster vaccine administered; 8
357094 9/14/2009 CA 11 11 M 9/9/2009 (R) deltoid sore, (R) arm mild-mode
357121 9/14/2009 F 9/14/2009 We received the following informatio
357122 9/14/2009 F 9/14/2009 We received the following informatio
357125 9/14/2009 TX 44 44 M 9/7/2009 Initial report received on 02 Septem
357140 9/14/2009 1.5 F 1/26/2009 Very busy immunization clinic. Bes
357141 9/14/2009 AR 25 25 F 6/30/2009 Went to ER 6/17/09 0200 for chills,
357142 9/14/2009 CA 1 1 0M 9/10/2009 Pt developed redness and itching a
357143 9/14/2009 CA 23 23 F 9/10/2009 Patient was injected with Fluvirin ins
357144 9/14/2009 AZ 61 61 F 9/8/2009 Noted pain (Lt) lower back. While dr
357145 9/14/2009 AZ 49 49 F 9/2/2009 Localized warmth and pruritus at inj
357146 9/14/2009 AZ F 9/8/2009 Was given Influenza on 8/31/009, s
357147 9/14/2009 AZ 30 30 M 8/27/2009 Flu vaccine given (Lt) upper arm , n
357148 9/14/2009 WA 4 4 M 9/8/2009 6.5 X 4.5 cm raised erythematous d
357149 9/14/2009 PA 4 4 M 9/9/2009 After shots, patient returned within a
357150 9/14/2009 MN 8 8 F 8/28/2009 Received VARICELLA vaccine 8/17
357151 9/14/2009 NV 3 3 F 9/10/2009 FOC called 9/2/09. States child had
357152 9/14/2009 FL 1 0 1F 9/8/2009 Rash, Acycliver 200 1/2 tp to qil 45D
357153 9/14/2009 MO 25 25 F 8/24/2009 GARDASIL vaccine was noted at te
357154 9/14/2009 MO 22 22 F 8/25/2009 GARDASIL vaccine was stored at te
357155 9/14/2009 MO 20 20 F 8/25/2009 GARDASIL vaccine was noted at te
357158 9/14/2009 MO 25 25 F 8/25/2009 GARDASIL vaccine was not stored
357160 9/14/2009 MO 21 F 8/25/2009 GARDASIL vaccine was stored at te
357161 9/14/2009 MO 22 22 F 8/25/2009 Gardisil vaccine was stored at temp
357169 9/14/2009 MO 21 21 F 8/25/2009 GARDASIL vaccine was stored at a
357171 9/14/2009 MO 20 20 F 8/20/2009 Gardisil vaccine was store at tempe
357184 9/14/2009 VA 17 17 F 9/14/2009 LEFT SHOULDER AND DELTOID 3
357185 9/14/2009 FL 34 34 M 9/14/2009 3 days ago 4 mm rash inceased, pr
357186 9/14/2009 KS 12 12 F 9/14/2009 Mom reports pt developed jaundice
357187 9/14/2009 TX 4 4 M 9/14/2009 Left arm became very red and swoll
357188 9/14/2009 SC 55 55 F 9/14/2009 Patient contacted the health dept th
357189 9/14/2009 TX 4 4 M 9/14/2009 Patient received Tdap instead of Dt
357190 9/14/2009 CA 5 5 F 9/14/2009 2 days after vaccine administration,
357191 9/14/2009 NC 21 21 F 9/14/2009 Patient presented 24 hours followin
357192 9/14/2009 VA 65 65 F 9/14/2009 Received Yellow Fever Vaccine (Lo
357193 9/14/2009 IA 2 2 1M 9/14/2009 pt had varicella vaccine, within 2 hrs
357194 9/14/2009 NC 56 56 F 9/14/2009 Patient felt dizzy 30 minutes after th
357195 9/14/2009 WA 53 53 F 9/14/2009 Pt received injection on the 11th, sh
357196 9/14/2009 AZ 73 73 F 9/14/2009 Patient's husband described: within
357197 9/14/2009 NJ 4 4 F 9/14/2009 Patient began complaining of sore t
357198 9/14/2009 NJ 2 2 0.7 M 9/14/2009 Began running fever, almost immed
357199 9/14/2009 NC 4 4 M 9/14/2009 C/O BURNING AND REDNESS LE
357200 9/14/2009 MO 17 17 F 9/14/2009 On 9/4/09@ 1400 client called me a
357201 9/14/2009 MO 20 20 F 8/24/2009 Gardisil vaccine was stored at at tem
357205 9/14/2009 MO 22 F 8/24/2009 GARDASIL vaccine was stored at te
357207 9/14/2009 MO 19 19 F 8/24/2009 Gardisil vaccine was store at tempe
357208 9/14/2009 NM 51 51 F 9/14/2009 extreme achiness at site and into jo
357209 9/14/2009 MD 50 50 F 9/14/2009 Client reported 4" X 11/2" area of in
357210 9/14/2009 LA 23 23 F 9/14/2009 morning after receiving the Pneumo
357211 9/14/2009 TN 24 24 F 9/14/2009 Enlarged, grape-sized nodule above
357212 9/14/2009 NV 1.5 1 0.5 F 9/14/2009 High Fever (104 degrees), dizziness
357213 9/14/2009 NE 6 6 M 9/14/2009 48 hours after nasal flu mist vaccina
357214 9/14/2009 NV 0.1 0 0.1 M 9/14/2009 My son's whole body was shaking. H
357215 9/14/2009 CA 4 4 M 9/14/2009 SWOLLEN,REDNESS ON VACCIN
357216 9/14/2009 WV 59 59 F 9/14/2009 Severe shoulder pain beginning ~2
357217 9/14/2009 AZ 8 8 F 9/14/2009 Daughter vomitted 4 hours after rec
357223 9/14/2009 OH 19 19 M 9/6/2009 He got PNEUMOVAX vaccine (SC)
357224 9/14/2009 NY 35 35 F 9/14/2009 Itchy all over, feels warm all over Be
357225 9/14/2009 NY 50 50 F 9/14/2009 "Throat closing" - itching, hives - Lo
357226 9/14/2009 NH 0.1 0 0.1 M 9/14/2009 Infant was given vaccines. Cried, an
357227 9/14/2009 VI 4 4 M 9/14/2009 The patient developed erosive lesio
357228 9/14/2009 PA 16 16 F 9/10/2009 Received flu shot and Hep A. 3 min
357229 9/14/2009 MA 12 12 M 9/21/2009 Urticarial rash all over body.
357230 9/14/2009 OH 14 14 F 8/27/2009 Swelling 4.5cm x 4.5 cm, erythema,
357231 9/14/2009 OH 13 13 F 8/27/2009 Swelling, erythema, warmth at injec
357239 9/14/2009 OH 19 F 9/14/2009 Several minutes after vaccine patien
357240 9/14/2009 OH 73 73 F 9/9/2009 4 hours after immunization, left delto
357241 9/14/2009 CA 4 4 F 9/14/2009 Left outer aspect of arm swollen wit
357242 9/14/2009 NM 26 26 F 9/14/2009 Err:508
357243 9/14/2009 NM 63 F 9/14/2009 Indigestion, 20 minutes.
357244 9/14/2009 CO 0.5 0 0.5 M 9/14/2009 Episode of apparent limpness, letha
357245 9/14/2009 IA 27 27 F 9/10/2009 Received flu shot on 9/1/09 by 1200
357246 9/14/2009 IA 24 24 F 9/10/2009 By evening a nickel size welt appea
357247 9/14/2009 IA 26 26 F 9/10/2009 Two Quarter size welts on left deltoi
357248 9/14/2009 IA 26 26 F 9/10/2009 1/2 dollar size welt on (L) deltoid. W
357250 9/14/2009 IA 41 41 F 9/10/2009 "Right deltoid burned on injection an
357251 9/14/2009 IA 43 43 F 9/10/2009 Over the course of 2 days develope
357252 9/14/2009 IA 34 34 F 9/10/2009 Developed redness and started to it
357253 9/14/2009 IA 41 41 F 9/10/2009 Received the flu shot on 9/2/09 at 0
357254 9/14/2009 IA 49 49 F 9/10/2009 On 9/3/09 in the evening face and e
357255 9/14/2009 MI 62 62 M 9/14/2009 Patient said shortly after vaccination
357257 9/14/2009 9 9 F 9/14/2009 Patient received Boostrix one month
357258 9/14/2009 MI 64 64 F Was not feeling well prior to shot (na
357259 9/14/2009 WA 5 5 F 9/14/2009 Pt awoke approx 18 hours after vac
357260 9/14/2009 NC 44 44 F 9/14/2009 Pt reported on 09-12-09 at 9:30 AM
357261 9/14/2009 IN 65 65 F 9/14/2009 4 hours post vaccination 5 episodes
357262 9/14/2009 ID 11 11 F 8/13/2009 Patient immunized in am, a few hou
357263 9/14/2009 ID 5 5 M 7/31/2009 Redness began 7/30 with swelling o
357264 9/14/2009 ID 1.3 1 0.3 F 8/17/2009 Patient vaccinated 8-4-09, pt presen
357265 9/14/2009 ID 72 72 M 8/29/2009 None Stated
357266 9/14/2009 ID 5 5 M 8/14/2009 Diffuse swelling of entire L thigh to k
357267 9/14/2009 IL 69 69 F 9/14/2009 Redness, swelling, not itching, very
357268 9/14/2009 HI 49 49 F 9/9/2009 Slight sore throat. Aches & pains in
357269 9/14/2009 HI 59 59 F 9/5/2009 Received vaccine @ 08:40, @ 10:0
357270 9/14/2009 WI 19 19 F 9/12/2009 I was driving home from a friends ho
357271 9/14/2009 TX 42 42 F 9/19/2009 arm swelling, large red streak, itchin
357272 9/14/2009 NY 69 69 F 9/14/2009 Patient c/o itchiness after taking 3rd
357273 9/14/2009 NY 23 M 9/14/2009 Pt in few hour experienced numbne
357218 9/15/2009 OR 13 13 F 9/15/2009 Shortly after vacinnation with Garda
357219 9/15/2009 IA 62 62 F 9/15/2009 About 3 hours after vaccine was giv
357220 9/15/2009 CA 47 46 U 9/15/2009 Received Samllpox vaccine along w
357274 9/15/2009 NC 8 8 M 9/8/2009 Red area on back of left arm. Cool p
357275 9/15/2009 NC 8 8 M 8/21/2009 Heat, red, itching, swelling @ site (
357276 9/15/2009 NC 11 11 F 9/8/2009 9-3-09 Back of Lt arm red, > than go
357277 9/15/2009 NC 10 10 M 9/6/2009 2 1/2 hours post vaccination, swellin
357278 9/15/2009 OH 35 35 F 9/15/2009 Pt call 9AM rash developed/itching
357279 9/15/2009 OH 11 11 M 9/15/2009 Administered FLULAVAL 0.5ml to h
357280 9/15/2009 KS 15 15 F 9/14/2009 Approx. 3 days after varicella immun
357285 9/15/2009 VA 8 8 M 9/4/2009 Flu vaccine licensed for 18 yrs and
357286 9/15/2009 WA 62 62 F 9/1/2009 Chills, fevers, sweating, severe pain
357287 9/15/2009 CA 4 4 F 9/3/2009 Pt received DTaP 9/1/09 came into
357288 9/15/2009 ID 66 66 F 9/9/2009 No adverse events.
357289 9/15/2009 CA 1.3 1 0.3 F 9/11/2009 Maculo papular rash starting on fac
357290 9/15/2009 PA 18 18 F 9/9/2009 The student received the flu shot R
357291 9/15/2009 PA 21 21 F 9/9/2009 The student became lightheaded ab
357292 9/15/2009 PA 18 18 F 9/9/2009 The student received a flu vaccinati
357293 9/15/2009 ID 65 65 F 9/10/2009 Vaginal Herpes infection
357294 9/15/2009 MN 56 56 F 9/9/2009 9/4/09, low grade fever, vomiting, na
357295 9/15/2009 PA 77 77 F 9/10/2009 Patient came back to our pharmacy
357296 9/15/2009 FL 55 55 F 9/8/2009 IM (R) deltoid - injection of PNEUMO
357297 9/15/2009 VA 6 6 M 9/11/2009 Pt received FLUMIST at about 14:2
357298 9/15/2009 DE 57 57 F 9/9/2009 Itching in area of injection down to e
357307 9/15/2009 PA 72 72 U Patient called 9-15, reported itching
357308 9/15/2009 NJ 1.6 1 0.6 M 9/15/2009 Grand mal febrile Seizure.
357309 9/15/2009 PA F 9/3/2009 Eyes red, swollen throat and face sw
357310 9/15/2009 CA 21 21 F 9/14/2009 Pt given GARDASIL left deltoid on 9
357311 9/15/2009 CT 13 13 M 9/14/2009 Administered GSK to < 18 yr old.
357312 9/15/2009 CT 14 14 M 9/14/2009 Administered GSK to < 18 yr old c/o
357313 9/15/2009 ME 33 33 F 9/8/2009 Body ache from injection site to top
357314 9/15/2009 LA 34 F 9/8/2009 None stated
357315 9/15/2009 NH 1 1 0M 9/2/2009 Maculo papular blanching pink rash
357316 9/15/2009 MD 43 43 F 9/10/2009 7.0 x 5.0 cm wheal. 25mg BENADR
357317 9/15/2009 CA 68 68 F 9/11/2009 My veins all around site of shot pron
357319 9/15/2009 IA 5 5 F 9/10/2009 Child woke up crying with a headac
357320 9/15/2009 OH 72 72 F 9/10/2009 9/9/09- Injection 1100 am. 2-Tyleno
357321 9/15/2009 NC 1.3 1 0.3 M 9/15/2009 Deep febrile seizure 11 days after M
357325 9/15/2009 AL 87 87 F 9/15/2009 Knot under skin at site of injection -
357326 9/15/2009 MA 60 60 F 9/14/2009 Once given flu shot, patient immedi
357327 9/15/2009 MA 80 80 F 9/11/2009 Redness approx. 4 inches in diam.
357328 9/15/2009 DE 78 78 F 9/3/2009 Swelling from elbow upwards, mild p
357329 9/15/2009 CT 11 11 M 9/4/2009 Parents noted malaise, headache, s
357330 9/15/2009 CT 4 4 M 9/4/2009 Swelling and cellulitis at sight.
357331 9/15/2009 OH 14 14 F 9/5/2009 Swollen area around injection site. T
357332 9/15/2009 VA 66 66 M 9/8/2009 Approx 12 hours after ZOSTAVAX v
357333 9/15/2009 KY 3 3 F MCA stroke on 9/4/09. Aphasia. He
357335 9/15/2009 FL 68 68 F 9/6/2009 Redness, inflammation, hardening o
357336 9/15/2009 NE 2 2 0.9 F 9/9/2009 Facial swelling, nose & eyes, 12 hrs
357338 9/15/2009 CA 12 12 F 8/31/2009 12yr female who had a syncope spe
357339 9/15/2009 CO 62 62 F 9/4/2009 Bitter taste in mouth that happened
357340 9/15/2009 TX 69 69 F 9/8/2009 Patients arm was in pain the evenin
357341 9/15/2009 OH 27 27 F 9/9/2009 In the afternoon the day the vaccine
357342 9/15/2009 WA 5 5 M 9/15/2009 "Clumps of Blistering Hives" to L arm
357343 9/15/2009 HI 74 74 F 8/27/2009 Tingling, stinging, itching, at and ab
357344 9/15/2009 OH 44 44 F 9/8/2009 Extreme muscle pain on L side arm
357345 9/15/2009 AL 51 51 F 9/3/2009 Patient feels like she has a cold com
357346 9/15/2009 SC 64 64 F 9/8/2009 Patient reported redness, swelling,
357347 9/15/2009 WA 57 57 F 9/4/2009 About 1 hour after receiving flu shot
357348 9/15/2009 VA 22 22 M 9/11/2009 Fever, sweats, headache, swollen/r
357349 9/15/2009 GA 31 31 M 9/9/2009 Swollen lips in AM after - Treated w
357350 9/15/2009 MI 17 17 F 9/15/2009 Blood Clot in lung on 4-12-2009 and
357351 9/15/2009 SC 5 5 M 9/15/2009 Administered immunization to patien
357352 9/15/2009 MD 25 25 F 9/15/2009 Reports pain, reddness and swelling
357353 9/15/2009 OK 18 18 F 9/15/2009 Pt. stated that she didn't feel well af
357354 9/15/2009 MS 1 1 0F 9/15/2009 1:00 p.m. on September 12th, 2009
357355 9/15/2009 GA 15 15 F 9/15/2009 Client was given a Tdap on 2/6/09 a
357356 9/15/2009 OK 67 67 F 9/15/2009 Pt received Pneumovax 0.5mL IM R
357357 9/15/2009 HI 17 18 F 9/15/2009 the first two vaccines were no extrem
357358 9/15/2009 MN 12 12 F 9/15/2009 fever, arm-swollen, red, sore, nause
357359 9/15/2009 CA 4 4 M 9/15/2009 Redness, swelling, warm to the touc
357360 9/15/2009 KY 41 41 F 9/15/2009 Patient received yellow fever vaccin
357361 9/15/2009 NC 13 13 F 9/15/2009 Grandmother/guardian reports head
357362 9/15/2009 FL 16 16 F 9/15/2009 Dizzines,Hypotension,Blurred Vison
357363 9/15/2009 NJ 2 2 0.9 M 9/15/2009 Hives post flu vaccine, pain in leg -
357364 9/15/2009 KY 42 42 M 9/15/2009 Patient received an subcutaneous in
357365 9/15/2009 TN 16 16 F 9/15/2009 Patient had the 1st shot of Gardasil
357366 9/15/2009 VA 4 4 M Pt grandmother reported to staff on
357367 9/15/2009 CA 47 47 F 9/8/2009 Throat tightness, chest congestion ,
357368 9/15/2009 AL 38 38 F 9/1/2009 Approximately 2 hours after receivin
357369 9/15/2009 CA 11 M 9/10/2009 Vaccines given 8/24/09 - red swolle
357370 9/15/2009 MD 1.7 1 0.7 M 9/15/2009 PT FATHER SAID A KNOT DEVEL
357371 9/15/2009 ID 12 12 M 9/15/2009 Bilateral axillary lymphadneopathy 4
357372 9/15/2009 DE 15 15 F 9/15/2009 within 20 minutes of shot, became d
357373 9/15/2009 AK 11 11 M 9/8/2009 Head shaking, approximately every
357374 9/15/2009 MI 7 7 F 9/15/2009 Concerns about dosage. Child given
357375 9/15/2009 MI 8 8 M 9/15/2009 no advers events reported. Concern
357377 9/15/2009 NJ 11 11 M 9/15/2009 Hives (urticaria) from head to toe ap
357378 9/15/2009 WA 23 23 F 9/15/2009 After beng given a Hep A vaccinatio
357379 9/15/2009 CA 5 5 F 9/15/2009 Pt. got red cheeks, forehead, nose a
357380 9/15/2009 OK 48 49 F 9/15/2009 Redness on arm, soreness of arm, f
357381 9/15/2009 OR 18 18 F 9/7/2009 On 12/1/08 patient given GARDASI
357382 9/15/2009 MI 18 18 F 9/8/2009 After injection patient started turning
357383 9/15/2009 WA 16 16 M 7:45 pm 8-21-09 nausea, headache
357384 9/15/2009 UT 2 2 0.2 F 9/15/2009 ITP
357385 9/15/2009 IN 5 5 M 9/8/2009 R leg is Red, warm, and swollen the
357386 9/15/2009 LA 5 5 F 9/8/2009 Knot-swollen-red
357387 9/15/2009 AZ 40 40 M 9/15/2009 L arm cellulitis-Rx Keflex 500 QiD<
357388 9/15/2009 WA 38 38 F 9/15/2009 Patient reported CHill, panic, Racing
357389 9/15/2009 MS 48 48 F 9/9/2009 None stated.
357390 9/15/2009 FL 72 72 F 9/15/2009 None stated.
357391 9/15/2009 GA 31 31 F 9/18/2009 General weakness 10 minutes after
357392 9/15/2009 CA 80 80 F 9/15/2009 Patient complaint of nose bleeding a
357393 9/15/2009 FL 77 77 F 9/4/2009 Patient returned three days after va
357394 9/15/2009 VA 5 5 M 9/15/2009 Rash at injection site area - Erythem
357395 9/15/2009 OH 81 81 F 9/15/2009 9/15/09 Pt. had 0.5ml of FLUVIRIN
357396 9/15/2009 DC 4 4 M 9/15/2009 DTAP/IPV given 2 months after 4th
357397 9/15/2009 NM 67 67 F 9/15/2009 Reaction @ injection site [redness]
357398 9/15/2009 MO 1 1 0F 9/15/2009 9/11/09 broke out all over red, raise
357399 9/15/2009 MN 40 40 M 9/12/2009 Pt filled a VAR and said he had prev
357400 9/15/2009 CA 61 61 F 9/11/2009 Site swollen on injected (L) arm, beg
357401 9/15/2009 ND 3 3 F 9/14/2009 Given PEDIARIX, MMR, Chickenpo
357402 9/15/2009 SC 12 12 F 9/15/2009 Received 3rd dose HPV vaccine in
357403 9/15/2009 PA 42 42 F 9/11/2009 Pt complained of right forearm tend
357404 9/15/2009 CA 18 18 M 9/15/2009 Fainted in car a few minutes after sh
357405 9/15/2009 WA 2 2 0.1 F 9/15/2009 Pt has a raised bump at the injectio
357406 9/15/2009 AZ 57 57 M 9/4/2009 Tingling in throat & cough for appro
357408 9/15/2009 FL 49 49 F 9/13/2009 Left arm very swollen, red, hot to to
357409 9/15/2009 IL 5 5 M 9/3/2009 L arm became swollen & warm & pa
357410 9/15/2009 MI 73 73 F 9/8/2009 No History of allergy to getatin of Ne
357411 9/15/2009 MI 13 13 M 7/8/2009 I placed injection (IM) on 7-7-09 & re
357412 9/15/2009 AZ 0.2 0 0.2 M 9/11/2009 Patient developed a bump with redn
357413 9/15/2009 TX 28 28 F 9/6/2009 Patient noticed numbness below elb
357414 9/15/2009 MO 45 45 F 9/4/2009 TDAP given 9-1-09. On 9-2-09 at 2:
357415 9/15/2009 CA 77 77 F 9/11/2009 Received shingles vaccination 7/15
357416 9/15/2009 KS 1 1 0M 4/23/2009 Staring, dazed appearance for 4 hrs
357417 9/15/2009 CA 63 63 F 9/9/2009 July 29 got shingles vaccine. On 8-3
357418 9/15/2009 IA 17 17 F 9/9/2009 Eyes became red & sore, face red,
357419 9/15/2009 NC 11 11 M 9/11/2009 Temp up to 103.4 & Headache x 4 d
357420 9/15/2009 OR 19 19 F 9/8/2009 Approx. 3 hours after receiving TDA
357421 9/15/2009 NY 11 11 F After the nurse administered the vac
357422 9/15/2009 IL 18 18 M 9/8/2009 Patient fainted after receiving flu va
357423 9/15/2009 VA 63 U 9/14/2009 Received vaccine same time as hus
357427 9/15/2009 OH 20 F 9/11/2009 C/o left upper extremity numbness a
358471 9/15/2009 WA 11 F 9/24/2009 Complaints of blurry vision, R knee
357256 9/16/2009 DC 4 4 M 9/14/2009 Client in advertently given KINRIX fo
357426 9/16/2009 PA F 9/15/2009 Redness swelling and itching of R a
357430 9/16/2009 U 9/15/2009 Initial and follow-up information has
357433 9/16/2009 WA 19 19 F 9/11/2009 Left upper arm local reaction with er
357434 9/16/2009 MD 23 23 F 9/15/2009 9-9-09 - Pt received 3rd GARDASIL
357435 9/16/2009 DE 11 11 M 9/11/2009 1 day after shot felt nauseate pale f
357436 9/16/2009 NY 1.6 1 0.6 M 9/14/2009 Swelling and tenderness to left uppe
357437 9/16/2009 MS 3 3 M 9/16/2009 Pt developed oval rash adjacent to
357438 9/16/2009 FL 27 27 F 9/16/2009 Diffuse hives and pruiritis- onset 2hr
357439 9/16/2009 MN 15 15 F 9/16/2009 Varicella given Rt arm SQ on 9/14/0
357440 9/16/2009 VA 51 51 F 9/14/2009 Pt reported pain, redness and bliste
357445 9/16/2009 FL 54 54 F 9/16/2009 Throat constriction, stomach pains &
357446 9/16/2009 TX 81 81 M 9/16/2009 Took Influenza & Pneumoccal shot
357447 9/16/2009 IL 43 43 M 9/16/2009 Red and itchy eyes, upper back pai
357448 9/16/2009 FL 40 39 F 9/16/2009 Individual called my office to report
357449 9/16/2009 LA 33 33 F 9/16/2009 Received flu shot at 0900 am Septe
357450 9/16/2009 ME 15 15 M 9/16/2009 MALAISE, JOINT PAIN, NUMBNES
357451 9/16/2009 MI 5 5 M 9/16/2009 LEFT LEG BECAME SWOLLEN AN
357452 9/16/2009 NY 55 55 F 9/16/2009 Patient stated that she had fever, ch
357453 9/16/2009 MD 0.5 0 0.6 M 9/16/2009 RECEIVED VACCINES AT APPRO
357454 9/16/2009 MA 64 64 F 9/16/2009 Within 5 minutes of immunization, p
357455 9/16/2009 OH 39 39 F 9/16/2009 APROXIMATELY 40HRS AFTER R
357456 9/16/2009 TX 67 67 F 9/16/2009 Employee states that after 2 hours o
357457 9/16/2009 ND 61 61 F 9/16/2009 After receiving the seasonal flu shot
357458 9/16/2009 CA 26 26 U 9/16/2009 Patient reported a hive-like rash to a
357459 9/16/2009 OH 48 48 F 9/16/2009 Received the flu shot around 4:30-5
357460 9/16/2009 TN 18 18 F 9/16/2009 Patient fainted and was assisted to
357461 9/16/2009 IN 34 34 F 9/16/2009 Within a half an hour, I began to sw
357462 9/16/2009 KY 13 13 F 9/16/2009 Vaccine administered 9/14/09 at 2:0
357463 9/16/2009 CA 16 16 M 9/16/2009 patient got VZV/Tdap/MCV 4, and w
357464 9/16/2009 PA 55 55 F 9/16/2009 received influenza vaccine 9/14/200
357465 9/16/2009 IN 45 45 F 9/16/2009 extreme fatigue, tingling of left arm
357466 9/16/2009 NY 69 69 F 9/16/2009 Patient presented with rash 1 month
357467 9/16/2009 WA 42 42 F 9/16/2009 Swelling started soon after the shot
357468 9/16/2009 PA 56 56 F 9/16/2009 Received shot on Sept 14 at 1:30PM
357469 9/16/2009 WA 14 14 F 9/16/2009 Pt was to receive Gardasil #1, Fluvi
357470 9/16/2009 WA 4 4 F 9/16/2009 5 days after receiving her 2nd varcil
357471 9/16/2009 UT 81 81 F 9/16/2009 Patient complained of agitation, trem
357472 9/16/2009 MO 54 54 F 9/16/2009 Patient developed redness, warmth
357473 9/16/2009 TX 34 33 F 9/16/2009 The patient developed high fever >1
357474 9/16/2009 WA 12 12 F 9/16/2009 at 25 days after shot she developed
357475 9/16/2009 TX 14 14 F 9/16/2009 Per mother, pt awoke on Saturday,
357476 9/16/2009 IL 61 61 F 9/16/2009 On four occasions in the two years
357477 9/16/2009 OR 1.8 1 0.8 M 9/16/2009 Induration, swelling, redness and ra
357478 9/16/2009 TX 35 35 F 9/16/2009 RASH AT INJECTION SITE CONSI
357479 9/16/2009 FL 23 22 F 9/16/2009 I received the injection around 10 am
357482 9/16/2009 NC 58 58 F 9/16/2009 Beginning 9/15/09 at 6 or 7 PM EST
357483 9/16/2009 IA 42 42 F 9/16/2009 Patient complained feeling slight fai
357484 9/16/2009 FL 26 26 F 9/16/2009 Received a call from a patient reque
357485 9/16/2009 SC 79 79 F 9/16/2009 Right after vaccine administered ble
357486 9/16/2009 MI 49 49 F 9/16/2009 Received injection 10:30am within o
357487 9/16/2009 OH 74 74 F 9/16/2009 Serious swelling of upper arm, shou
357488 9/16/2009 65 65 F 9/16/2009 Red, swelling at injection site. lastin
357489 9/16/2009 KS 5 5 F 9/16/2009 Approx 30-40 min after receiving a i
357490 9/16/2009 CA 13 13 U Patient received vaccine 9/14/09 &
357491 9/16/2009 CA 18 18 F 9/11/2009 Redness & swelling to site. Doctor
357492 9/16/2009 GA 1.5 1 0.5 M 9/15/2009 Mom called our office later in the da
357493 9/16/2009 MN 76 76 M 9/16/2009 None stated.
357494 9/16/2009 MN 65 65 F 9/16/2009 Given FLUZONE vaccine injection o
357495 9/16/2009 CA 15 15 F 9/15/2009 Nausea, dizziness (Patient received
357496 9/16/2009 PA 73 73 M 9/16/2009 Vaccinated 9-12-2009 @ 3:15PM. S
357497 9/16/2009 MO 79 79 F 9/15/2009 Pt complained of severe arm pain. S
357498 9/16/2009 CA 71 71 M 9/8/2009 At 9:30 PM (4 hrs after injections/ p
357499 9/16/2009 IL 86 86 F 9/16/2009 Pt experienced unusual swelling an
357500 9/16/2009 FL 46 46 M 9/14/2009 Pain, redness & swelling at site, R a
357501 9/16/2009 TX 22 F 9/26/2009 Approx. 2 1/2 - 3 hours after injectio
357502 9/16/2009 TX 9 9 F 9/16/2009 Pt developed redness of about 3 1/2
357503 9/16/2009 OH 5 5 F 9/16/2009 Sterile abscess and cellulitis on upp
357504 9/16/2009 MA 15 15 M 9/16/2009 Nausea and vomiting s/p flu vaccina
357505 9/16/2009 KY 31 31 F 9/15/2009 Patient received FLUZONE shot - a
357506 9/16/2009 OH 0.3 0 0.3 F 9/12/2009 PENTACEL, PREVNAR and ROTA
357508 9/16/2009 KY 31 31 F 9/14/2009 Day after flu shot patient relied com
357509 9/16/2009 NC 65 65 F 9/16/2009 TD given 9-14-09; patient experienc
357510 9/16/2009 WI 67 67 F 9/16/2009 On 9-15-09 pt developed nausea, th
357743 9/16/2009 RI 75 75 F 9/16/2009 Most painful shot ever gotten, walke
357480 9/17/2009 WA 3 3 M 9/17/2009 Received Hep A and Flu Mist on 12
357481 9/17/2009 6 6 F 9/17/2009 Large local reaction, 3x4 cm wheal,
357507 9/17/2009 MI 0.5 0 0.5 F Had nasal congestion for 2-3 days p
357517 9/17/2009 PA 23 23 F 9/16/2009 Initial information from a consumer w
357524 9/17/2009 MD F 9/14/2009 Initial information was received on 0
357525 9/17/2009 12 F 9/14/2009 Initial report received on 08 Septem
357526 9/17/2009 3 F 9/14/2009 Initial report received on 10 Septem
357528 9/17/2009 IL 2 2 0.4 M 9/17/2009 Patient received Varicella Vaccine o
357529 9/17/2009 CA 9 F 9/17/2009 Cough and stuffy nose lasting more
357530 9/17/2009 OH 81 81 M 9/17/2009 Patient experienced nausea and run
357531 9/17/2009 SC 17 17 F 9/17/2009 PATIENT STATES THAT ON 9-14-
357532 9/17/2009 VA 68 68 F 9/17/2009 Fever 100-101.4 developed approx.
357533 9/17/2009 NY 4 4 M 9/17/2009 Left arm with erythema and edema
357534 9/17/2009 NY 0.8 0 0.8 M 9/17/2009 CBC obtained 3 days post influenza
357535 9/17/2009 KS 58 58 F 9/17/2009 Approx. 12:30 p.m. Inluenza injectio
357536 9/17/2009 PA 10 10 F 9/17/2009 pt developed Graves Disease an au
357537 9/17/2009 FL 17 16 M 9/17/2009 30-45 min after vaccines given child
357538 9/17/2009 SC 12 12 F 9/17/2009 Approximately 2 minutes after recei
357539 9/17/2009 IL 69 69 F 9/17/2009 Received pneumonia vaccine 9/14/0
357540 9/17/2009 OH 19 19 F 9/17/2009 Swelling at injection site which got w
357541 9/17/2009 CT 13 13 F 9/17/2009 Extreme Fatigue, Nausea, migratory
357542 9/17/2009 WI 45 45 F 9/17/2009 Influenza vaccine administered at 7
357543 9/17/2009 NM 10 10 F 9/17/2009 Fever of 104 degree noted by schoo
357544 9/17/2009 AR 2 2 0.8 F 9/17/2009 scratching/clawing at eyes crying
357545 9/17/2009 MN 29 F 9/9/2009 Severe dizziness, nausea, vomiting
357546 9/17/2009 OH 19 19 M 9/12/2009 About 5 min after vaccination, pt c/o
357547 9/17/2009 IL 5 5 M Behavioral changes, agitation, obse
357548 9/17/2009 AZ 11 11 F 9/9/2009 "Persistent crying for 3 hrs, with fev
357550 9/17/2009 GA 66 66 F 9/14/2009 Red, swollen, heat in area, hard kno
357551 9/17/2009 OR 64 64 F 8/24/2009 Next morning: red blister/rash 1" lon
357552 9/17/2009 NY 50 50 F 9/11/2009 Positive cellulitis on vaccine site.
357553 9/17/2009 CO 73 73 F 9/15/2009 Red skin at injection site approx 19-
357554 9/17/2009 SD 4 4 M 9/11/2009 Entire thigh to under knee of left leg
357555 9/17/2009 FL 1 1 0M Red rash all over. Fever coughing ru
357556 9/17/2009 WA 1.3 1 0.3 F 9/10/2009 Fever 101.0 - 103.0.
357557 9/17/2009 VT 3 3 M 9/10/2009 Pt received Shot Thur and reported
357558 9/17/2009 ME 14 14 F 9/6/2009 Patient and mother report - after HP
357559 9/17/2009 CA 1.4 1 0.4 M 9/10/2009 Pt's mother stated swelling, red and
357561 9/17/2009 OH 15 15 F 9/17/2009 Five days after receiving the guardis
357562 9/17/2009 MN 22 22 F 9/17/2009 Pt is an International student from C
357563 9/17/2009 ME 43 43 F 9/17/2009 She had injection on tuesday here i
357564 9/17/2009 SC 34 34 F 9/17/2009 Received T/C from Carole Chiv. Sta
357565 9/17/2009 PA 38 38 F 9/17/2009 rash on chin, abdomen, and both ar
357566 9/17/2009 VA 70 70 F 9/17/2009 At 2pm pt got Zostavax shot. By the
357567 9/17/2009 IL 29 29 M 9/17/2009 5 minutes after recieving vaccine, cl
357568 9/17/2009 MN 25 25 F 9/17/2009 approx. 12 hrs after vaccine I starte
357569 9/17/2009 MI 1.1 0 0.1 U 9/17/2009 slight rash and low fever.
357570 9/17/2009 TN 22 22 F 9/17/2009 Patient broke out in hives/rash withi
357571 9/17/2009 KY 51 51 F 9/17/2009 c/o of itching at the site of injection i
357572 9/17/2009 OH 32 32 F 9/16/2009 Pain in Left Shoulder where vaccine
357573 9/17/2009 NY 4 4 F 9/17/2009 Progress Notes JOSEPH LURIO 9/
357574 9/17/2009 IA 93 93 F 9/17/2009 Redness and swelling from the shou
357575 9/17/2009 41 41 M 9/17/2009 2 days after anthrax vaccination to t
357576 9/17/2009 MI 18 18 F 9/17/2009 Client received HPV, HAv, MCV4. A
357577 9/17/2009 NM 49 49 F 9/17/2009 arm described by employee as "swo
357578 9/17/2009 TX 13 13 F 9/17/2009 The study subject is a 13-year-old fe
357579 9/17/2009 VA 41 42 M 9/17/2009 LLL pneumonia (fever 101-102 x 3 d
357580 9/17/2009 AZ 24 24 F 9/17/2009 Diffuse urticarial reaction
357581 9/17/2009 WA 29 29 M 9/17/2009 One week after recieving smallpox v
357582 9/17/2009 OH 62 62 F 9/17/2009 Pain from mid clavical to upper arm
357583 9/17/2009 MT 65 65 F 9/17/2009 Vaccine administered without any n
357584 9/17/2009 CA 3 3 M 9/17/2009 Developed itchy rash all over body a
357585 9/17/2009 NY 14 14 M 9/17/2009 Patient developed chest tightness/p
357588 9/17/2009 VA 0.5 0 0.5 M 9/11/2009 NICU graduateY (24 5/7 wks) gestatio
357589 9/17/2009 VA 18 18 M 9/17/2009 This 19 yo patient reported onset of
357590 9/17/2009 TX 62 62 F 9/14/2009 Rt. eye is not clear. Suggested pt. c
357591 9/17/2009 CA 67 67 F 9/15/2009 7-8 after receiving PNEUMOVAX, p
357592 9/17/2009 NJ 0.2 0 0.2 M 9/17/2009 Rash around mouth, and on angle o
357593 9/17/2009 TX 65 65 F 9/17/2009 10:10 AM rec'd flu vac 9/1/09. 4:00
357594 9/17/2009 CA 4 4 F 8/29/2009 4 y/o female received MMR, IPV in
357595 9/17/2009 KY 28 28 M 9/17/2009 Approximately 10 minutes after vacc
357596 9/17/2009 GA 0.2 0 0.2 M 7/24/2009 Diarrhea x 4 days
357597 9/17/2009 LA 70 70 F 9/17/2009 Redness, cellulitis at site of injection
357598 9/17/2009 OH 14 14 F 9/17/2009 Vaccine given on 9-16-09 @ 245/PM
357599 9/17/2009 PA 60 60 F 9/17/2009 Injection given 9/11/09 on 9/17/09 p
357600 9/17/2009 MA 53 53 M 9/16/2009 Headache, nausea, achy, numbnes
357601 9/17/2009 MA 44 44 F 9/17/2009 Flu vaccine received @ 10:30-within
357602 9/17/2009 IA F 9/17/2009 09/16/09 weak, tired, feeling cold.
357603 9/17/2009 WA 1 1 0F 9/17/2009 Excessive crying, irritability. Resulte
357604 9/17/2009 AL 50 50 F 9/17/2009 Redness, puffed or swollen, abut siz
357605 9/17/2009 NY F 9/17/2009 Numbness & tingling of hands & ext
357606 9/17/2009 SC 69 69 F 9/8/2009 Customer noticed red rash on left a
357607 9/17/2009 SC 7 7 F 9/11/2009 One day following administration of
357608 9/17/2009 WI 3 3 M 9/19/2009 Left Parotitis.
357609 9/17/2009 AZ 60 60 F 9/14/2009 Received flu shot 9/10/09 @ mid mo
357610 9/17/2009 IN 76 76 M 9/11/2009 Patient received shot at approximat
357611 9/17/2009 MI 27 27 F 9/11/2009 Redness. Heat radiation aft swelling
357612 9/17/2009 MI 44 44 F 9/13/2009 Five minutes after FLUVIRIN injectio
357613 9/17/2009 NY 76 76 F 9/15/2009 High fever, vomiting, SPLITTING he
357614 9/17/2009 MI 46 46 F 9/11/2009 Lt arm sore and red, firm warm area
357615 9/17/2009 DE 40 40 M 9/9/2009 -Bruise on left arm in area of injectio
357616 9/17/2009 OH 4 4 F 9/11/2009 DTaP and IPV administered in R thi
357617 9/17/2009 TX 48 48 U 9/10/2009 L arm pain & swelling following imm
357618 9/17/2009 MN 17 F 9/8/2009 Itchy, swelling, lungs filling up, swol
357619 9/17/2009 WV 69 69 F 9/10/2009 Lq. red swollen area entire upper ar
357620 9/17/2009 WA 74 74 M 9/9/2009 Patient described extreme achiness
357621 9/17/2009 MO 26 26 F 9/17/2009 Per pt phone call 9/14/09, pt receive
357622 9/17/2009 MD 61 61 F 9/15/2009 Light headed, itchy eyes, red eyes,
357624 9/17/2009 GA 11 11 M 9/17/2009 Right arm red and swollen around in
357625 9/17/2009 GA 4 4 F 9/17/2009 Right thigh swollen, red area around
357626 9/17/2009 OH 2 2 0.9 F 9/17/2009 Bruise was next day, swelling starte
357627 9/17/2009 DE 68 68 M 9/17/2009 No adverse events
357628 9/17/2009 DC 28 28 F 9/14/2009 Reports that within 8 hrs of receiving
357629 9/17/2009 TX 74 74 F 9/16/2009 L mild upper arm - Red, warm, sligh
357630 9/17/2009 TX 53 53 F 9/17/2009 Pneumonia shot given Sept 14, 200
357631 9/17/2009 ND 66 66 M 9/11/2009 Relates the evening of the vaccine t
357632 9/17/2009 OR F 9/17/2009 Severe pain developed locally at inj
357623 9/18/2009 MA 40 40 F 9/10/2009 Rev'd vaccine Wed 9/2/09 and had
357640 9/18/2009 RI F 9/18/2009 Pt received pneumonia vaccine 9/16
357641 9/18/2009 IN 27 27 F 9/14/2009 Received shot on 9-11-09 approx 1
357642 9/18/2009 IL 7 7 M 9/12/2009 Red swollen arm.
357643 9/18/2009 CA 10 10 F 9/14/2009 Within 24 hours of receiving varicell
357644 9/18/2009 FL 14 14 F 7/27/2009 Within minutes of the administration
357645 9/18/2009 FL 71 71 F 9/18/2009 Patient states that she was not able
357646 9/18/2009 FL 62 62 F 9/17/2009 9/8 vaccinated -migraine starting ab
357647 9/18/2009 NY 67 67 M 9/18/2009 Red rash on left and right hand- Itch
357657 9/18/2009 AZ 4 4 M 9/18/2009 2 days after receiving VARIVAX and
357658 9/18/2009 AZ 6 6 M 9/20/2009 (L) arm erythematous, hot, edemato
357660 9/18/2009 GA 7 7 M 9/18/2009 Moderate/Severe swelling and redn
357661 9/18/2009 FL 54 53 F 9/18/2009 24 hours after receiving my vaccina
357662 9/18/2009 GA 65 65 F 9/18/2009 On 9-17-2009 patient called me to r
357663 9/18/2009 TX 59 59 F 9/18/2009 Reddness at site on right arm, down
357664 9/18/2009 FL 64 64 F 9/18/2009 shot hurt more than usual shotsSOB
357665 9/18/2009 FL 74 64 M 9/18/2009 hurt more at onset; SOB, muscle ac
357666 9/18/2009 NY 3 3 M 9/18/2009 Pt. presented 24hrs post immunizat
357667 9/18/2009 MI 47 47 F 9/18/2009 Skin rash with some itching appeare
357668 9/18/2009 WI 7 7 F 9/18/2009 MOTHER CALLED THIS AM TO RE
357670 9/18/2009 MN 0.2 0 0.2 M 9/18/2009 Persistent, unconsolable crying all n
357671 9/18/2009 MN 68 63 F 9/18/2009 Itching, slight rash, and facial flushin
357672 9/18/2009 AZ 4 4 M 9/18/2009 12 cm by 10 cm swelling and indura
357673 9/18/2009 MN 23 23 F 9/18/2009 Itching, hives, headache, sore throa
357674 9/18/2009 LA 42 42 M 9/18/2009 LYMPHNODE SWELLING AND PA
357675 9/18/2009 NV 29 29 F 9/18/2009 2330, 16 Sep 09. Pt states the left
357676 9/18/2009 FL 48 48 F 9/18/2009 Pain and swelling to left deltoid area
357677 9/18/2009 TX 53 F 9/18/2009 PATIENT STATES INSIDE ARM AN
357678 9/18/2009 IL 57 57 M 9/18/2009 I recieved the Flu shot on 15 Sep 20
357679 9/18/2009 MI 54 54 F 9/18/2009 Tdap was administered at 11am 11
357681 9/18/2009 WI 45 45 F 9/18/2009 HIVES NEAR LEFT ELBOW 45 MIN
357683 9/18/2009 AZ 36 36 F 9/10/2009 Pt states when vaccine was injected
357684 9/18/2009 AZ 46 46 F 9/18/2009 Flat erythematous - "hive like" - area
357685 9/18/2009 OR 5 5 M 9/17/2009 Woke on day 2 after KINRIX (DTaP
357686 9/18/2009 OR 1.1 1 0.1 F 9/15/2009 Febrile seizure 9 hours p shots.
357687 9/18/2009 NY 3 3 M 9/18/2009 Localized vesicular rash/eruption at
357688 9/18/2009 NM 50 50 F 9/18/2009 Patient felt lightheaded and needed
357689 9/18/2009 IL 0.2 0 0.2 F 9/18/2009 Within 24 hours of administration, m
357690 9/18/2009 GA 46 46 F 9/18/2009 Pt noticed increasing redness and s
357692 9/18/2009 PA 1 1 0M 9/18/2009 Lump & redness at HIB vaccine site
357693 9/18/2009 CA 4 4 F 9/17/2009 Extensive local reaction, redness, m
357694 9/18/2009 VA 29 29 F 9/18/2009 Enlarging red, tender area around in
357695 9/18/2009 KS 19 19 M 9/18/2009 Injected Novartis FLUVIRIN vaccine
357696 9/18/2009 MN 57 57 F 9/17/2009 Small ruptured capillary immediately
357697 9/18/2009 MA 1.1 1 0.1 F 9/18/2009 Diffuse mildly raised erythematous p
357698 9/18/2009 MA 60 60 F 9/19/2009 Within 1 wk of vaccination rash beg
357699 9/18/2009 UT 11 11 M 9/18/2009 Arms are swollen. No redness or wa
357700 9/18/2009 GA 16 16 M 9/18/2009 Pt was given JE-VAX yesterday at a
357701 9/18/2009 MN 4 4 F 9/18/2009 Hives
357702 9/18/2009 TN 62 62 F 9/18/2009 Uniformly erythemic, pruritic, round
357703 9/18/2009 NY 18 18 F 9/18/2009 Received the vaccine at 12, about 1
357704 9/18/2009 NC 66 66 F 9/18/2009 Left arm was red,swollen, and warm
357705 9/18/2009 MI 49 49 M 9/18/2009 Client seen in clinic for routine Tdap
357706 9/18/2009 OR 43 43 F 9/18/2009 Patient states she had pain, rednes
357707 9/18/2009 AL 15 15 F 9/18/2009 Redness, warmth- left arm.
357708 9/18/2009 TX 32 F 9/18/2009 Adverse reaction occured at about 1
357709 9/18/2009 AZ 64 64 F 9/18/2009 Lt upper arm above elbow to below
357710 9/18/2009 WI 59 59 F 9/18/2009 Three hours after receiving immuniz
357711 9/18/2009 OH 6 6 F 9/18/2009 24 hours after second Varivax she d
357712 9/18/2009 AZ 80 80 F 9/18/2009 9/16/09 1630 patient was in her usu
357713 9/18/2009 CA 2 2 0.4 M 9/18/2009 GAVE 5TH DTAP TO A 2YR OLD
357714 9/18/2009 NY 11 11 F 9/18/2009 Received Tdap and Varicella and M
357715 9/18/2009 OK 67 67 F 9/18/2009 Pt. received Pnueovax in right delto
357716 9/18/2009 VA 32 32 F 9/18/2009 Received vaccine 9/1/09 at 6:44pm
357726 9/18/2009 IL 66 66 F 9/18/2009 Patient's right upper arm became ve
357727 9/18/2009 CA 14 14 F 9/18/2009 My daughter had the flu shot given
357728 9/18/2009 MA 36 36 M 9/18/2009 Joint pain. Bilat. upper extremity we
357740 9/18/2009 AR 33 33 F Pt got vaccine after lunch. Since sh
357741 9/18/2009 NH 32 32 F 9/16/2009 Hives all over body, neck and face,
357742 9/18/2009 KS 43 43 F 9/17/2009 9/14/09 after shot arm pain. 24 hour
357744 9/18/2009 CT 16 16 F 9/18/2009 None. Student given a second MEN
357745 9/18/2009 MA 64 64 F 9/18/2009 Nosebleeds occurring spontaneous
357747 9/18/2009 IL 53 53 F 9/19/2009 Patient came to pharmacy for Pneu
357748 9/18/2009 PA 5 5 F 9/18/2009 Varivax & IPV given at 3:15 pm. Pt
357749 9/18/2009 GA 4 4 F 9/18/2009 Looks like break-through Varicella in
357863 9/18/2009 UT 45 45 M 9/18/2009 Left arm sore. By 9pm felt nauseate
357717 9/19/2009 IL 27 27 M 9/19/2009 I was having shortness of breath, w
357718 9/19/2009 24 24 M 9/19/2009 Mild pericarditis treated with NSAID
357719 9/19/2009 FL 13 13 F 9/19/2009 day after immunization generalized
357720 9/19/2009 OK 34 34 F 9/19/2009 Nausea, vomiting, fever of 101 degr
357721 9/19/2009 AZ 57 57 M 9/19/2009 Asthma exacerbation: wheezing, dif
357722 9/19/2009 NE 0.2 0 0.2 M 9/19/2009 Patient received the rotavirus vaccin
357723 9/19/2009 NY 68 66 F 9/19/2009 Shingles vaccine given on same da
357724 9/20/2009 ID 59 59 F 9/20/2009 Unexplained body itching, progress
357725 9/20/2009 IL 42 42 F 9/20/2009 On 5/19/09 when making a follow-u
357729 9/20/2009 IN 2 2 0.7 F 9/20/2009 ABOUT FORTY HOURS AFTER TH
357730 9/20/2009 GA 49 49 F 9/20/2009 After receiving the flu vaccine at wo
357731 9/20/2009 MI 57 57 F 9/20/2009 I received a flu vaccination around 1
357732 9/20/2009 MT 37 37 M 9/20/2009 Had influenza vaccine approx 1:30
357733 9/20/2009 MT 61 61 M 9/20/2009 had flu shot at 6pm. 10 pm felt thro
357734 9/20/2009 WA 40 40 F 9/20/2009 Extreme pain at injection site, unabl
357735 9/20/2009 AK 8 8 F 9/20/2009 Flumist vaccine was given intranasa
357736 9/20/2009 MA 9 9 M 9/20/2009 Patient was administered LAIV even
357737 9/20/2009 FL 0.2 0 0.2 M 9/20/2009 low grade fever (100.5F), diarrhea in
357738 9/20/2009 NH 70 70 M 9/20/2009 Onset of symptoms within a few hou
357739 9/20/2009 TX 39 39 F 9/21/2009 Itchy rash across chest.
357659 9/21/2009 MN F 9/19/2009 Patient had swelling and itching at s
357682 9/21/2009 WI 55 55 M 9/20/2009 Swelling at the injection site.
357691 9/21/2009 CO 19 19 F 9/18/2009 Patient became light headed, dizzy,
357746 9/21/2009 DE 19 19 F 9/18/2009 Patient given PNEUMOVAX on 9/14
357750 9/21/2009 0 0 0M 9/16/2009 Infant received Hepatitis B vaccine
357751 9/21/2009 0.2 0 0.2 F 9/16/2009 2.5 mo. female vaccinated with ROT
357752 9/21/2009 75 75 F 9/11/2009 E.R. on 04-29-09: Dry hives - heada
357753 9/21/2009 F 9/16/2009 RN requested DPT vaccine but rece
357754 9/21/2009 NV 4 4 F 9/11/2009 One day after immunization, child d
357755 9/21/2009 IL 27 27 M 9/16/2009 Maculo papular rash on Bilat upper
357756 9/21/2009 LA 4 4 F 9/17/2009 Left deltoid 5 1/2 cm wide to 4 1/2 c
357757 9/21/2009 CA 0.2 0 0.2 M 9/18/2009 Enteritis (loose, mucousy stools x 1
357758 9/21/2009 WI 16 16 F 9/15/2009 None
357759 9/21/2009 MA 59 59 M 9/15/2009 Patient complained of tingling in left
357760 9/21/2009 WA 4 4 F 9/16/2009 Pt had got 4 yo imms in May in ano
357761 9/21/2009 NJ 36 36 F 9/11/2009 Reports left pupil dilated 60" after in
357762 9/21/2009 OR 2 2 0.8 F 9/14/2009 Shots recd 9-9-09 PM. Lt. leg a littl
357763 9/21/2009 OR 4 4 M 9/4/2009 Low grade fever noted @ "bed time
357764 9/21/2009 VA 9 9 M 9/18/2009 9/1/09 - Left arm red, hot, tender no
357765 9/21/2009 OH 35 35 F 9/1/2009 Client made a phone call to clinic on
357766 9/21/2009 AZ 11 11 F 9/16/2009 On 9-16-09 clients aunt called clinic
357767 9/21/2009 OR 11 11 F 9/15/2009 Patient received all 5 doses of Rabi
357769 9/21/2009 CA M 9/8/2009 When pt was a little over 1yr old he
357777 9/21/2009 FL 16 16 F 9/21/2009 Patient had her second injection of
357782 9/21/2009 MO 12 12 M 9/21/2009 My son developed a low grade feve
357784 9/21/2009 TX 12 12 F 9/21/2009 Mom called 6 days after immunizati
357787 9/21/2009 WI 11 11 F 9/21/2009 Pt was given 3 immunizations and w
357788 9/21/2009 WI 4 4 M 9/21/2009 Pt was given pre-kindergarten immu
357791 9/21/2009 CA 74 74 F 9/21/2009 I was a patient in the hospital for a c
357792 9/21/2009 VA 48 48 M 9/21/2009 After pt properly screened and iden
357793 9/21/2009 TX 90 90 M 9/21/2009 Within days of receiving Fluvirin pat
357797 9/21/2009 TX 18 18 F 9/21/2009 extreme fatigue, mono, chronic stre
357806 9/21/2009 OR 35 35 F 9/21/2009 The flu shot was administered via in
357807 9/21/2009 CA 53 53 F 9/21/2009 Within 24 hours of the vaccination, I
357816 9/21/2009 MO F 9/21/2009 Patient recieved flu shot at approxim
357830 9/21/2009 CA U 9/21/2009 This case was reported by a physici
357832 9/21/2009 IL 11 11 M 9/18/2009 Woke up at night with hot flashes, s
357833 9/21/2009 CA 66 66 F 9/16/2009 Red, swollen about 4-5 inches below
357834 9/21/2009 GA 55 55 F 9/21/2009 4 hours after vaccination she was n
357835 9/21/2009 NJ 4 4 F 9/21/2009 Seizure - went to ER. Received 4 do
357836 9/21/2009 IL 67 67 F 9/22/2009 24 hours after vaccine administratio
357837 9/21/2009 OR 37 37 F 9/21/2009 My left arm hurts from shoulder to w
357838 9/21/2009 LA 51 51 F 9/21/2009 One minute after receiving vaccine
357839 9/21/2009 AZ 80 80 M 9/18/2009 Flu like symptoms, chest congestion
357840 9/21/2009 IL 32 32 F 9/21/2009 Shortness of breath, lightheadednes
357841 9/21/2009 IA 6 6 F 9/21/2009 Urticaria tx with Celadrin 4mg, antih
357842 9/21/2009 FL 71 71 F 9/21/2009 Patient states she had a rash 2 day
357843 9/21/2009 AL 62 62 F 9/21/2009 Red spot at injection site with little re
357844 9/21/2009 NM 28 28 F 9/21/2009 Pt stated a couple of hour after rece
357845 9/21/2009 MO 0.2 0 0.2 M 9/21/2009 Swelling of bottom lip with repetitive
357846 9/21/2009 MI 13 13 M 9/21/2009 Child was given a VARIVAX and ME
357847 9/21/2009 OK 58 58 F 9/17/2009 Day of vaccination- No symptoms. 2
357848 9/21/2009 KY 21 21 M 9/21/2009 Pt complained of dizziness, light he
357849 9/21/2009 CA 60 60 F 9/20/2009 Patient experienced lightheadednes
357850 9/21/2009 WA 2 2 1F Swollen red hot left arm where flu sh
357851 9/21/2009 AZ 11 11 F 9/21/2009 (R) upper arm cellulitis - Itching and
357852 9/21/2009 PA 52 52 F 9/21/2009 L Axillary lump noted in arm on 9-20
357853 9/21/2009 FL 81 81 M 9/20/2009 Itching+ red blotches on arms + legs
357854 9/21/2009 FL 67 67 F 9/20/2009 Itching and bright red blotches on b
357855 9/21/2009 CA 49 49 F 9/18/2009 12:20pm 9/18/09 patient returned to
357856 9/21/2009 MN 53 F 9/21/2009 Patient contacted clinic the 17th sta
357858 9/21/2009 CT 4 4 M 9/16/2009 Erythema right upper arm. Warm no
357859 9/21/2009 MA 3 3 M Approx. 1 hour after receiving vacci
357869 9/22/2009 AZ 42 42 M 9/18/2009 Started feeling tenderness, pain in h
357872 9/22/2009 AZ 33 33 F 9/21/2009 9/14 - going to bed extremely sore a
357873 9/22/2009 DE 71 71 F 9/22/2009 Rash/swelling at inj site.
357875 9/22/2009 OH 18 18 F 9/17/2009 A cluster of seven patients who all r
357876 9/22/2009 KS 33 33 F Initial report received on 09 Septem
357878 9/22/2009 FL 25 25 F 9/9/2009 Patient had arm being sore at end o
357879 9/22/2009 FL 68 68 F 9/14/2009 Diaphoretic, felt faint, numbness in
357880 9/22/2009 TN 48 48 F 9/18/2009 Pt complained of numbness in arm
357881 9/22/2009 TX 21 21 M 9/14/2009 None
357882 9/22/2009 PA 55 55 F 9/3/2009 Redness, induration at injection site
357883 9/22/2009 VA 63 63 F 9/21/2009 Large red area on rt arm is inflamed
357884 9/22/2009 MO 52 52 F 9/14/2009 Arm erythema, painful to the touch,
357885 9/22/2009 CA 25 25 F Pain between the spine and shoulde
357886 9/22/2009 CA 71 71 M 9/21/2009 24 hrs after vaccination, pt's neck (b
357887 9/22/2009 OH 50 50 F 9/14/2009 Headache, Fever, Arm Swollen, Arm
357888 9/22/2009 MI 66 66 F 9/15/2009 Got shingles as a result of vaccine.
357889 9/22/2009 CA 4 4 M 9/4/2009 Left arm erythema and induration no
357890 9/22/2009 IN 10 10 F 9/14/2009 9-11-09 off @ 2:30p (showing swell
357891 9/22/2009 CO 62 F 9/14/2009 Erythema, induration, fevers, myalg
357892 9/22/2009 KS 63 63 F 9/15/2009 3 hrs after shot developed severe le
357893 9/22/2009 NH 0.2 0 0.2 F 9/14/2009 Erythema Multiforme.
357894 9/22/2009 CA 10 10 M 9/11/2009 Varicella shot given on 9/10/09 at 2
357895 9/22/2009 MA 0.2 0 0.2 M 9/16/2009 Irritability: "Screaming" "inconsolabl
357896 9/22/2009 CA 64 F 9/11/2009 Two days after shot, there was swe
357897 9/22/2009 IL 55 55 M 9/14/2009 Rash on legs, knees & forearms. U
357911 9/22/2009 CA 67 67 F 9/21/2009 Extreme case of cellulitis (according
357912 9/22/2009 NY 0.2 0 0.2 F 14 mo girl w/ SCID s/p 1 dose ROTA
357913 9/22/2009 VT 0.2 0 0.2 F 9/9/2009 Sustained tachycardia presenting a
357914 9/22/2009 CO 0.2 0 0.2 M 9/14/2009 Within hours of receiving vaccines,
357915 9/22/2009 FL 7 7 M 9/15/2009 Partial seizure - new onset 1 week a
357916 9/22/2009 OR 0.1 0 0.1 F 9/17/2009 About 5 pm pt. was asleep in mom's
357917 9/22/2009 CA 40 40 F 9/16/2009 On Sep 1 2009 pt received Inactiva
357918 9/22/2009 NE 21 21 F 9/4/2009 Felt lightheaded about 5 minutes af
357919 9/22/2009 CA 15 15 F 8/19/2009 Chest pain, trouble breathing, rapid
357921 9/22/2009 FL 4 4 M 9/15/2009 Vaccines administered 9/11/09 LT A
357922 9/22/2009 IL 66 66 F 9/16/2009 Pt states she hasn't been able to mo
357923 9/22/2009 WA 10 10 F 9/15/2009 Confusion lasting < 24 hours 5 days
357926 9/22/2009 NC 10 10 M 9/16/2009 Mild inflammation with erythema 8-1
357927 9/22/2009 ME 2 2 0.2 M 9/16/2009 9.3 x 6.5 cm area of erythema with
357928 9/22/2009 IL 73 73 F 9/17/2009 Gave flu shot, and pt started bleedin
357929 9/22/2009 ID 67 67 M 8/17/2009 Client seen 7-29-09 for travel, was g
357930 9/22/2009 AK 10 10 F 9/17/2009 Pt broke out in hives shortly after th
357931 9/22/2009 MI 37 37 M 9/18/2009 Within 2 minutes of shot he felt light
357932 9/22/2009 IL 14 14 M On 8/18/09 I took my son to his prim
357934 9/22/2009 CA 4 4 M 9/15/2009 Allergic Reaction, left arm turned re
357935 9/22/2009 NC 68 68 M Pain in the left shoulder and arm 8-1
357936 9/22/2009 NC 68 68 F 9/18/2009 Pt broke out in hives on arms, neck
357937 9/22/2009 MI 11 11 F 9/15/2009 Child woke today with low grade fev
357938 9/22/2009 PA 42 42 F 8/31/2009 Complained of soreness L arm with
357939 9/22/2009 NV 1.1 1 0.1 F 9/14/2009 5X3 cm Erythema, very itchy, red an
357940 9/22/2009 IL 62 62 F 9/15/2009 Swelling, redness, and warmth in ar
357942 9/22/2009 IA 68 68 F 9/16/2009 Flu vaccine given @ 0922 AM. Ons
357943 9/22/2009 MT 56 56 F 9/18/2009 Patient received self limiting left side
357944 9/22/2009 IL 4 4 M 9/17/2009 Red raised sandpaper appearance
357945 9/22/2009 FL 79 79 F 9/17/2009 Pt reported arm swelling and "bruise
357946 9/22/2009 IL 65 65 F 9/13/2009 Pt given PNEUMOVAX & FLUVIRU
357947 9/22/2009 IN 76 76 F 9/11/2009 Following injection, patient reported
357948 9/22/2009 CA 0.4 0 0.4 M 9/14/2009 Received vaccines 8/31/09. Fever 1
357949 9/22/2009 MI 71 71 F 9/16/2009 Thursday- Sept. 10 6pm - vaccine; 1
357950 9/22/2009 NY 34 34 M 9/17/2009 Shortness of breath, coughing, light
357951 9/22/2009 MO 35 35 F 9/17/2009 Shot was given in Lt arm. Patient re
357952 9/22/2009 MA 12 12 M 9/18/2009 Mother called 9/18/09 @ 1:46p to re
357953 9/22/2009 OH 24 24 M 9/17/2009 FLUVIRIN vaccine administered in R
357954 9/22/2009 CA 82 82 F 9/18/2009 On 9/18/09 this volunteer for hospita
357955 9/22/2009 IL 36 36 M 9/15/2009 Next day fever, headache - 30 degr
357956 9/22/2009 CA 17 17 F 9/16/2009 Received tetanus shot 9-14-09. Tha
357957 9/22/2009 MT 66 66 F 9/17/2009 Pt. given Tdap, she is over 64 yrs. o
357958 9/22/2009 IL 13 13 M 9/15/2009 Mother stated child developed 2X3i
357959 9/22/2009 MO 49 49 F 9/18/2009 Pt said lymph node swollen on left s
357960 9/22/2009 AZ 5 5 F 9/16/2009 Fever only up to 102 degrees 1 day
357961 9/22/2009 NV 4 4 F 9/14/2009 Local reaction 3 - cm - Redness and
357963 9/22/2009 IA 0.7 0 0.7 M 9/13/2009 Vomited several times bit. 7 & 10:30
357964 9/22/2009 ME 55 55 M 9/3/2009 The pt reported fever, pain, redness
357965 9/22/2009 NH 9 9 M 9/11/2009 RA swelling, erythema 8x6 cm, indu
357966 9/22/2009 WV 7 0 0.5 M 9/22/2009 Flumist given on Thursday, Sept. 17
357967 9/22/2009 VA 39 39 F 9/22/2009 RASH 2 HOURS POST VACCINE.
357968 9/22/2009 MO 79 80 F 9/22/2009 she presented to the clinic with redn
357969 9/22/2009 NC 62 62 F 9/22/2009 CLIENT RECEIVED PNEUMOVAX
357971 9/22/2009 MO 73 73 M 9/22/2009 an hour and a half after getting a re
357972 9/22/2009 MN 1.5 1 0.5 F 9/22/2009 Cellulitis on bilateral thighs where in
357973 9/22/2009 OR 38 38 F 9/22/2009 ABOUT 10 MINUTES AFTER RECE
357974 9/22/2009 NJ 1.2 1 0.2 M 9/22/2009 On July 10, 2009 patient received o
357975 9/22/2009 CA 48 48 F 9/22/2009 9/18/09 8am client called and retur
357976 9/22/2009 CA 1.1 1 0.1 F 9/22/2009 HEP B NOT NEEDED
357977 9/22/2009 IL 47 47 M 9/22/2009 Broke out in red flat rash on inner a
357978 9/22/2009 OH 4 4 F 9/22/2009 R thigh started swelling on Sat.am 8
357979 9/22/2009 NY 52 52 F 9/22/2009 Within 1/2 hour of vaccine administr
357980 9/22/2009 CA 50 50 F 9/22/2009 I was injected with the flu vaccine o
357981 9/22/2009 MI 80 80 M 9/22/2009 patient says muscle still tender after
357982 9/22/2009 UT 4 4 F 9/22/2009 Patient put in car after receiving sho
357983 9/22/2009 NV 61 60 M 9/22/2009 L arm severe pain
357984 9/22/2009 MS 3 3 F 9/22/2009 rash began about 1 hour after shot
357985 9/22/2009 CA 67 67 F 9/22/2009 shingles rash eruption 2 weeks afte
357986 9/22/2009 AZ 11 11 F 9/22/2009 Immediately following injections, pa
357987 9/22/2009 GA 24 24 F 9/22/2009 Developed cough, throat/chest tight
357988 9/22/2009 MN 70 70 M 9/22/2009 I experienced extreme dizziness aft
357989 9/22/2009 PA 72 72 M 9/22/2009 Pt developed a red rash around the
357990 9/22/2009 GA 22 22 F 9/22/2009 Pt presented with swollen, firm uppe
357991 9/22/2009 VA 14 14 F 9/22/2009 Left arm injection site was warm, re
357992 9/22/2009 NC 43 43 F 9/22/2009 STARTED FEELING WEAK ABOUT
357993 9/22/2009 WA 52 52 F 9/22/2009 Within two hours of vaccination, the
357994 9/22/2009 IN 0.2 0 0.2 F 9/22/2009 Patient hadYa high fever and scream
357995 9/22/2009 AL 15 15 F 9/22/2009 9/17/09- Rec'd Tdap, varicella at He
357996 9/22/2009 CO 67 U 9/22/2009 three days after injection patient rep
357997 9/22/2009 WA 31 31 F 9/22/2009 Pt complained of itching, redness of
357998 9/22/2009 NC 42 42 F 9/22/2009 12 hours after vaccine, general feel
357999 9/22/2009 GA 32 32 F 9/22/2009 Developed chest/throat tightness, fl
358000 9/22/2009 CA 53 F 9/22/2009 3 hours after receiving seasonal infl
358001 9/22/2009 AR 13 13 M 9/22/2009 Pt had meningitis vaccine on 09/15/
358002 9/22/2009 WA 0.4 0 0.4 M 9/22/2009 Death of patient.
Y
358003 9/22/2009 SC 73 73 F 9/22/2009 Immediately after receiving flu vacci
358004 9/22/2009 OR 41 41 F 9/22/2009 Rash and some itching appeared on
358005 9/22/2009 VA 55 55 F 9/22/2009 Whole body itching, esp. of scalp an
358006 9/22/2009 MA 49 49 F 9/22/2009 TIngling/numbness down arm and in
358007 9/22/2009 NJ 32 32 F 9/22/2009 Around 11 pm started coughing and
358008 9/22/2009 CA 1.3 1 0.3 F 9/22/2009 Chicken pox rash 10 days after vac
358009 9/22/2009 SC 12 12 F 9/22/2009 Shortly after taking the vaccine she
358010 9/22/2009 PA 82 82 F 9/22/2009 Swollen right arm from elbow to fore
358011 9/22/2009 48 48 F 9/22/2009 Pt rcvd immunization on Friday and
358015 9/22/2009 OR 41 41 F 9/22/2009 Swollen node left side of neck.
358016 9/22/2009 IL 74 74 F 9/22/2009 The patient received a flu shot on W
358017 9/22/2009 IL 52 52 F 9/22/2009 Pt called 9/20/09 and complained o
358018 9/22/2009 NC 34 34 F 9/22/2009 Vanish Point retractable syringe 25G
358019 9/22/2009 CA 65 65 F 9/22/2009 Approximately 1-2 hours afterwards
358020 9/22/2009 IA 49 49 F 9/22/2009 Used 1 1/2 needle over 240 lbs not
358021 9/22/2009 IN 33 33 F 9/21/2009 Patient said she was experiencing s
358022 9/22/2009 WI 45 45 F 9/22/2009 Pt received FLUZONE on 9/15/09 a
358023 9/22/2009 AZ 4 4 M 9/18/2009 L arm swollen, warm. 5 cm long, 3 c
358024 9/22/2009 MA 21 21 F 9/22/2009 Syncope episode, lightheaded, nau
358025 9/22/2009 MI 48 48 M 9/22/2009 Patient was breathing very deeply.
358026 9/22/2009 CA 66 66 F 9/21/2009 Had fever of >103 and projectile vom
358027 9/22/2009 KY F Fever M/V, soreness at site within 1
358028 9/22/2009 VA 40 40 F 9/22/2009 Sx began 4 hours after vaccine adm
358029 9/22/2009 VA 6 6 F 9/22/2009 A/P neck pain - right side of neck w
358030 9/22/2009 MI 0.3 0 0.3 F 9/22/2009 Once arrived at home, from Dr office
358031 9/22/2009 MI 59 59 F 9/22/2009 Breathing difficulties started about 3
358032 9/22/2009 CA 71 71 M 9/21/2009 24 hrs after vaccination, pt's neck (b
358033 9/22/2009 CA 25 25 F Pain between the spine and shoulde
358034 9/22/2009 CA 67 67 M 9/22/2009 Patient experienced chest pain imm
358035 9/22/2009 NY 1 M 9/22/2009 Mother reports swollen leg.
358036 9/22/2009 MI 23 23 M Says shot did not hurt but 5-10 mins
358037 9/22/2009 VA 50 50 F 9/22/2009 Seen in clinic 9/17/09 with L arm inj
358038 9/22/2009 AZ 36 36 F 9/10/2009 Pt states when vaccine was injected
358039 9/22/2009 NY 4 4 F 9/4/2009 Within one hour after injections of p
358040 9/22/2009 TX 12 12 F 9/15/2009 Given MENACTRA, GARDASIL, Inf
358041 9/22/2009 VA 5 5 M 9/15/2009 Rash at injection AREA Erythema a
358042 9/22/2009 OH 76 76 M 9/14/2009 -patient got flu & pneumo shots on W
358043 9/22/2009 CA 5 5 F See copy of progress note.
358044 9/22/2009 NY 4 4 M 9/10/2009 Developed wheezing & cyanosis aft
358051 9/22/2009 FL 3 3 F 8/17/2009 A non-serious, spontaneous report
358077 9/22/2009 OK 2 2 0.2 F 8/22/2009 A non serious spontaneous report o
358078 9/22/2009 OH 1.6 M 8/21/2009 A non-serious spontaneous report o
DATEDIEDL_THREATER_VISIT HOSPITALHOSPDAYS X_STAY DISABLE RECOVD VAX_DATEONSET_DATE
n has been received from a physician concerning a child who was vaccinated with a dose ofUROTATEQ. Subsequently, the patient had dev
n has been received from a physician Y concerning an 8 week old female who on 17-DEC-2008 Y was vaccinated ### with the first ###dose of ROTAT
n has been received from a certifiedYmedical assistant (C.M.A.), for the Pregnancy Registry Y for GARDASIL, concerning
### 2/18/2008
a 14 year old femal
n has been received from a 62 yearYold male physician with environmental allergies, Y asthmaNand atopic 11/9/2008
dermatitis who on### 09-NOV-2008 w
n has been received from a physician concerning Y a patient (age and0 gender not reported) who Y on an unspecified date was vaccinated with
ction of redness, swelling, itching at injection site. Y 6/4/2008 6/5/2008
eruption, 3-4 lesions consistent withYVaricella lesions. Fever of 103 and febrile convulsions lasting
Y approx.1/24/2008
one minute. 2/8/2008
ed by patient, he began to complain Yof generalized itching, then nausea approximately 30 min. Y to 1 hr. after Hep ###B vaccine### administration.
02 within 24 hours of immunization,Ysmall pink lesions on trunk. Y 2/13/2008 2/14/2008
01 beginning within 24 hours of imm. Y Y 4/29/2008 4/30/2008
00.5 within 24 hours of immunization. No other illness symptoms. Y 5/27/2008 5/28/2008
ception area immediately after injection
Y of Gardasil and fell to floor and had full body twitching Y for 5 to 10 seconds.
1/2/2009 Was 1/2/2009
not observed fallin
given an adult Hep A dose instead of a pediactric dose. Y 4/3/2008 4/4/2008
A given to child instead of a pediactric dose. Y 1/2/2009 1/2/2009
ately 8 hours after receiving vaccines Y child spiked fever of 104 degrees(rectal) with vomiting Y and diarrhea. Twin### sister had ###fever spike as we
vaccines along with twin sister and Y spiked a fever of 103 degrees (rectal) within 8 hours afterY administration. She ### wasn't having
### the vomitti
with low-grade fever of 100.8 within 24 hours of immunizations. Y 6/10/2008 6/11/2008
m raised tender eryth around injection Y site, temperature of 99.8 Y 6/9/2008 6/11/2008
er, chills; local redness, swelling at site
Y of imm. Symptoms developed 7 days after imm. Y 5/30/2008 6/5/2008
or seizure still being determined,eventsY startedYin june of 08, she has 3Y experienced over 100 Nsyncope episodes5/1/2008
since6/24/2008
that time, a month or s
12/11/08 Pt reports bumps on the back of hands bilaterally approx 1cm in diameter that spread N all over body. ### Pt repots the ###bumps are ver
OUT W/ CHICKEN POX Y ### ###
cal swelling, induration, erythema, warmth,
Y and tenderness resulting in a physician office visit.
Y ### ###
U 1/2/2009
scribes reaction as increased tempYof 103F, Red hot swollen right arm, body aches and nausea. U Patient was seen### at1/2/2009
ED and recieved Ben
sting 1-5minutes. Fever 104+. Final Y Diagnosis: Febrile Convulsions. Additional: Acute Suppurative
Y OM12/8/2008
w/o ruptured eardrum.### Treatment
on L arm located about 2-3 in away from affected area where shot was administered. There Y were a 2 rounded ### red areas and ###then several
ospital 12/03/08 for swelling of rightYupper arm, treated with Bactrim, seen again 12/4/08 for Y flu area slightly
12/1/2008
bigger, 12/2/2008
sent to hospital
redness, induration, warmth in posterior upper arm (triceps area); occurred one mo. after vaccine. Y ### ###
d vaccines below and appeared well Y with no complaints. Upon exiting, pt collapsed in hallway.Y Pt unresponsive ###for a short ### time, with sligh
ender supra clavicular lymphadenopathy.Y Also some milder adenopathy in brachial region. Y Both were in left arm,### which had ###received DTA
ot flu shot and needle insertion didn't hurt, but "it felt like the needle hit something". Reports N
he had a "fireball"
11/3/2008
of pain when ### medicine inject
ceived flu shot Nov 3 & ok until Nov.Y 22nd. Woke up and had #6 pain left arm (upper only) with N pain to left11/3/2008
LUE distal to that.### Still has som
flu shot left deltoid on 11/3/08. No significant increased pain when administered flu shot as N compared with 11/3/2008
other years11/3/2008
when got flu shot. C
008 rec'd flu shot pt sore for 1st couple
Y of days. Ok until Nov. 15 pain (L) shoulder just belowNacromion #3. 11/3/2008
Nov 20 call Dr.### & used Alleve, T
getting her shot 11/3/2008. Reports Y bowling that night and noticing sore arm. Reports on 11/13/08
N noticed
11/3/2008
she was dropping ### things. Hav
08, shot given Nov 4 & 5 sore arm, "went away". Nov 8 & 9 am sore arm around injection site. N Reports 11/3/2008
some tingling 11/8/2008
left arm shoulder to e
m pain. Refusal RN interview. Therefore below is not completed. U 11/3/2008
ed his flu shot on Nov 3, 2008. States 1-2 days after the shot he had stiffness in his arm (left)...
N "Can't lay11/3/2008
on it"...." have
11/5/2008
to move it around a
eceived 11/3/08. States toward the end of November (approx. Nov 12th) he developed an achiness N in both
11/3/2008
shoulders rating ###it a #5. States e
3/08- W/E of Nov 8 & 9. -> sender couldn't hardly life her arm - was weak. On & off ever since. N 12/1/08 11/3/2008
left arm- had 11/9/2008
to hold arm close to h
t rash after getting vaccine, 12 days after rash blister appeared, a few days after that blister Nwere gone but 12/5/2008
area still itchy and
### painful. Patie
2008 flu shot given left arm. Nov 4, noted tensed muscle feel- expected. 8-10 days later right N shoulder 11/3/2008
started hurting in ###rotator cuff-intens
ection was blistered , raised , red and tender to touch. No fever. Plus irritability. Area aroundYsite was red x an ### elongated area ### appears "bur
rts child with "severe" hip and joint pain. Complains of severe pain in legs, feels like she has the flu, mom feels### this is more ###than an averag
itching one vaccine left arm administered area. Symptoms started 11/25/2008, Dx Arthrus reaction. Y Rx with ATARAX
### 12/2/2008
25 mg QID as neede
12/30/2008- Temp 101 degrees- redness and induration at left upper thigh. Y ### ###
ceived Menactra vaccine on 12-31-2008. Rapidly developed redness and swelling at injection Y site only. Area of### redness was ###5 in x 5 in. Are
veloped Shingles 3 days after vaccination. Patient had no prior history of Shingles, was notNill, had not been ill### for atleast ###
3 months prior to
occurred immediately after the shot was administered. large raised red area approximately 6Yinches in circumference ### with ### itching and burnin
d area approximately 4 inches in diameter with a pink circular eurthmia approximately another Y 2 inches surrounding ### the outer ### portion of the
nt complains of major swelling in the arm where the vaccine was administered. Swelling to the U point where1/2/2009
he could not 1/2/2009
lift his arm. He com
as given Zostavax vaccine at approximately
Y 12:30pm on 12/20/08 (subcutaneously per protocol) Y at Pharmacy. ### He had no problems
### at time
he had itching at injection site beginning soon after
Y vaccine given (given 2 12/19). Around midnight
Y 12/21, pt awoke ###to get out ###of bed and had
9/29/2008 Y N 9/29/2008 9/29/2008
flu vaccine 12/8. On 12/10 developed fever andY seizures. Sepsis work 2 up negative, head CTYnegative. Dx: 12/8/2008
complex febrile### seizures. 3/3/09
ngestion-nasal,ears,head - vision and hearing. Severe headaches. Chills - cold sweats-Y fever,
N severe weakness, ###confusion- ###very, very bad
er DTaP was given right thigh became erythematous and very edematous, no treatment necessary. Y 12/8/2008 ###
gue, itching around face, neck, scalp, shoulders, ears. Flushing of face, also apparent. Started U itching again 1/2/2009
left arm1/2/2009
toward back.
bumps on legs after shots. Y ### ###
ports temp of 103 degrees vomiting,Ydiarrhea starting 12/29/08. Seen at hospital on 1/1/09 U ### ###
and swelling around vaccination siteYwith warmth. Pt took BENADRYL 11/7/08 and IBUPROFEN Y X several
11/5/2008
days. Saw11/6/2008
family practitioner.
mber 26 at 10 am received the ZOSTAVAX vaccine; about 10pm had a terrible headache andU took 2 ADVIL. On### 27 at 2 am### woke up with ch
owing Flu vax developed pain and tenderness LUE with decreased ROM persist Sx as of 12-29-08. N ### ###
ain "10/10" in deltoid area rad. downYbiceps area also into shoulder/neck. This was flu shot #2 Y alt recall of first vaccine
### by manufacturer.
###
eeks after the f/u shot, I experienced
Y joint pain, in the foot, ankles, knees, neck, arm, elbow and hand. 2/10/09### Received PCP ### medical reco
struggling before shot- held by father. Shot was administered to L arm. Child looked up at Y mom and "smiled" ### then became ###briefly limp, res
ates she recieved Zostavax 12/10/08 Y and developed Zoster 12/13/08. Location of Zoster wasYon scalp ### ###
mplains of generalized urticara withYtightness in chest. Swelling of the tonsils was observed,Uhowever patient 1/5/2009
denied1/5/2009
any prior illness.
served having trouble breathing. Patient
Y had altered mental status. Patient did not improveUafter epi-pen1/5/2009 administration.
1/5/2009
ost- MMR reactions; fine pink papular rash and fever onset 8 days after MMR vaccine administration.Y Fever
5/21/2008
of 103. 5/29/2008
MMR rash. Pt developed pink macular Y rash on 5/14; initially few spots on legs, then on trunk Y and arms. Afebrile.
5/5/2008 Acting
5/14/2008
well. No other sx.
SEEN FOR WELL CHILD VISIT ON 12-29-2008,RECEIVED VARICELLA, HEPATITIS A, AND Y FLU VACCINES. ###PARENT ###CALLED ON 12
ness at vaccine site with low grade fever
Y of 100.5 and crankiness since night before Y 4/8/2008 4/9/2008
heat, redness, and swelling at imm site (right thigh). Y 4/25/2008 4/26/2008
le, red skin at DTaP imm site. Y 2/13/2008 2/15/2008
ENTED TO ALLERGY/IMMUNIZATIONS CLINIC C/O A 5 DAY RASH OVER BOTH ARMS AND U INSIDE OF THIGHS. ### 1/1/2009
PT BELIEVES IT M
rxn to DTaP- area of erythema, localized firm edema, and heat at DTaP site on arm Y 5/1/2008 5/2/2008
tous, maculopapular rash midly pruritic in the antecubital fossae bilaterally as well as dorsumNof the hands and ### on the1/1/2009
proximal legs bilatera
, bruising at site of immunization Y Y 3/24/2008 3/27/2008
ubcutaneous swelling at immunization Y site, not red, not tender. No additional symptoms. Y 4/15/2008 4/22/2008
icella vaccine swollen to the size of a half dollar, red and hot. Tender to the touch. No ShortnessY of Breath
4/28/2008 4/29/2008
ceived the MMR & Varicella vaccines in the left anterior thigh. She had a large area of redness Y with an irregular
1/5/2009 border
1/5/2009
present over the are
and swelling in left thigh where Varicella vaccine was given appeared 6 days after imm. Fever Y from 6/3 - 5/27/2008
6/5 (6-8 days 6/3/2008
after imm).
ot on 12/2/08 and on 12/4/2008 hadYsevere pain and edema in ankle and foot and with in a week Y total joint
12/2/2008
involvement.
12/4/2008
MD visit follow wee
Hives, trouble breathing / problems have
Y continued since first injection / she breaks out in hives
N when there 1/23/2008
is a change3/25/2008
of temperature (outs
s, pain in back, headache, chills, stiffness
Y Y 1/2/2009 1/2/2009
ays developed ipsilateral upper arm numbness and pain and tingling into the L hand. WithinYa few days,10/3/2008 ipsilateral thigh had numbness and
ceived vaccine on december 18, had Y fever of 102F on december 24 and first chicken pox were U noted on january ###3. 1/3/2009
was ordered for the patient and Prevnar was given. Patient felt light headed after the shot and Y fully recovered.
11/6/2008 11/6/2008
rmation was received on 23 December Y 2008 from a health care professional. A one year old Nmale patient with a### runny nose at the time of v
was reported by a lawyer and described the occurrence of joint pain in a female Y subject of unspecified
U age9/1/1999
who was vaccinated with LYME
o hospital on 12/24/08 for intussusception; ROTATEQ
Y vaccine was1given on 11/3/08. 1/21/09 Y Reviewed 11/3/2008
hospital medical### records of 12/23
STAVAX shot 6-16-08. Has had restricted range of motion in that arm. If she immobilizes
Y armU couple days 6/16/2008
the pain 6/16/2008
dissipates. Exercise ma
reased muscle pain, fatigue,
Y weakness, dysphagia, weight loss. Pt requiring Prednisone Y IVIGNevery q monthly.8/7/2007Methotrexate
9/1/2007headache, mu
daughter received her 1st shot of 3 (to complete full dose) she started having problemsY soon after.- light headed,
3/12/2008 dizziness,
3/12/2008 fainting, fatigue,
ches 2) Visual Change: felt like water was in her left eye 3) Neck pain 4) Total body myalgiasY5) BP 0f 140/100 ### ###
ved flu shot and Pneumovax in different arms on 11/11/08 . Later that day she developed L arm Y soreness with ### fevers to 102 ###degrees F. Als
as given PNEUMOVAX and Flu shot on 11/11/08 he developed chills and significant aches and Y fatigue later that ###day. Had ###a large red rash
o clinic on 12/30/08. After leaving PCP's
Y office (in clinic at approx. 5pm) - had tennis ball sized
U area of inflammation, ### redness ### at left arm - a
oped severe right arm pain a few hours
Y after the shot. Had chills and continued arm pain. DevelopedY a blotchy### red indurated ###rash on right d
was administered 12/15/08. Baby returned Y 12/16/08 with bloody diarrhea. Stool culture done-Ynegative for O and### P negative###for salmonella,
08 Patient received PNEUMOVAX around 230. At midnight woke up left arm sore at injection Y site at 2am woke### up pain at###
injection site radi
eaction to vaccine 1-2 days after administration. Nauseous, dizziness, headache, ringing in the ears. Was 10/8/2008
exposed10/9/2008
to grand children just p
ain (next morning) extending down arm to fingers - around left shoulder blade. Shortness ofYbreath - red (hives) ### fever. Pt called
### MD. Told t
esents with stomach pain, watery red eyes, itching, sweaty, red, flushed face. Y ### ###
d hypersensitivity reaction, warmth,Yredness and swelling locally. Patient reported hives bilaterallyY on arms, but### not observed
### on examinati
er vaccine had slight rash at vaccine site (RA-VARIVAX) with itching. Following day had rash Y on face - more
2/12/2008
pronounced
2/14/2008
with itching. No
diffuse maculo-papular rash on shoulder,Y back, upper thigh, neck, spots face, arms, no fever. Y non pruritic. ### 12/6/2008
r receiving Hep A vaccine pt developed sand papery rash, slight irritation. No fever, cough, sob, Y and no 7/21/2008
recent illness.
7/21/2008
U ### ###
lled, daughter is very weak, cannot Y keep eyes open. Llips are pale. Weak. Told mother to take Y her to ER. Took### to ER -started
### feeling better
derness, erythema left upper arm no fever- probable allergic reaction. Could not rule out cellulitis. U ### ###
ted 12/27, started on face and is slowly spreading downwards. ### ###
nch raised, erythematous area to right Y deltoid warm to touch. Vaccine given 12-22-08, reaction Y began on 12-23-08 ### around ### 1:00 pm. Reac
Y ### ###
tion was administered in left arm. Patient then passed out & was laid down. Pt was drooling, Y then her legs & arms
### extended ###outward (strai
p B injection in gluteal region. Y ###
ng, tingling and redness around corners of mouth. N ### ###
r well child visit and had just finished 10 day course OMNICEF this am for bilat. ear infections. Y Developed1/5/2009
generalized 1/5/2009
hives couple hrs afte
ea, light headed, dizziness at 13:20. B/P 136/85, P. 89 Denies respiratory problems. Face flushed, N diaphoretic.
1/5/2009 14:001/5/2009
continued c/o nause
after getting immz on rt lg. Treatment cold compress. 1/2/2009
ed receipt IM Influenza age 16-17 (1997-98)
Y with development red rash. Told not to take again....no
Y documentation
1/1/1998 available. No other sy
ught by mom for over 1 week h/o small "knot" right anterior thigh after vaccinations. No painYor discomfort. Small ### 1" diam. ###area of non ten
t arm still sore. Hard to grasp or lift heavy objects. Vaccine given on 12-4-08. No treatmentUgiven at this 12/4/2008
time. 12/5/2008
red and swollen 12cm by 7cm tense and tender Y ### ###
n: rash 10 days after SMPX, MEN, Y AVA vaccine. Believes due to SMPX vaccine. Symptom: Rash, diffuse3/3/2003 start: 03/10/2003
3/13/2003 Comment: 782
2/15/08, notes soreness, states no below waist eccythmosis, scattered lesion anterior and posterior trunk12/5/2008 and neck, reddened ### raised macul
d suspected immune reaction. Patient has lost sleep. Arm has pain without swelling. PatientUhas seen doctor and ###has had### Medrol DP + Sle
ection site x 2 days. On 3rd day radiated
Y to L shoulder at deltoid. Constant throbbing pain, restricts
N mobility. Severe
### enough ###to wake from s
ears, jaw tightness, lightheadedness, Y chest tightness 20 after Engerix-B #1 U 1/5/2009 1/5/2009
d vaccine on Friday. Saturday night pt noticed site where he received the vaccine was itching U and he had developed
### 11/1/2008
a rash that was abou
TWINRIX given. Blistery type scab 12/11/08, now has a scar barely visible and felt like had Yflu, muscle aches, 12/3/2008tiredness, maybe
### a little feve
on immunizations on 10-23-08- Broke out i rash (generalized) and periodic temp (101)- no temp today, but still### rash- irritable
###at first but not
chool nurse office-phone call from RN- states "big wheel- she can put 4 fingers over to coverUdiameter-appears### red raised ###
- slightly painful to
mplains of swelling at site of injection. stomach cramping and headache. Swelling at site of injection
Y approximately
10/6/2008 10/7/2008
the size of a nickel.
lled and stated this (L) arm around injection
Y is red and swollen and getting larger. States sheYhas been using10/7/2008
cool compresses,
10/8/2008 no fever. Ad
mplains of swelling at injection site on left arm. Swelling is approximately size of golf ball. Y 10/8/2008 10/9/2008
on 12/10/08 arm red from site of injection to elbow, took TYLENOL today in am, no relief as Uof yet (350pm) sleeping ### off and ###on all day due
ours, patient experienced motor function impairment with her legs buckling underneath her, Y 10-12 times over the ###next 3 hours
### falling each t
s given vaccines for Typhoid and Cholera.
Y I was allergic to them. In less than 24 Y
hrs I had difficulty
Y moving2/1/1982
and was taken
2/1/1982
to ER at hospital
01 Dr. ran rapid strep -> negative continue
Y to have ear and sinus trouble. 12/18 Dr. irrigated U(L) ear (perforated)### & did sinus
###x-rays.
e within 15 min - 5 cm red spot painful Y - itchy- muscle weakness- slept 12hrs- went to urgent Y care on 12/28/08. ### No infection ###at vaccine site-
administered in L thigh on 12/18/08. On 12/26/08, 4 vesicles appeared @ injection site. Slight U firm mass underneath,
### some
###discomfort.
ports that a rash began 3 days afterYthe vaccine on her hands. She described as bumps andNreported itching. Then ### rash progressed
### to her
ately 1 wk following injection: large hives 4" to 6" (blister like) on both legs from knee to hip forN about 1 week- shooting
### pains
###in hands-follow
acked out after receiving HPV vaccine. Y ### ###
headache, increase menstrual periods (3 in 2 months). N ###
aP on L deltoid very red, swollen, hot to touch, site of flu shot on R deltoid also very red, swollen
Y and hot to touch.
d area at vaccine site + about 1.5cm. Hardened area- circular. U 12/9/2008 12/9/2008
school teachers c/o S.O.B. & wheezing to school nurse - treated with Ibuprofen. Y ### ###
TC on 12/31/08- c/o .5cm red area with 3 small bumps that appeared 2 days after Immunization. Y ### ###
houlder w/red itchy rash Y U ### ###
1520 client fainted 5-10 secs., did not fall, no injuries noted, B/P 90/60, R14, P60, no SOB noted,Y push/grips strong,### perria### intact, skin u/d a
arm just distal to shoulder, reddened
Y area roughly 4cm in diameter with another 1cm borderUwhich is lightly reddened. ### The
###area is very wa
n has been received from a Certified Y Medical Assistant for the Pregnancy Registry for GARDASIL Y concerning
6/30/2008a 19 year
6/30/2008
old female with pen
n has been received from a consumer, for the Pregnancy Registry for GARDASIL vaccine, concerning U his 25 year old wife general anesthe
n has been received from a physician, for the pregnancy registry for GARDASIL, concerningUan 18 year 5/27/2008 old female 8/30/2008
with a history of 2 pregn
n has been received from an office manager concerning
Y a female who
4 Y in August 2007, was Y vaccinated with
8/15/2007
a dose 8/17/2007
of PNEUMOVAX 23 va
n has been received from a physician Y concerning Y a 65 year old female4 who was vaccinated Y with a second 0.5 ### ml dose of PNEUMOVAX
### 23
n has been received from a physician concerning his 71 year old wife with no known Y allergiesN and no pertinent### medical history
### who on 19-D
symptoms 4 weeks post Influenza vaccine,
Y increased difficulty ambulating x 4 weeks myalgias,N neuropathies,10/9/2008evaluated
11/9/2008
by ER physician on
swelling and induration anterior Right Y thigh at typical location of immunization -- MMR and DTaP Y adm on3/25/2008
right side x 2-34/4/2008
days. Afebrile. Tre
d a seizure two hours after recievingY the vaccine. She had no history of seizures and she did Y not have a fever### at the time###
m, mild redness, progressing in severity
Y and radiating dowm arm to wrist and up into shoulder U and neck, rash ### at injection ###
site extending d
ed that the evening after receiving her shot she had redness, swelling, and slight pain at siteYof injection. 1/5/2009 1/5/2009
ated that pt developed a mild URI and vomitingY3 days post immunization 3 and a fever of 102.
Y Parents brought
12/3/2008 pt in12/6/2008
2 weeks post immuniza
minutes of getting vaccines Left leg (injection site) broke out with whelps spreading to the abdomen.
U Patient1/5/2009
given 1/41/5/2009
tsp. of Benadryl po an
ted with approx 5 cm area of redness, Y sl warmth but minimal swelling. Mildly tender. No streaking.
Y Rx'd 3/19/2008
Tylenol or Motrin
3/20/2008
for discomfort.
01 -102, body aches, and fatique x 4 days. Y 1/2/2009 1/3/2009
RECIEVED VACCINE. 12/23/08 VISITED DOCTOR COMPLAINING OF UPPER RESPIRATORY U INFECTION/### EXACERBATION
### OF ASTH
r (102.9F), SOB & rash 3 days afterYreceiving Pediarix,
Y hib, Prevnar.4 Evaluated in ER 11/6/08Y at Hospital. 11/3/2008
Patient admitted
11/6/2008 for 1 week due
as given Hep B shot at 1Yminute of age.Y On theYsecond day of life patient
84 Y was having Y seizures
N and could no longer ### drink from### her bottle. O
noted on right arm near site of varicella administration. U ### 1/3/2009
given in same arm 12/20/08. 12/22/08 Rt arm w/2" area of erythema, ver tender, induration N and tender distal deltoid,
### continue
### pain control,
was given Tdap vaccination on 12/29/2008
Y for post exposure to Whooping cough. He followed Y up on 12/30/2008 ### c/o dizziness,
### chills, wea
0 hours after getting Tetanus booster I started having servere chills and body aches the entire U day. The night 1/3/2009
after that
1/4/2009
I had a fever of 102.
was reported by a lawyer and described the occurrence of rheumatological symptoms in a female U subject3/1/1999
of unspecified
3/15/1999
age who was vacc
spontaneous report of Bell's Palsy has been received from a Registered Nurse concerning aN52-year-old10/5/2008 female subsequent
10/5/2008to FLUMIST. M
previously health 8-month-old
Y boy with a 2-weekY history of runny nose
25 and cough without fever.Y Three days prior ###to admission
### he developed
mber 10 pt received Flu vaccine. At 9:30
Y am. After
Y the vaccine he went 1 to the dentist who prescribed
U an antibiotic###for the tooth
### infection. On
ite hurt longer than any previous flu shot and muscle continues to hurt especially with movement N of arm, with some ### restriction
### of movemen
sore for prolonged amount of time after receiving flu shot. Burning all the way down to the elbow Y for a few seconds, ### then ached### for a month
sore at site of injection for a prolonged
Y amount of time immediately after injection. Y ### ###
sore after receiving flu shot for a prolonged
Y amount of time "joint pain"-not relieved by Ibuprofen.
Y ### ###
y-absence of muscular control of right
Y facial muscles-upper, middle, lower face-Drooping eye N and mouth. 12/8/2008 ###
t dizzy, was short of breath, and hadY a dry mouth 20 minutes after leaving the hospital, which Y lasted for 4/14/2008
2 hrs. In the 4/14/2008
evening the patient de
ateral leg pain with cramping. Generalized muscle and joint pain, symptoms began around midnight U today.1/5/2009 1/6/2009
hrs of vaccine. L arm at vaccine swollen, red and painful. Treated with BENADRYL. Also, had Y a fever. ### ###
6:00pm, Rash appeared on L arm and Y L side of face and chest. Pt. also had local reaction ofY warmth and redness, ### described ### "like the size
swelling (L) lateral thigh. ### ###
accine and after a few min. later had asthenia, numbness and tingling down (L) arm, dizzy, ringingN in ears, frontal headache, no SOB. Coug
### N ### ###
h left elbow pain, progressed to rightY elbow, then to other joints. Peaked, with all over, achy N body and high 10/9/2008
fever. Patient has###been slowly g
flu clinic 17 mo was given FLUMIST approved for equal to or greater than 2 year olds. No reactions.
U 11/6/2008
on the 11th with a horrendous headache. Lasted about 3 hrs. Woke up on the 12th with a bad Y headache and ### dizziness. ###Headache went a
us case was received from a health professional on 27 December 2008. The patient was enrolled Y in a study5/3/2006
for which Sanofi Pasteur was n
ort was received 27 December 2008Yfrom an investigator as part of a study for which sanofi pasteur is not 5/2/2006 a sponsor. A 32 ### year old female p
ort received on 27 December 2008 from Y a physician. A 31-year-old pregnant female experienced Y oligohydramnios
5/4/2006approximately### 193 days a
ort was received 27 December 2008Yfrom an investigator as part of a study for which sanofi pasteur is not 5/1/2006 a sponsor. A 28-year-old
### pregna
ort received on 27 December 2008, Y from a physician, as part of a study for which is not a sponsor.
Y A 38-year-old
5/4/2006 pregnant female experienc
ort was received 27 December 2008Yfrom an investigator as part of a study for which sanofi pasteur Y is not 5/3/2006
a sponsor. A 28-year-old pregnan
ort was received 27 December 2008Yfrom an investigator as part of a study for which Sanofi Pasteur is not5/8/2006 a sponsor.8/2/2006
A 30 year old female
ort was received on 27 December 2008 Y from an investigator as part of a study for which Sanofi U Pasteur is 5/5/2006
not the sponsor.
1/10/2006 A 29 year old fem
ort was received 27 December 2008 from an investigator as part of a study for which Sanofi Pasteur is not5/8/2006 a sponsor.8/2/2006
A neonate male patie
rmation was received on 20 OctoberY2008 from a health care professional. A 51 year old female Y patient received ### an intramuscular
### injection
ts have given patient the not unexpected warmth and redness at the shot site. What is unusual U is that he subsequently
### developed hyper pi
n has been received from a consumer concerning his 77 year old wife with depression, Penicillin N allergy, Sulfonamide
### allergy,
### LEVAQUIN a
eared 3 days after immunization was given. Rash is located behind the left ear and has spread N onto the12/1/2008
neck. Rash 12/4/2008
is described as itchy.
ast her 1 yr. shots she started running a 100,5 temp. she had vomiting and loose stools..sheYalso developed a ### rash 11/1/2008
all over..i was told the r
eadache 48 hours after administration of Zostivax and pneumococcal vaccines. Redness to Y site of zoster 1/2/2009
vaccination.1/4/2009
veloped upper respiratory symptoms, Y cough, and fussiness one day following his 2 month immunizations.
Y 7 days###following### vaccination he d
zziness lasting 6 - 8 hours. No other symptoms. Completely resolved in approximately 18 hours. Y ### ###
ped a blister like rash on top of left hand about 2 hours after receiving the vaccine parents administered
Y 2 1/6/2009
children's chewable
1/6/2009 Benadryl chil
nauseous, ringing in the ears, paleness for about 10 minutes after the vaccine. Y 1/7/2009 1/7/2009
e in one day later with hives, treatedY with atarax. Y 1/6/2009 1/6/2009
esented to Immunization clinic on 01/06/09 for the second dose of HPV vaccine, having received N the first8/19/2008
dose on 08/19/08.
8/19/2008 During screeni
mplained of severe pain, weaknessYin upper arm from site of injection to elbow onset immediately N post vaccine.
12/8/2008 Reported
12/8/2008 12/15/08, advise
r vaccine administration, painful, red swelling of left upper arm U 1/5/2009 1/6/2009
ERED FROM HIVES, RASHES ANDY A MILD GRADE FEVER FOR 7 DAYS FOLLOWING VACCINATION. Y 12/1/2007
THE PT 12/2/2007
RECEIVED TX WITH P
d area on arm warm and swollen. U 1/6/2009 1/7/2009
s and swelling to left upper arm x 4 Ydays s/p pneumococcal vaccination 28NOV08. Reports Y onset of symptoms### one12/2/2008
day following vaccinatio
after receiving the first dose of the injectable flu vaccine, the patient developed red bumps. There Y were three larger ### bumps### near the injection
d Gardasil shot and then Depo-Provera Y about 1 week later. 2 months later, this past Friday she passed a mass### of tissue
1/2/2009
vaginally that was
t. Wed night to check up on anything and wife told me he was in bed. He noticed earlier thatYevening hive-like 1/3/2009red bumps1/7/2009
on arms, torso an
was reported by a lawyer and described the occurrence
Y of joint pain0 in a 45-year-old femaleNsubject who6/14/2000
was vaccinated with LYMERIX. A
arm began itching. Got worse and 1 day later heat & redness began than increased until theYpatient took Benadryl. ### I1/2/2009
advised ice- good res
sore after receiving flu shot for a prolonged
Y amount of time initially felt burning 3 weeks following.
Y Arm was painful ###and hard ### to lift.
rmation was received on 02 December Y 2008 from a health care professional. A 40 year old female N patient with### a nut allergy ###received an int
tis; red, warm, tender treated with Keflex and Septra Y ### ###
ter received her second injection of YGARDASIL on December 22, 2008. On December 31, 2008 U she had a sudden ### and severe ### hives react
ella-like rash - Rt upper arm 3 clustered vesicles erupting 1 wk ago, now crusted and 2 1-2 mm Y erythematous papules ### 1/1/2009
on ant. chest. + URI
ction with itching, redness, and swelling on right thigh at the site of Flu vaccine. Y ### ###
fever 106 degrees F, redness at injection
Y site. N 1/5/2009 1/6/2009
ceived first dose of GARDASIL and may have been pregnant 7/31/08-LMP-5/15/08 receivedYGARDASIL6/19/2008 16-1608
within minutes of administration of vaccines. Y ### ###
L administered 12/22/08, within hours patient noticed "tremors" (looks like she is having chills). Y Family and friends ### noticed### episodes too. Ep
night, back pain, fever, headache, neck,
Y stiffness, and arm pain. U 1/5/2009 1/6/2009
ort received from health authorities in Y a foreign country on 5 January 2009 under the authority Y reference number:
7/4/2008 PL-URPL-OCR-20081218
7/4/2008
N
ort received on 05 January 2009 from Y an other manufacturer who had provided a copy of a litigation report. 3/27/2001
The report 3/27/2001
referenced a case. F
7th Monday: Nurse at medical center Y gave me Pneumonia shot on Right shoulder. The shotNwas high on the shoulder ### and### it pricked the Bo
ped seizure activity < 12 hours. S/P YHep A vaccine Y #2. Admitted and3started on Anticonvulsants. U 3/3/09 MR 1/7/2009
received 1/7/2009
for DOS 1/7-10/2009 w
### N ### ###
d with juvenile onset diabetes
Y mellitus 17 days Y after live flu vaccine. 11/12/09-records
Y receivedN for DOS 12/14-12/15/08-DC
### ###
DX: New onset d
3:30 am Hives hospital ER. (10/18/08 Y 9:22 am city hospital ER cover in hives- extreme itching-skin Y turning black ###and blue ### from top to bottom
8pm- Body aches, fever/chills, postYnasal drip, sore throat. Evening of 10/23/08, had increased Y sinus congestion, ### body aches, ### fever/chills
ministered flu vaccine; patient began to faint (vasovagal episode) occurred; vital signs taken. Y ### ###
ness & swelling - started - by 4-5 pm on 1-5-09 - gotten progressively worse & longer. > 50 cent. U noted at office
1/5/2009 visit 1-7-09
1/5/2009 445pm.
facial swelling hives body approximately 3 hours after receiving immunization contacted PCP- Y MD given ZYRTEC ### not seen ### by PCP. Mothe
n left arm - net sore at first - but after 2 days very painful when lifting, putting on coat - etc. Lasted
Y about 2 weeks. ###Daughter### was injected as
Y Y ### ###
le with left arm swelling from mid upperY arm to mid lower arm. After speaking with provider possibly Y cellulitis not### associated. However starts
ceived VARIVAX on 9/26/02 in the right thigh. She returns to clinic on 9/22/03 with a diagnosis of shingles. 9/26/2002
It is described
9/22/2003 in the medical re
ceived VARIVAX on 1/12/98 at another facility. Site of immunization is not recorded in records. U She came 1/12/1998
to our facility on### 11/26/99 with a d
ceived VARIVAX on 5/7/07 in the right thigh. She returns to clinic on 10/09/08 with diagnosisUof shingles described 5/7/2007 in 10/9/2008
medical record as "loc
ceived VARIVAX on 2/15/05 and 9/18/07. Both immunizations were administered in the left thigh. Patient 2/15/2005
returns to 3/2/2006
clinic on 3/2/06 with a
ceived VARIVAX on 12/27/02 and returns to clinic on 6/2/04 with a diagnosis of shingles. She U received the VARIVAX ### 6/2/2004
in the right arm. The s
alergica, ronchas, comez¢n, mano, problemas al tragar, se me hincho la cara, hasta la fecha U no se me quita el dolor de cabeza, me siento
action, hives, itchiness, dizziness, problem swallowing, my face was swollen, to this day myUheadache doesn't go away, I feel very nervous
n has been received from a physician concerning an 18 year old female with no relevant medical N history or allergies who in approximately 2
-Patient received Td on 9/26/2008 and started having soreness at beginning of November/08--started N having
9/26/2008
upper 11/1/2008
arm, neck pain (left side
creased swelling on L arm from top of shoulder to mid-humerus, rednessover same area withNitching. Pt. also 1/6/2009
complains1/7/2009
of pain upon move
on arm and spreading. Hot to touch,Ychild could not move arm said it felt numb. Swollen Y ### 1/5/2009
nt received the Pneumovax injection in the Right arm and on 1/7/09 she had noticed increased Y pain in the1/6/2009
arm along 1/7/2009
with 2 areas of rednes
out one minute of receiving Gardasil I immediately started throwing up, became dizzy, covered Y in sweat, 5/31/2007
shaking, and 5/31/2007
felt faint. I was requir
ned 1/08/09 and stated that she had spoken with her friend who had a reaction to the Tetanus U vaccine, and 9/9/2008
she wanted to### report that she h
acc,pt c/o dizzyness,when seen pt looked pale and sweaty,pulse 55,bp 88/54,pt put on tableYat trendlenberg 1/7/2009
position1/7/2009
felt better ,bp 99/69,p
as administered at 11:00am on Monday. By 10:00pm Tuesday evening patient has an extremely running 1/5/2009 nose, coughing,1/6/2009low fever ~100, s
rting 1 day after shot. Strong family history of allergy to flu shot, in mother and brother. Y 1/6/2009 1/7/2009
a call from patient above stating that she became very ill 4 days after the 2 vaccines were given. Y Pt. reported nausea,
### extreme
### fatigue, wh
p after injection. Awoke limping with red, hot, tender swollen leg within 5 hours of IZ. Remained Y hot, became itchy, ### leg color ###uneven with do
perienced acute leg weakness progressing
Y to include arm weakness and overall body weakness N within a11/4/2008
two-week period. ###Saw family phy
phone call received by health department
Y nurse from patient's mother with complaints of patientY having itching1/6/2009throat,1/6/2009
hives, and SOB, stat
d female presented to Student Health Center at TAMU on 11/25/08 with complaint of right arm U pain ever since ### she got her### flu shot in mid o
hree days later w/complaint of fever, chills for two days. Has large, warm, reddened area at site, U swelling. 1/5/2009
States began 1/6/2009
the day after injecti
tingling and numbness/neuropathy-type symptoms in arm vaccine was administered (right). NShe also states 7/25/2008
some 7/26/2008
motor symptoms, mainl
the shots on 10/23/2008 at 19:45 pm. Y After 24 hours developed itching and swelling of the forearmY that extended ### to the entire
### arm. The ar
n minutes after Td shot pt. had seizure Y in car with mother. Pt. reported dizziness, ears ringing, N confusion upon1/6/2008
arousal.1/6/2008
Pt. reporting body ac
S FACE; NOSE; EYE NOT INVOLVED TREATED WITH ACYCLOVIR 800MG 5X/DAY Y ### ###
rre Syndrome after receivingY the flu Yshot. VeryYsevere case, currently34 Yin intensive care at Hospital
U 2/25/09-records ### received
1/1/2009 for DOS 1/5-2/
an MMR shot on December 19, 2008 as part of my registration requrements. As of today, there U remains a very ###tender area ###on my right arm
of double pneumonia one Y week after Y vaccines were given. Treated w/ initial antibiotic shots,Ythen oral antibiotic
9/30/2008 Amoxicillin.
10/5/2008 This was her 2
12/4/2008 N ### 12/4/2008
bilious vomiting, abd. bloating, pain -YER admitted Y - multiple tests run2(x-rays, labs) - no etiology
N - remains fussy, ###
spitting
1/4/2009
more - mother feels
s of upper lip < lower lip as well a little
Y swelling. Sinus area feel dry, rash developed on legs,Yarms, and face. 1/7/2009
Swelling1/7/2009
of lower eye lids.
uid-filled vesicles on red bases appeared on 1/2/09. VARIVAX done 12/15/08. Y ### 1/2/2009
o RUE to include erythema and edema 15cmx9cm. Warm to touch and pain. SXS started last U night. Pt tx'd1/7/2009
IV Abx and 1/7/2009
PO Abx.
ction to ADACEL . Pt has redness, warmth, pain, induration measuring as 3"x5" around injection U site. 1/5/2009 1/5/2009
dness - Left deltoid - pt. did not use ice or take analgesic. She decided not to wait for Dr. - he U was seeing 1/6/2009
in-pts @ hospital.
1/7/2009Advised to use
onsciousness approximately ten minutes after GARDASIL, episode lasting less than 30 seconds. Y 1/6/2009 1/6/2009
er vaccine, infant became extremely fussy, "stomach hurting" screamed with feelings- has only N gradually improved- ### on RANITIDE### and Hypo
n has been received regarding a case in litigation as reported in a newspaper article Y that theNauthor's normal 4 year old daughter was trans
follow up information has been received
Y from a licensed practical nurse (L.P.N.) for the Pregnancy
Y Registry
1/23/2008
for GARDASIL
3/8/2008 concerning a 26
n has been received from a physician Y concerning a female patient with a history Y of mouth ulcers
N who on8/18/2007
an unknown 8/18/2007
date was vaccinated
n has been received from a consumer Y concerning Y her 16 year old daughter
4 with no medical Nhistory or drug
12/6/2008
allergies12/7/2008
who on 06-DEC-2008
n has been received from a consumer, who is the mother of the patient, for the pregnancy registry Y for GARDASIL concerning
2/25/2008 an 18 year ol
d soreness/pain complaints from site of injection diminishing over time but lasting 5 weeks. ComplaintsY finally subsided
### 12/31/09.
###
ates child developed swelling to the Yleft deltoid area approximately 8-12 hours after receivingYflu vaccine. Also he ###complained ###of itching at th
ination patient appeared pale and weak. He was instructed to sit down. His head fell to the side Y and his eyes closed. ### He opened ### his eyes s
ately ten minutes after his vaccination, patient was standing by the door and began to faint and Y slowly fall to floor.### No injuries### reported. He
as mistakenly administered both DT & TDAP vaccines - no adverse reaction was observed subsequently Y ###
ted with redness on his torso and reported having a fever the night after receiving influenza vaccine.Y Pt referred
1/3/2009 to primary
1/3/2009 care provider.
cella and FLUZONE R arm 12/15/2008. Y Mother reports today an area " 3"x4", that is warm, U red, hard and rashy" ###at the injection
### site R arm
and approximately 15-30 sec after injection. Was assisted to prone position. No respiratory effort for approximately ### 30 seconds.### Color re
n has been received from a physician Y concerning a 77 year old female patient with Y VICODIN, N LYRICA and 10/5/2007
AMBIEN12/7/2008
allergies, diabetes me
nstop day of vaccines unconsolable Y 12/5/2008 12/5/2008
d right deltoid IM injection of PNEUMOVAX
Y and since then had local reaction, large, of pain,Uedema, a erythema ###slowly improving.
###
oid soreness, dizziness and joint pain. U 1/2/2009 1/2/2009
ed vaccine on 12-10-08. 2. Itching aroundY neck and back 7 day later. 3. Itching from head to N toe. Also rash inside ###mouth. ###
ceived vaccines (PREVNAR, HAVRIX, VARIVAX and MMR II) on 10-16-08. Follow up with FNP Y on 10-20-08 d/t ###
a rash that###started on 10-1
al exam. Child received HIB and DTP on 7/15/08. Child was very limp, quiet the next day, and Y left leg where HIB was given was red and a
with auras, nausea and headache. Y 1/5/2009 1/5/2009
n has been received from a Registered Y Nurse for the Pregnancy Registry for GARDASIL concerning U an 18 year ###
old1/16/2008
female who on 11-OCT
IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANASAL ROUTE Y ###
Swelling 4 inches around injection site; observation U 1/7/2009 1/9/2009
sick the week before vaccine with aY'virus'. Day of vaccine was feeling ok, day following vaccine Y (11/21/08) thought ### she had ###burner her ton
D INFLUENZA IM VACCINE VIA INTRANASAL ROUTE Y ###
IVED THE INFLUENZA INTRAMUSCARLY VACCINE VIA INTRANSASAL ROUTE Y ###
left elbow to left shoulder with pain/deep ache all around the left shoulder, and Nausea. SheYstates the nausea 1/7/2009 started
1/7/2009
just shortly after rec
cieved Flumist (lot 500570P)
Y intranasal
Y 13Nov08 Y as part of his military
17 Yunit vaccination
Y program.
N He developed### vague lower###back pain app
atient @ 11am. Started w/diarrhea after getting 1st Hep a/b combo.injection during the night(approx.12-14
U 1/8/2009
hours after 1/8/2009
shot). Morning is no
fter injection, heat flush & abd cramping.
Y 2) 10 Ymin after, itching & heat
3 @ injection site. 3) 15N min after, itching### & hives over###entire arm/sho
d swelling to left upper arm @ 7pm Yon 12/4/08 but did't think much of it until swelling had increased
Y the next
12/4/2008
morning.12/4/2008
Child seen in health
SERIES OF 3 GARDISIL VACCINES, Y HAVE BEEN EXPERIENCING PAIN IN FEET, HANDS, N THEN OTHER 8/2/2007 JOINTS,
9/2/2007
BEEN TO DOCTO
009 CHILD STARTED RUNNING A Y FEVER, 1O2.2 PARENTS WERE ADVISED TO TAKE TO Y ER. 2 DAYS PRIOR ### TO 1/1/2009
THIS CHILD WAS
tdap in the afternoon of 1-06-09. At 6pm that evening noticed a rash around site (Left arm) that Y injection was1/6/2009
given. Reported
1/9/2009 this on 1-09-0
WO DAYS OFIMMUNIZATION RASH APPEARED AT LOCAL SITE BECAME BIGGER THROUGH Y OUT DAY ### TO APPROX ###7 INCHES IN D
ceived HPV vaccine on 10/23/07
Y and
Y 12/31/07.Y On 2/25/08 patient 7presented with breathingYdifficulty and was### diagnosed
2/25/2008with pulmonary e
where dtap and polio was given is red and warm to touch. Not painful. Moving fine, no fever,Yno other s/s4/28/2008 illness 4/30/2008
patient called immunization clinic at 1:15pm today 01/09/2009 asking for nurse who administered U vaccination
1/8/2009to her daughter.
1/9/2009 Mother claim
000-Patient calls this office and speaks to this nurse. States that @ approx. 0630 today sheYwoke up to itchy 1/6/2009
red bumps1/7/2009
all over her (R) ar
ry 6, 2009, 2.5 weeks after vaccine adminstration, Macular rash on chest neck and back, vesicular Y lesions on back,### number
1/5/2009 less than 10. C
NING OF PAIN AND TENDERNESS SINCE INJECTION, PAINFUL TO RAISE ARM OR LAY U ON ARM.STATES ###ARM WAS ###SWOLLEN AN
ceived vaccine on 12/18/08. Contacted Y telephone helpline 12/19/08 to report arm is swollen,Yred, warm to the ### touch; temp### was 98. Patient
C/O at about 5 - 6 PM started with chills and fever, highest temp 102.9, and headache. In morning Y noticed1/6/2009
both arms1/6/2009
red (from top of hands
hat Sunday a.m. feeling very tired. YComplained of arms feeling heavy and a headache. Later Y that day complained
8/18/2008 8/31/2008
of numbness and tinglin
accine at 4 in the afternoon, the pain at site woke me up at 3:30 am. Site was raised red andYhive like. Took 1/7/2009
benadryl 1/8/2009
and advil. Site size big
was reported by a healthcare professional
Y via sales representative and described the occurrence
N of muscle
7/1/2008
wasting in an adult female sub
was reported by a physician
Y via a sales representative
Y and described 0 the occurrence
Y of abdominal
U pain in a 2-month-old subject of unspec
Y via a sales representative
Y and described the occurrence
Y of abdominal
U pain in a 2-month-old subject of unspec
was reported by a physician and a Y sales representative and described the occurrence
Y of Bell's
N palsy in a 32-year-old### 1/6/2009
female subject who w
d 1/8/09 stating that he had receivedYthe Shingles vaccine the day before and was experiencing U facial numbness,
1/7/2009swollen 1/8/2009
tongue and droop
ates child developed Temp 103.8 within 24 hours of vaccine administration with prolonged crying. Y Did not
11/5/2008
seen medical11/6/2008
TR. Advised physi
ation Provided U 5/23/2008
ported to facility with 5 1/2 cm x 8cm reddened and indurated area on left deltoid are. Area was Y warm to touch1/6/2009 and patient
1/7/2009
reported feeling
ent received MENACTRA about 9:15 AM. V/S given and reviewed side effects. After gettingYhome, client1/2/2009 states having1/2/2009
S.O.B. and tightnes
r body started 1/8/09, worsened 1/9/09. Fever. U ### 1/8/2009
d area with erythema/ warmth. Y 1/6/2009 1/7/2009
ven GARDASIL- fainted after getting it, patient complained of headache prior to fainting. Y 1/8/2009 1/8/2009
theaded, tachycardia, intermittent tinnitus.
Y Cramps not related to monthly cycle. Mood swings, N abnormal3/18/2008
pap smear.4/22/2008
er immunization complained of nausea, light headed, dizziness patient monitored. Symptoms Y resolved. Patient
1/9/2009said she
1/9/2009
was better
e. 2/18/09 Neurology consult received Y dated 1/15/09 with no definite dx: Impression: Transient U word finding difficulties
### 1/8/2009
(dysphasia) with R h
cc IM right deltoid. With in 10 min after IM injection mother noted redness and bruise area 50 Y mm around1/9/2009
top of shoulder.
1/9/2009
veloped shingle along C3 within 1 week of ZOSTAVAX. Y ### ###
veloped redness and pain at injection Y site. Evaluated by provider as cellulitis. Treated with CEPHALEXIN
Y for 7###
days.1/1/2009
Re- evaluated one we
hrs of receiving 4 month vaccine (PEDIARIX; Act HIB; PREVNAR; ROTATEQ) child had sleep Y disturbance and### "high1/2/2009
pitched scream-supe
U 1/8/2009 1/9/2009
nset of 104 degree fever. Parents administered
Y TYLENOL alternating with MOTRIN. At 1:33pm Y parents called.
1/5/2009Child1/6/2009
with 106 degree fever
welling. Increase fever of 45ø C and with projectile vomiting 15-20 mins. after vaccine given symptoms
Y started.
1/7/2009Pt went
1/7/2009
to ER 11 pm 1/8/09
e fever, sore throat, swollen neck lymph nodes, runny nose, muscle aches and fatigue. Taking U ibuprofen. 1/8/2009 1/9/2009
son (a DMD) is visiting from out of time
Y and noticed that his mother had a raised area on her U arm that he found
1/8/2009
out was1/9/2009
the injection site. It
broma at site (subcutaneous tissue on left arm) of Pneumovax injection. I first noticed a scab Y had formed 9/18/2008
on the site and was### surprised. It
and fever. Had Vaccine mid-afternoon Y on the 10th. Had a fever that evening and through theUnight. Early1/10/2009
morning complained
1/10/2009 of stomach a
sly received two doses of Meningococcal vaccine Y 1/10/2009
00dF), which lasted several months.Y Cough, which lasted a couple months. Head cold, too.Y (Treatment10/9/2008 was with three
10/9/2008
sequential and diff
n afternoon, shut van sliding door on my left hand. Went to ER due to severe pain, possibleNbroken hand.1/7/2009 Had a tetanus
1/8/2009
shot during ER tr
erature, respiratory illness
Y ,flu,running nose. 1/15/09-per vaccine provider phone call-patientNpresented to1/7/2009office 4 days1/9/2009
after vaccine C/O flu
nflamation, pain at shot site...about 2 1/2 X 3 1/2 inches, lasted over 1 week. Now, 2 weeksUlater, site is visibly### pink; swelling,
### inflation and
changes including fussiness towards bath water, speech regression to none and glossy eyedYstaring with 1/5/2009 lack of smiling
1/6/2009
and responsivenes
n has been received from a registered Y nurse, for the Pregnancy Registry for GARDASIL concerning Y an 18 year###old female### who on 24-NOV
n has been received from a physician concerning an 18 year old female who in May Y 2008 was U vaccinated5/1/2008
with the third dose of GARDASIL
N
n has been received from a physician Y concerningY a 9 weeks old male, 5 who on 19-DEC-2008, Y was vaccinated with ### the "normal
### dose" of RO
st PNEUMOVAX - 0 reachon 1-6-09Y2nd PNEUMOVAX - tenderness, redness from site to elbow Y (Lt), hardness
1/6/2009@ site1/6/2009
local RXN only - no
nfection near injection site of upper Yleft arm. N ### ###
omiting, fatigue and hot flashes. Started 20 min after injection. Pt received at work and sent U home early 1/6/2009 1/6/2009
onsciousness sonorous breathing rigid Y extremities twitching extremities lasting approximately Y 15-20 minutes.### ###
g total body urticaria. Treated with antihistamine/steroids. Y
ed and reported a rash all over her body
Y on 12/24/08. Went to ER on 12/29/08 - Urgent careY at medical center.### Rx with Methylprednisolon
###
Y ### 1/6/2009
ness at injection site that lasted 4 days- 0 raised - some pain with palpation - itching on 3 of Y 4. ### ###
ed unconsolable crying + Screaming >4hrs following immunizations U ### ###
MMR + VARIVAX vaccine on 12/22/08 for an employment physical, experienced rash on abdomen U + fatigue. ###Reaction reported
### 1/5/09
ction redness, swelling for > 3days. U ### ###
102.4 evening following vaccine - mother
Y took him to after hours pediatric clinic who told herNto watch him12/9/2008
- saw his regular ###MD on Wednes
ps all over face, neck, arms and legs U 7/31/2001 1/5/2009
redden area to (R) thigh & Rash noted to stomach + legs -, mom stated started with rash to Ysite the next am and ###rash started
### 12/19/08.
redness 7.5cm x 3.5cm, tender and itchy for 2 days. Rx'd Benadryl. Y ### ###
ure unknown. Symptoms include, wheezing,
Y runny nose, difficulty breathing through nostrils,Ntime course9/30/2008
- ongoing following
10/3/2008administration
omplains of sore right arm, 8 days after shot given. Sats has limited motion of arm without having U full ache in arm###muscle.### No swelling or ra
ection site for 2 months. Y N 11/6/2008 11/6/2008
11:30 am pt developed rash on face, neck, and chest. Dr checked pt. Administered 1 teaspoon Y BENADRYL and ### 1 teaspoon
### prednisolone
m noticed swelling at injection site after 5:00PM , 0 fever; spoke with on call triage nurse; applied
U cool compress; ###Rx Benadryl,
### Motrin 12/31
d varicella immunization on 7/30/08 He came into the office w/rash for 2 days on 1/6/09 & was Y diagianosed 7/30/2008
with chicken
1/5/2009
pox. Hx symptom
d diffuse, maculopapular rash fever 108. Pt previously never vaccinated Y ### ###
about 2-3 days after injection her arm Y felt red and warm, told to put ice on it & take TYLENOLY - 2 days later 10/2/2008
she went to ER### where they lanc
m swelling shoulder to elbow, painful. Y Painful to raise arm. Next day red patches same area. Y Took AMOXICILLIN ### 875 MG ###2 X a day for fi
eption. 2/23/09 Received hospital medical records Y of 1/8-1/9/2009. 2 FINAL DX: Intussusception Y Records reveal### patient
1/8/2009
experienced interm
t hot, dizzy, lightheaded, hands were clammy, tight fisted, tingly and patient was breathing hard Y and fast 1/9/2009 1/9/2009
oid developed edema after 2 days. U ### 1/5/2009
swelling with in duration and elevated warmth at site of vaccination treated with ice. Y ### ###
e had nausea and chest pain within Y30min. Then aching felt bad. Went to bed. Woke and went Y to toilet 4 hours###
after vaccine.###"Passed out"
ceived a pneumococcal vaccine (in Y left thigh), an influenza vaccine (in left arm) and his 3rd hepatis
Y A&B 11/3/2008
vaccine of the
11/3/2008
series (in left thigh)
nterior cervical adenoopathy on left and few shotty nodes on right. Notable scattered faint erythematous
Y papules
###on the face,### trunk, and ar
ported temp of 101.1 on evening of vaccines
Y with swelling, redness, size of fifty cent piece next
Y AM. Fever that### night 103.5### with site red, firm
TDAP Vaccine on 1/7/2009. Came in to employee health on 1/9/2009 with left arm red, warm Y to touch, and1/7/2009
stated the1/9/2009
area was larger than
s after vaccination, patient complained of sore arm, then started to complain of wobbly legs, Yblurred vision, 12/9/2008
and had12/9/2008
high fever, and lasted 2
t message on voicemail 01/09/2009 stating she had sore L jaw after receiving immunizationsYon day prior.1/8/2009 Call returned
1/9/2009
to client 01/12/200
rong immunization in wrong area. Y 1/7/2009
WITH MOTHER AND NOTIFIED HER OF ERROR AND ALSO NOTIFIED DR. AND MY PRACTICE Y MANAGER1/7/2009
AND 1/7/2009
MEDICATION ERROR
Rt arm swollen from elbow up 1 1/2 size. red spot spread to size of hand. approx 7-8 cm. wrsit Y redness, rt. 1/8/2009
ankle swollen
1/9/2009
,Mom gave advil
U 1/9/2009 1/9/2009
02F, VOMITING X1 DAY. RUNNY NOSE, Y COUGHING, FATIGUE X5 DAYS. N 1/6/2009 1/7/2009
nset 36-48 h after immunizations; chills and possible fever 42-54 h after initial immunization;Ydocumented 1/7/2009 afebrile Day 1/9/2009
3 after immunization
FTER VACCINES PT DEVELOPEDY MILD URTICARIA TO CHIN AREA AS WELL AS MILDYSWELLING TO 1/9/2009
UPPER 1/12/2009
EARS; NO RESPIRA
d two Hep B vaccines during hospital stay. Date and times are listed under # 10 and 11. Y ### ###
s of upper right arm pain since vaccine administered. States is painful to raise arm when dressing. N No redness,###
swelling, or### pain with palpat
L OVER BODY N 5/27/2008 1/9/2009
gling at all sites from bottom of feet to scalp after first dose of rabies shot - ongoing. N 9/16/2008
Now new9/17/2008
onset progressive bila
g difficulty, fever, body aches, tongue swelling, vomit, blood was showing as secondary issueYin the nasal 1/9/2009 airway area1/9/2009
and upper throat area
oped a 3 inch diameter redness with hardened lump. The area felt as if it were a severe burn. Y Problem lasted### for 10 days. ###
fter small pox and anthrax vaccinationY he noted onset of mildly symptomatic and diffuse papular Y rash, No systemic
### or ill symptoms. Impres
izure - Had flu shot 11-14-08, 2nd flu Y shot 12-18-08, on same day of flu shot cough, fever, crying,Y decreased appetite
### called
###911.
d Tdap injection LT arm on 12-28-08. Y C/o pain movement area below injection site, red swollen. Y PR saw PMD ### and was started
### on predniso
nd listless, poor muscle tone AM following
Y vaccination. Parent felt he had a seizure while sleeping.
Y Was taken### to ER. Dx### with pneumonia,
received 12/27/08. On 12/30/2008 Y began experiencing itching of nose, 101 f temperature; aching U of neck and ###
back. Dad contacted
### PMD w
ceived on Saturday, 12/27/08. On Tues. Y 12/30/08 began experiencing itching of nasal cavity, U nasal infection, nasal
### bleeding, ### 101 degrees
adache from 12-17-08 time given till Dec 28, 2008 almost (2 wks) also hoarseness same time. Y Everything is ok### now. ###
n has been received from a physician Y concerning an approximately 70 year old patient who Y on an unspecified date was vaccinated with a d
Y and described the occurrence of anemia in a female U subject of unspecified
### age###
who was vaccin
was reported by a consumer and described
Y the occurrence of injection site burning in a 70-year-old
N female
11/7/2008
subject 11/7/2008
who was vaccinated wi
was reported by a pharmacist (alsoYthe subject) and described the occurrence of arm rash inU a female subject ### of unspecified###age who was
fever, Heat @ site. Y Y 1/5/2009 1/6/2009
of breath, bodyaches. Treated with Y TORADOL IM & ALBUTEROL NEBULIZER X 2. Symptoms Y started 1/9/2009
around 1800. 1/9/2009
menactra + Hep A vaccine within 5 mins of receiving the vaccine the patient was getting ready Y to leave and
1/12/2009
passed out1/12/2009
in our waiting room.
d shaking, shivering with pain around 1am after receiving flu shot at 6 pm night before. Symptoms Y lasted about
1/8/2009
3 hours.
1/9/2009
Pain was headache
ed out info sheet stating he had fainted w/previous injection at Dr's office(date unknown, butYin 2008). He1/10/2009came to get 1/10/2009
FLUVIRIN, TWINRIX
n has been received from a female registered with ankylosing spondylitis. Who on 21-Nov-2008 N was vaccinated ###with a dose ###of ZOSTER va
### N ### ###
d cold, cough, vomiting after
Y Influenza vaccination, Y requiring hospitalization
48 for Pneumonia. N 1/26/2009 MR 12/9/2008
received for DOS ###12/15/2008-1/
mins of receiving HPV injection pt became pale, lightheaded, vision became black, diaphoretic. Y Had pt wheeled### to obs. room- ###monitored pt f
With X 3days fever 99 , HA, myalgia on 11/12/08 Blood drawn for yellow fever IgG and Igm.YResults was11/7/2008 antibody low-unable ### to separate f
er flu vaccine administered, developed diffuse eczematous rash that persisted months after vaccine U given. Rash###comes and ###goes.
1-7-09 = lt leq red + swollen + warm Yto touch ordered- TYLENOL, Compresses, HC cream & U BENADRYL po-> 1/5/2009
RECK1/6/2009
1-8-09 -> (on AMOX f
d a flu shot in October 2008. She felt immediate pain in shoulder, radiating down arm. SheYfelt the flu shot 10/1/2008
was given10/1/2008
higher up on her sho
eveloped a satellite pustule near vaccine
Y site. Area appeared to have a generalized cellulitis Y around site.
12/8/2008
Member sent to### ER and was tre
ch over upper body, extremities + bottoms of feet. Felt very "hyper" "wired". Difficulty sleeping Y that night, diarrhea,
###sweats,### swollen axillary l
Y Y 10/9/2008 ###
Vaccinated at 9AM- Pain in left upper arm 4PM and continues. Shot was given top of arm at N shoulder in back. Saw ### family doctor,
### neurologis
ours; woke up dizzy; then complained of a stomachache. Y ### ###
nted 4 days after vaccination per mom's report: with HPV vaccine patient was getting up from Y sitting down on couch ### when### she fainted. Mo
20 x 20 over (L) arm PCV7 site. Y 1/6/2009
adache, brown spot in vision - 30 mins. Y - fever 102 degrees x 9hrs. Headache and dizzy afterY72hrs. 1/5/2009 1/5/2009
he side where HEPTAVAX was given with headache for a few hours. Y 1/7/2009 1/7/2009
with 11.5cm x 13cm area of erythema. Warm to touch, painful on palpation. Area blanchesYon palpation,1/5/2009 sl erythematous
1/7/2009no clearly dema
hema, pruritis and pain at site of VARICELLA
Y injection within 24 hours vaccine. Seen at 48 hours.
U ### ###
ed body rash with mild edema,"patches" and hives. Y 12/4/2008 ###
mage in right arm. I have peripheral Y neuropathy, blood clots, bone infection and blood veins infected
N in right
10/1/2008
arm.
n has been received from Y a nurse concerning
Y aYmale who was vaccinated0 with all three doses
U of ROTATEQ 11/1/2008
at appropriate
11/1/2008 intervals. In Nov
n has been received from a physician Y concerning a 63 year old female patient with Y upper respiratory
N tract infection
### at the time
### of vaccinatio
n has been received for the pregnancy registry for GARDASIL from a physician concerning aU 15 year old female ###who on 23-OCT-2008
### was
noted at injection site on left leg, without
Y itching. Presented to the primary care provider the following
Y day and
1/6/2009
received1/7/2009
prescription for Augm
wo HPV shots had muscle sorenessY and slight fever. After Shot #3 had severe whole body Y myalgias and1/6/2009
stiffness "I1/7/2009
can hardly move". Te
s received two Varicella vaccinations. The first vaccination was given by our office (administer Y unknown)9/6/2006on 8-19-02.1/9/2009
The second vaccina
IVED GARDASIL, MENACTRA AND ADACEL IMMUNIZATIONS ON 01-12-09. AFTER INJECTIONS, Y PT
1/12/2009
GOT DIZZY 1/12/2009
AND PALE WHILE
patient had a seizure at 7:00 pm. No fever was noted by his mom. Diastat 2.5 mg was given Y rectally times 1/9/2009
two doses 1/9/2009
and patient was fully
ENTED TO OFFICE ON 12-24-08 WITH C/O SORE THROAT, COUGH AND FEVER. STREP Y SCREEN PERFORMED, ### RESULTS
### NEGAT
e, malaise, myalgias began approximately 16 hours after receiving the vaccine. Approximately Y 24 hours later,1/8/2009
they began
1/9/2009
to improve and ha
owing vaccination patient developed Y fever to 102, irritability, rash, wheezing 1/6/2009 1/9/2009
omplaining with joint pain, backpain,Yheadache, and face red the day after the vaccine. Y 1/7/2009 1/8/2009
am - parent returned to health department; states infant difficult to arouse, sleeyp, only sipping Y at bottle. 1/7/2009
Had fever (100.1F
1/7/2009 rectal), 1/7, ar
ter recived the first HPV guardasil shot
Y on 9-16-2008. She received meningococcal vaccineUat the same9/16/2008 time. After9/17/2008
the first shot she had a
seizure 7 hours after 2nd dose of flu vaccine; Patient
Y went to Hospital1 and was admitted. 3/5/09
Y MR received 1/12/2009for DOS
1/12/2009
1/13/09 with D/C DX
e on face and swelling of face. GivenY Benadryl 1cc per Dr. Y 1/13/2009 1/13/2009
within 24 hours of vaccination. No history of seizures
Y prior to this episode.
5 None since. 1/19/09
Y Reviewed hospital ### medical### records of 01/01
SS; PAIN & NUMBNESS STARTING Y IN LOWER Y EXTREMITIES; RASH 5 LOWER EXTREMITIES (MILD, ERYTHEMATOUS; ### 1/2/2009NO VESCICL
1 PM-PT REPORTED FREQ NON-PRODUCTIVE Y COUGH AND BRONCHOCONSTRICTION Y (FELT LIKE CHILDHOOD ### ASTHMA,
### BUT NO
oid slightly swollen, with warmth to touch and client complains of numbness. Y 1/9/2009 1/10/2009
of chills without fever, myalgias, starting 24 hours after injection. 1/8/2009 1/9/2009
, raised bump at the site, soreness from elbow to shoulder. Y 1/13/2009 1/13/2009
as a very happy and relaxed baby prior to getting vaccinated. He only cried when he was hungry Y or gassy and ### was very social
### with everyon
1am stiff neck, tight jaw muscles. 13:30
Y Left arm bottom itched, 1"x4" hard lump w. red edges N sprayed w/1/10/2009
bactine and 1/10/2009
took anti-histimine. 1
e minutes of vaccine administration the patient developed upper respiratory congestion and sneezing. Y Over
1/12/2009
the next1/12/2009
five to ten minutes he
ped strong daily headaches. She reports a history of sever headaches in her past history. She U noticed daily 1/6/2009
headaches1/8/2009
after 1st Gardasil v
mildly painful, warm, red, slightly swollen beginning first day after injection and continues to be U on the 3rd1/10/2008
day following1/11/2008
injection without wor
veloped genital herpes primary episode 12/16/08. Treated with hydrontisone prior to culture Yresult. Resolved 7/12/2007
on own. Pt and ###her mother re
lightheaded, tachycardia tinnitus since
Y May 08. 2/24/09 MR received from PCP from 3/2008Uto 1/2009 for 3/18/2008
multiple visits
5/23/2008
with multiple c/o. P
lightheaded, tachycardia tumoritis Y persisting since May! Patient c/o sf since May 23 (initiallyUseen 5/28/08 5/20/2008
for complaints).
5/23/2008 2/24/09 MR rec
lightheaded, tachycardia, tinnitus since
Y May 08. 2/24/09 MR received from PCP from 3/2008 U to 1/20095/20/2008
for multiple5/23/2008
visits with multiple c/o.
rm- erythematous mac raised. Confluent rash surrounding. Approximately 4cmx2.5cm. LeftYupper arm in1/9/2009 area of Dtap
1/10/2009
injection site.
of entire arm down to fingers. Erythema at site. Y 1/6/2009
d fever of 104 degrees following day Y 1/5/2009 1/8/2009
o LL at site of vaccine. Advised to use cool compresses to site and to call office if more concerns.U 1/7/2009 1/9/2009
w grade), rash of a vesicular inflamed Y type; located proximal to injection site, began 2 3 wks after
Y injection, 12/5/2008
looking like a red ###bump that furth
a where she got ADACEL is tight, hot, red, swollen (about size 4-6" wide and red from elbowUto shoulder). Hasn't ###
taken any### otc. meds or us
veloped low back pain that radiatedYafter 30 minutes to abdomen. Pain described as cramping Y / pressure. 11/4/2008
7 on pain11/5/2008
scale of 0-10 generaliz
- x2Days, Motrin/Tylenol. Y Y 1/5/2009 1/6/2009
accines pt broke out in hives, lg itchy red welts --> both arm, back and chest. Benadryl givenUand change to Zyrtec. ### ###
ed child had congestion, sweats, tiredness and cough since given FLUMIST. Advised to use U asthma meds and### follow up w/ ###
MD if symptoms
ain since flu shot reported on 12/5/08.
Y As of 12/16/08 saw MD, diagnosed with bursitis, RELAFEN U prescribed.
11/7/2008 May11/7/2008
need cortisone injectio
his whole right arm was swollen, red & sore down to the elbow for 3 days following vaccination. Y Did not see11/4/2008
MD. 11/5/2008
his whole right arm was swollen red & sore from shoulder to finger tips. Applied warm soaksYwith relief. Slight ### swelling & redness
### still noted
Reported persistent pain after flu shot.
Y Saw MD, was told injection "hit a nerve". 1/5/09 Pt reportsN receiving cortisone
### shots
###for bursitis. No
upper arm became red, warm & swollen.Y Injection site induration to size of 50 cent piece and
Y was fury red.
1/5/2009
Cold compress
1/6/2009applied. On 1
m area of erythema and warmth to posterolateral upper R arm U ###
t tetanus/pertussis vaccination-onset of reddness, edema, pruritits to injection site area 2-3 inchY diametric1/6/2009
day 4-apply 1/9/2009
1 degree cortisone c
RECOMBIVAX HB instead of Hep A. Discovered when putting in NCIR. Medication Error. Y ### ###
of left deltoid following Influenza vaccination
Y on 11/4/08. 11/5/08 increased soreness, fever andY chills; 11/7/08
11/4/2008
went to
11/5/2008
primary care diagnos
ess and swelling at injection site, (+)Yfever 1 day after injection; treated at student health services
U 1/12/09 for 1/9/2009
severe 1/10/2009
local reaction vs cellulit
s after injection - developed bilat. chest pain and around to back. Short of breath. Took Benadryl Y 50mg PO 11/6/2008
and felt 11/6/2008
better in 5-10 min. Also
n has been received from a physician Y concerning Y a 15 month old child who on an unspecified Y date was vaccinated with a dose of 0.5ml of
n has been received from a registered Y nurse concerning a 15 month old female child who onN01-MAY-2008 5/1/2008
was vaccinated
6/27/2008 SQ with 0.5ml
n has been received from a physician concerning a child who on an unknown date was vaccinated U with a dose of PROQUAD (Oka/Merck u
n has been received from a licensed practical nurse concerning a 4 month old male patient with N a milk allergy
7/22/2008
and no7/22/2008
other medical history
n has been received from a physician concerning a 15 month old male with a history of sepsis U treated at birth
8/7/2008
who on8/7/2008
07-AUG-2008 was va
n has been received from a 61 year old female patient with osteoporosis, hypothyroidism and Y gastroparesis who ###on 24-OCT-2008
### was vac
### N 1/14/2008 ###
### N ### ###
hicken pox vaccine cause herpes one simplex encephalitis? Since my child was given a live strand of the virus### and 6/14/2004
it just so happen he ma
& influenza given in left arm 12/1/08, returned to office 12/4/08, developed rash 12/3/08 which Y is expanding,
12/1/2008
area itchy, located medial left
upper arm with 2 hours of vaccine did Y not radiate, stabbing, difficulty lift L arm up also 2 dayNhx of nausea, malaise### ###
r ZOSTAVAX vaccination; persisting through present - 1/12/2009-, and worsening -more; more places on body-; effectively ###
treated with non
d with rheumatoid arthritis on 01/08/2009 by a rheumatologist at a research center. I am 28 U years old, and first###
noticed1/8/2009
pain in feet about 1
es onset of pain at R shoulder vaccination site @ 12/11/08 PM. Exam c/w localized inflammatory reaction 12/4/2008
at lateral aspect of deltoid. No s
patient called after hours with c/o fever, n/v/d since he received the flu shot on 12/18. He told the nurse he would ###go to a local
### hospital. I ca
ythema Multiforme, Diarrhea, Nausea, Vomiting, chills. ### ###
n has been received from a Licensed Practical Nurse concerning a 16 year old female who on Y 30-JUN-2008 1/5/2009
was vaccinated
1/5/2009with the first d
n has been received from a nurse practitioner
Y concerning
Y a 17 year3old female with
Y no medical
Y history and drug ###allergies
1/2/2009
who on 31-DEC-2
n has been received from a physician Y concerning a 12 year old female who on 29-OCT-2008
Y Y was vaccinated with### the third###dose of GARDA
follow-up information has been received
Y from aYphysician concerning 3 a 67 year old female patient
Y with osteoporosis and seasonal
### allergy w
VAX 23 given 12/2/08 between 1-3pm. On 12/3/08 am T 100 and soft ball sized warm, red area Y noted at12/2/2008
injection site
12/3/2008
(LD). MD called by
right deltoid pain after Hepatitis B #2
Y vaccine over a year ago. N ### ###
gan with cough and upper respiratory infectionYafter vaccine administered.
17 Patient began taking
U over the counter### meds and ###got worse. Pa
9 Increase Tempature/ 01/06/2009 Tempatrue, nausea, fatigue, headache. Y 1/5/2009 1/5/2009
1/2/2009 Y 1 N 1/4/2006 1/1/2009
EKS AFTER VACCINATION PATIENT Y MAY HAVE COME DOWN WITH A SLIGHT CASE OF Y SHINGLES. 11/7/2008
A RASH/SORES ### APPEARED O
re than 24 hours I noticed a rash that started near her injection site on her thigh, on her buttocks,
Y near the
1/12/2009
back of her1/13/2009
neck on her back an
er receiving Hepatitis A and DTap the pt presents with redness, swelling, localized fever, andUcontact dermatitis.
1/12/2009 1/14/2009
AFTER I ADMINISTERED VACCINE Y TO THE CHILD,THE MOTHER STATED THAT THE CHILD Y WOKE 1/12/2009
UP IN THE 1/13/2009
MORNING WITH SW
er to 102. Had a large knot at the site of injection. U 1/12/2009 1/12/2009
m 7cm red/warm tender but non-indurated Y no streaking U 1/12/2009 1/13/2009
ped fever of 104.5 with irritability. Patient still with temp of 102 48 hours after vaccine administered
Y 1/12/2009 1/13/2009
ven around 11AM? About 3 hours after flu shot-started coughing and had a "tickle" in my throat, Y cough became### more frequent,
### then heart r
OLLEN LEFT DELTOID REGION, WARM AND SLIGHTLY TENDER. EXTENDS TO AXILLA, U CANNOT 1/12/2009
RULE OUT1/13/2009
SECONDARY CELLUL
ng (site of innoculation), arthralgias in knees and ankles bilaterally 2/9/09-records received for U DOS 1/14/09-presented
1/13/2009 1/14/2009 with C/O reaction to
ately 2 hours after received flu shot Y client starting sneezing and coughing. Eye lids began toYswell and had 12/5/2008
difficulty12/5/2008
breathing.
ningococcal (MCV4) vaccine on 01/09/09 Y in left arm SC instead of IM. Pt was brought to Urgent
Y Care on 1/9/2009
01/11/09 with1/10/2009
pain, erythematous
mach pains within 2 hours Y of shot. YHands then became tingly and had"pins and needles", throat Y then had1/14/2009
same feeling.
1/14/2009
Then had feverish
ministered 01/12/09, 01/13/09 morning red and swollen by evening small blister that increased in size to 1 inch diameter, blister broke am 1/1
en on 1/12/09 right arm, Had right arm Y swelling, redness, felt firm to touch, worsened over 2 days.
U Seen in 1/12/2009
clinic on 1/14/09,
1/12/2009 had indurated e
ter shot administered, felt chest pressure, heart pounding, congested chest & cough. Breathing Y problems1/9/2009also which1/9/2009
lasted about 25 minu
s after receiving the MMR vaccine he called by phone and said he felt like he was going to "black
Y out" but did not.
### He also### complained of "t
:30pm 12/30/08 Slight headache inYafternoon, Oral Typhoid stated that evening, 2 hours later Y became sick. Symptoms### nausea
### and low gra
ported having a fever, local myalgia and pharyngitis after having the TDAP vaccine. Definite Ytime course not known, ### but suspected
### to be wi
hot was administered and three hours later I experienced... Poor co-ordination. Tripped getting Y out of a 1/13/2009
car and tripped
1/13/2009
again when I tried t
me down with Shingles. Y Was treated with gabapentin and acyclovir. 01/21/2009 Office note received
Y from5/1/2007
PCP DOS1/14/2009
1/14/09 with dx: Shing
EIVED THE FLU SHOT IN MID-OCTOBER Y ANDY DISPLAYED A FEVER 7 DURING VETERAN'S U DAY WEEKEND ###WITH NO ###OTHER SYMP
east 103, chills, fatigue, loss of appetite, diarrhea, vomiting; vomiting lasted at least 2 days (ongoing
U but getting
1/12/2009 better)
1/12/2009
n: 47 y/o female AD SM reports theYonset of undocumented fever chills commencing 3 daysYafter BIOTHRAX. ### SM went
12/3/2007
on to develop coug
nt states with every flu vaccination since 2000 he will have URI symptoms (post nasal drip, nasal congestion, 6/16/2000
rhinnorhea,
6/19/2000
dry cough, watery
n c/o pain to L side of face from nose to L ear and L scalp - tender to touch. No lesions noted U except for small
1/6/2009
macule1/12/2009
on L upper eyelid an
hypersensitivity Rxn to vaccine & erythema/induration in L deltoid Y ### ###
given on 01/13/09 in arm. Mom gaveYchild Tylenol after injection at home. At 4:00Am (1-14-09) Y mom noticed 1/13/2009
rash on1/14/2009
child all over body. See
s been to 2 Doctors who say it is not related to the ZOSTAVAX injection. Rash is over trunk N but she feels it is spreading.
d & swelled where VARIVAX was given Y Y 1/12/2009 1/13/2009
fever, headache, body aches and joint pain, lethargy x 6 days. N 1/6/2009 1/8/2009
6x7cm hard red patch on left leg atYinjection site. U 1/13/2009 1/14/2009
es swollen shut, itchy. BENADRYL 2 Tsp PO Q6 PRN. Y 1/13/2009 1/14/2009
atous areas distal to site of injection. Non tender, non indurated 1 cm in diameter. Y 1/12/2009 1/13/2009
dominal discomfort, onset 4 days after Y injection with nausea. Symptoms lasted X 5 days. Y ### 1/2/2009
nt was a 34 year old male Officer with no medical problems prior to receiving anthrax Y vaccination
N #5 in Apr4/15/1999
1999. In Aug
9/1/1999
and Sept of that ye
eceived multiples doses of ENGERIX-B Y within aY one year time period, later diagnosed
Y with MS.
N Symptoms: 2/1/2006
Loss of vision
5/1/2007(CN II), weaknes
9 received flu vaccine. Pt reports that evening feeling chilled, dizzy, weak, severe aching bit. Y Forearm and 1/5/2009
difficulty breathing,
1/5/2009pale, HR102,B
ped cellulitis on the site of Pneumococcal
Y vaccine with fever, vomiting 01/9/09. 11 1/2 hours after the shot1/9/2009
treated with1/9/2009
Abx augmentin.
ceived yellow fever and typhoid injections without incident. Approximately 15 mins later GARDASILY inj given.
1/6/2009
Within mins
1/6/2009
patient had synco
hours-swelling 2"x3" raised 1/2-3/4 inch, hot, have been-icing/heat pack-5th day=still swollen, N very tender1/5/2009
and hot-very 1/6/2009
uncomfortable.
was fine at first but overtime developedY aching where vaccine was deposited inside arm to point Y of interfering with ###sleep.
11/1/2008
Also general arm w
ght, fever, non-weight bearing 1/10/2009 1/10/2009
ection site, fever, non-weight bearing
doses of GARDASIL I had all normal pap tests between the years 2004 to 12-1-20066. AfterU3 doses of GARDASIL ### I had### 2 abnormal pap
shot of GARDASIL on 2-7-08 had dizziness, headache, missed school. Second shot 5-7-08 Y had dizziness2/7/2008
and severe2/7/2008
headache - missed s
D AA male SM presents with 2-day historyY of SPV innoculation site concerns. Reports HA, malaise,
Y chills, and ###myalgia. Chills,
### Headache, g
ed his primary SPV on 11/27/07. Never Y developed Jennerian pustule. 3 weeks post inoculation,
Y he developed### a small, red, raised lesion a
one minute after receiving anthrax #1 and 2, she had very brief episodes of chest pain, lasting Y less than 21/8/2008
min that resolved without interve
oped redness, swelling, pain approx 24 hrs after receipt of anthrax vaccine. Swelling Start: 12/16/2007;
Y Erythema### Start: 12/16/2007; Edem
h on arm, redness into his armpit about 10 days after receipt of primary SPV Symptom: Edema U @ injection site### >120 mm not beyond elbow
/o eczema that received SPV and had exacerbation of his eczema. His concern is more focused Y on his children ###at home, 2 of whom have
redness, swelling around primary SPV site approx. 6 days after receiving vaccine. Symptom: Y Erythema Start: ### 12/10/2007 Symptom: Swell
rge local reaction with his 3rd and 4th anthrax shots. Symptom: Edema @ injection site 50-120mm Start:6/1/2003 06/2003; Edema @ injection site
he had large local reaction with his 3rd, 4th and 5th anthrax shots, including redness, swellingY and pain at7/1/2003
injection site. Erythema Start: 07
d large local reaction to anthrax vaccine Erythema Start: 05/2007; Swelling Start: 05/2007; Pain Y Start: 05/2007
5/12/2007
o PCP for evaluation of HA, body aches,Y general malaise and diarrhea she developed after U being vaccinated
11/5/2007
with SPV, anthrax and typhoi
n has been received from a physician concerning a male who was vaccinated with a dose ofUMMR II and was diagnosed with autism. The
n has been received, for the Pregnancy Y Registry
Y for GARDASIL, from 0 a nurse practitioner concerning
Y a 16
6/3/2008
year old female
6/3/2008 with no pertinen
n has been received from a physician's Y assistant Y (P.A.) concerning 3 a approximately 3 monthUold patient 12/4/2008
who was vaccinated
1/6/2009with a dose of
Y the occurrence of psoriasis in a 56-year-old female
N subject who was ###vaccinated ###with ENGERIX
eption. First began with bloody
Y diarrhea
Y 1-10-09. Y Resolved 1-11-09.2Recurred 1-14-09. US 1-15-09.
N Intussusception
1/7/2009 1/11/2009
at cecum. 1/29/09 Re
, hard area approximately 2 1/2" in diam. at injection site. Sore and burning. Approximately 12 U days after injection,### developed ### bumpy, itchy
ported elevated temperatures of 104.0 degree F the morning after vaccines, also mentioned Yextreme fussiness 1/12/2009and 1/13/2009
slight decreased appeti
developed at injection site the day of administration. Complains of itching at site. Erythematous Y from top of1/7/2009
deltoid to 1/7/2009
4cm above elbow. Coo
mins after receiving vaccine pt stated that he felt dizzy & had blurry vision. He was placed in Y supine position
1/14/2009with feet
1/14/2009
elevated v/s HR 100
ates that right wrist was swollen on 01/10/09 about 24 hours after MENACTRA and HAVRIX Ywas administered 1/9/2009
in right
1/10/2009
arm.
m to touch rash at injection site. Y 1/7/2009 1/9/2009
ted blood in infant's stool one day after
Y immunizations were given. Infant was fussy the evening U of vaccines,
1/9/2009
but has1/9/2009
been fine since.
ed screaming for hours on end, severe irritability, lethargy Y 9/5/2008 9/6/2008
ports hives on back- upper torso U 1/14/2009 1/14/2009
ported raised red very painful spot at site of injection, which got better with time. Y 1/6/2009
lled and reported need to go to ER folllowing immunizations given 12/31/2008. She stated respirations
Y became### labored
1/1/2009
and temperature 10
ays of receiving the 2nd round of the Y HPV vaccination,
Y my daughter2began with severe painYin her arms, legs, ### and hips, difficulty
### walking w
as accidently give Tdap instead of Td Y 1/15/2009
rs 102+, Nausea, Dizzy, lethargic, weak & tired U 1/14/2009 1/14/2009
1 x 7 cm reddened area noted this am. 1/13/2009 1/15/2009
per arm is very swollen and hard after receiving Shingle vaccine. Red circle approximately four N inches in1/12/2009
length is present.
1/12/2009 Some itchy. Ve
3rd hep B injection on 12/8/08. Within one day developed tender left axillar adenopathy lasting Y 2-3 days,12/8/2008
followed by 12/9/2008
swelling, erythema an
fever, vomiting, dehydration, elevatedY heart rate N 1/12/2009 1/14/2009
mplained of persistent redness, edema, was febrile and noticed streaks down arm post vaccination.Y Treated
1/6/2009
by on-call
1/7/2009
physician with an a
hemic stroke (basilar artery Y thrombus).
Y Underwent Y mechanical thrombectomy
20 Y 11/25/08.
Y 2/2/09
N Received11/5/2008
ER medical records ### of 11/19/200
receipt of vaccines in travel clinic client experienced syncope episode, i.e., lost consciousness,
Y became 1/15/2009
pale, dyaphoretic.
1/15/2009 B/P 110/70; clie
ceived vaccine 01/06/2009 and called pharmacy 01/14/2009 with complaint of a red rash at the U injection site1/6/2009
approximately
1/14/2009 2 inches in diam
B Vaccine series given at start of new Y job (1st dose 9/13/2006) because blood work Y showedNno immunity 2/14/2007
present from8/23/2007
previous immunizat
able screaming and fits of rage lasting for 15 minutes at a time, happening since an hour and U a half after1/13/2009
vaccination. 1/13/2009
At current time, symp
eactive lymphadenopathy and swelling in left anterior cervical chain and supraclavicular areas on 1/15/09 1/12/2009
with torso1/15/2009
macularpapular rash
d a febrile seizure with a temperature Y of 106.8 degrees and rising 7 days post MMRV shot. He'd Y had a double-ear ### infection
12/7/2007 as well at the tim
ed patient "almost passed out" and patient stated he had headache. I observed the patient to Y be alert/ appropriately
1/14/2009 1/14/2009
responsive.
d-mosquito bite size area where received vaccine, no fever, no other issues. No drainage, no Y bigger, not 1/8/2009
painful. 2 days
1/9/2009
later had lump the
was brought to my office for the next set of vaccines, his parents described 8 hours of high - pitched
Y screaming
7/7/2008
post the
7/7/2008
prev vaccines. No
A given to 9 month old child. U 1/6/2009 1/6/2009
severe irritability, 4-6 hrs immunization for several days U ### ###
Swelling, warmth redness U 1/5/2009 1/6/2009
2 area of redness with elevated temp and soreness at injection site. 12/25 redness and elevated Y temp resolved, ###quarter" sized
### knot at site
arm - redness and swelling, mild rash redness used Benadryl 2t sp Q60 until redness gone.Y 1/7/2009 1/8/2009
headedness and inability to focus visually 5 minutes after 3rd rabies Vac. administered . VitalYsighs remained 1/9/2009
stable. Some
1/9/2009nausea. All Sx s
en Tdap - recommended for ages 11-64 only. ADACEL- lot # C3027AA in right deltoid. Y 9/22/2008
ed of pain radiating from injection site in left deltoid down to her hand diminished grip strength,
U normal sensation.
1/14/2009No 1/14/2009
s/s inflammation. Ibu
red circle around administration site that was hard to touch, 0 itching. Area was tender to touch.Y Began 2 days ### after administration
### and laste
ed bandage over SPV site and approx. Y 3-4 days later develop a localized rash that becameYgeneralized over ### several days. SM received p
Area swelled red raised. Very sore. Mom gave BENADRY & ice to area - still present 1/15/09- Y 1/12/2009 1/12/2009
e to appointment for 4 mo WCC on YAmoxil started on 1-6-09. Appoint date 1-12-09. Had dry Y rash primarily
1/12/2009
on Abd.1/14/2009
& torso. Dr. instructed
sounding cry, crying consistently, notY consolable, after receiving immunization 0n 1/8/09. Had Y swelling at1/8/2009
injection site
1/8/2009
of DTAP for 1-2 day
9 per mother at 10:30 pm she felt infant
Y & he was hot. She gave Tylenol and child had seizure.
Y Child taken
1/14/2009
to ER 1/14/2009
by ambulance with temp
U
ours of vaccination Pt experienced generalized ache ness that lasted 3 days. Itching was significant
Y enough 1/8/2009
to require1/8/2009
antihistamines. No r
back of neck began to itch in the PM. Then when woke up 11-15-09 legs and arms were itching resemoline 1/13/2009
hives, welts/redness
1/14/2009 on bilatera
haking Chills myalgias for several hours. Resolved spontaneously. Fatigued the next day. Y 11/5/2008 11/5/2008
both parents for rash, Friday had a few spots on chest, has spread entire body and SaturdayY had fever to 102.### Received ###MMR 12/18/08, a
eived DTAP, IPV, MMR,Volvox and flu 1/6/09 T100.3 1/7/09 0 fever 1/8/09 fever to 104 lasting Y 3 day associated
1/5/2009with1/8/2009
headache 1/11/09 bl
ellulitis 24 hours after vaccination inYleft deltoid Y 1/8/2009 1/9/2009
njection 3:45p- woke up 9:45 pm same day-fever 102- aches all over body - had headache called Y doctor 10/2/2008
next day advised
10/2/2008
take 2 Tylenol an
miting, Diarrhea Daily-No reason hospitalized
Y for dehydration lost 30lbs. Continued to be sick-
N Colonoscopy,
8/22/2007MRI problems
10/1/2007 with Blood sug
hours of HPV dose given on 08/27/2008 - Had rash over trunk of body, Lasting 3 days did not Y seek medical
8/27/2008
attention.
8/28/2008
Within 24 hrs after 6/
30 Pt. called to report that she had a rapid heart rate which started approximately 1/2 hr afterYreceiving the1/6/2009
vaccine and 1/6/2009
lasted for approxim
veloped a 1"x1 1/2" induration that is red and warm where an ADACEL injection was given. U 1/6/2009
ucousy stools after ROTATEQ vaccine x 2 weeks. U ### ###
er UMM placed erythema, tenderness and warmth occurred- 9cm X 6 cm oral paten, resolving N after 2 more days. ###At visit 5###
days later paten
ived PEDIARIX/PREVNAR 1/09/2009 at 09:25 per / LPN- 1/10/2009 Mon report swelling, redness Y at site 1/9/2009
and thigh 1/10/2009
swollen 1/12/09 "doing
0-15 min after getting vaccines small white raised bumps. Lasted about 3 weeks itching 0 treatment
Y 9/11/2008 9/11/2008
p- size of "grape" in arm - where shot administered for one week - then thereafter, remains aUlump "pea" size in### upper left ###
arm.
n has been received from a consumer Y concerning her 8 week old daughter who on 11-DEC-2007 N was vaccinated ###with a dose### of COMVAX
n has been received from a consumer concerning a friend of the family's child who on an unspecified
U date was vaccinated with MMR II, and
n was obtained on request by the Company from the agency via a Public Case Detail Form U and a Case 3/26/2008
Line Listing concerning an approxim
n has been received from Y a physician
Y concerning a 22 year old female patient with no pertinentY medical history1/7/2009and no1/7/2009
known drug allergy
n has been received from a physician concerning a 15 year old female with no previousY medical,
N family, 12/7/2007
or social history
12/8/2007
who on 19-NOV-2
n has been received from a health professional concerning a 19 year old female patient whoYon 17-DEC-2008 ### was vaccinated
### with the first
n has been received from a physician Y and a hospital
Y medical librarian
1 concerning a 59 year N old female who on### 30-DEC-2008
1/1/2009 was vaccinate
n has been received from a physician, for VARIVAX (Merck), a Pregnancy Registry product,Yconcerning a female who was vaccinated with
minutes of vaccination to the left upper arm, patient felt weakness in right side (muscular and Y joint) from right hip###to knee; ###
weakness lasted
nt presented with swelling and redness on upper arm approx 2 inches from injection site 1 day Y post-injection. Her ###upper arm ###was hot and p
esented with cellulitis of right arm associated with swelling and axillary lymphadeopathy. Patient
Y reported fever, ###chills at home.
###
VERE PAIN AT THE SITE OF INJETION FROM 1/13/09(DAY OF VACCINATION) TO 1/14/09...MORE Y THAN
1/13/2009
36 HRS....WITH
1/13/2009 SITE (LEFT
d a rash on the thighs and face. U 1/13/2009
l pain/stomach cramps for 2 hours. No treatment given. Y 1/6/2009 1/6/2009
iented, unable to answer questions Yappropriately for 45 minutes. Went to ER and was seen Y by triage nurse, 1/6/2009
then symptoms
1/6/2009resolved and p
IVED EXPIRED FLUMIST LOT 500548P EXP DATE 12/18/2008. NO REPORTED ADVERSE U EVENTS TO DATE ### OF COMPLETING REP
rash & periorbital swelling beginningY 11/6/08 - Adverse reaction reported to Employee Health Y on 11/7/0811/5/2008
- referred to
11/6/2008
Nurse Practitioner at
ported burning and stinging in her hand starting several hours after she received the vaccineUon 12/30/2008. The ###next day### she said that the
nced large local reaction as well asYa "rash all over" Y 12/6/2008 12/7/2008
me to clinic today and presented with a possible reaction to the flu vaccine. The flu shot wasUadministered 10/9/2008
on October10/9/2008
9, 2008. The patient
veloped watery diarrhea 1/2/09. The diarrhea lastd until 1/6/09. Patient also developed irritability
Y and a decrease ###in appetite.
1/2/2009
me to Health Center at 12:06 pm on 1/16/09, 9 days after injections. Stated "prolonged hardUlump on my1/7/2009 right arm where
1/8/2009
I got the pneumo
ng, tightness in chest, cough, swelling
Y around his eyes and a bit of difficulty breathing. It was about 4 hours 1/13/2009
after the1/13/2009
shot.
PV on November 4th, 2008. she stated she didn't know she was pregnant. Had a miscarrieage Y in December.
11/4/2008(Came in today
### becase she
d an afebrile seizure event lasting 2-3 minutes Ythe evening after receiving
1 influenza A and Hepatitis
Y A vaccine
1/14/2009at her
1/14/2009
PMDs on 1/14/09. Sh
fever, body aches, chills, dizziness Y ### ###
n has been received from a case inYlitigation from a 64 year old female who on 29-OCT-2008 N was vaccinated in ###the right arm with a dose o
n has been received from a consumer Y concerning a 13 month old male with no medical history N or drug allergy6/5/2006
who on 6/5/2006
05-JUN-2006 was va
n has been received from a pharmacistY concerningY a 90 year old female
3 Y patient who was vaccinated
Y with a dose###of ZOSTAVAX### (lot# not p
n has been received from a registered nurse who Y reported that the one
0 Y of her patient's mother
U reported that there was a female patient who
was considered medically important. Information regarding PREVNAR was received from a U consumer regarding a female patient who expe
was reported by a lawyer and described the occurrence of arm pain in a 48-year-old Y male subject
N who was
5/13/1999
vaccinated6/1/1999
with LYMERIX (Gla
was reported by a lawyer and described the occurrence of joint pain in a male subject of unspecified
N age who was vaccinated with LYMER
Y age who ###was vaccinated
10/4/1999 with LYMER
N age2/23/2000
who was vaccinated with LYMER
was reported by a lawyer and described the occurrence of joint pain in a female subject of unspecified
N age who was vaccinated with LYME
was reported by a lawyer and described the occurrence of muscle weakness in a male subject N of unspecified
5/25/2000
age who was vaccinated with
1/10/2009 N 1/8/2009 1/10/2009
1/14/2009 N 1/13/2009
d hives/facial swelling, local
Y itching within 5 minutes of vaccine. Required EpiPen administration.Y 1/8/2009 1/8/2009
varicella shot R arm. 11/5 developed redness & blisters on R arm below injection site- pt here Y 11/6/09 1/14/2009 1/15/2009
became red, swollen, warm the eveningY of 12/30/08. Symptoms worsened next day. She was seen at clinic on ###11/1/09- They
### referred her
LA- like rash Y Y ### 1/10/2009
er of 101.9, aches, stiffness - around 6:30 pm. Around 1 am next am0 headache, sweating,Ynightmares,1/12/2009 few hives on1/12/2009
hands. Symptoms im
oulder started pinching. The pain progressed to point of doctor visit. Am currently doing physical
Y therapy for left
### shoulder.###
t ever given- hurt immediately and for approx 4 to 5 days after. Got really sick after for 4 days
N - puking etc. Started ### noticing ###that arm aches
induration, swelling on R thigh where
Y Hib and PREVNAR were given. Later developed into Y a localized abcess.
4/1/2006 Had recurrence of similar s
episode following GARDASIL administration. Held in clinic for 15 min following incident, withYBP initially 122/64
1/16/2009 and 1/16/2009
126/76 15 min later. G
firm, warm to touch 6.0cm X4.5cm, chemical taste in mouth approximately 20min after administration
Y patient
1/14/2009normally
1/14/2009
has chemical taste w
wollen, hot red to left thigh. Treatment CLENDA 75/5 1 top po tid x 10 days. U 1/14/2009 1/14/2009
olable, crying within 6 hrs. 2. Not having lower extremities 3. Hypersensitive below waste lineY 1/12/2009 1/12/2009
/blurriness/head pain/nausea. AnotherY student at his school had immunizations yesterday also, and was1/13/2009 sent home1/14/2009
from school with simila
oped redness, swelling and pain at injection site within 24 hrs of receiving his second ANTHRAX shot. 8/1/2007
d redness, pain and swelling at site of anthrax vaccine within a few hours after receiving the Y shot. 8/7/2007
d vaccine at our office on 1/5/09. On
Y 1/6/09 pt started with redness, swelling, hot to touch with
Y pain, some 1/5/2009
itching at 1/7/2009
the vaccine site. Wen
given 1/14/09. Left arm swelling. Y U 1/14/2009 1/16/2009
veloped hives within 2 hrs of vaccines being given. Rx BENADRYL PO. No tongue/lip swelling/wheezing.
Y 1/16/2009 1/16/2009
d rash over torso, about 30 lesions. No open areas, no s/s infection, no crusting. Y ###
cified dates, the subjects received unspecified doses of HEPATITIS B vaccine (unknown). At U an unspecified time after vaccination with HE
was reported by a sales representative and described the occurrence of decreased therapeutic U response in a subject of unspecified age an
Y and described the occurrence of hive in a 21-year-old
U female subject ###
who was ###vaccinated with E
was reported by a healthcare professional and described the occurrence of not responding to N therapy in11/2/2006
a male subject of unspecified age
was reported by a physician and described the occurrence of hearing deficit in a male subject U of unspecified age who was vaccinated with
e was reported by a pharmacist and described the occurrence of not responding to therapy inUa subject of unspecified age and gender who
was reported by a healthcare professional and described the occurrence of urticaria in a 10-year-old
Y female
9/22/2000
subject9/23/2000
who was vaccinated w
was reported by a healthcare professional and described the occurrence of arm weakness in Y a 39-year-old
9/16/2008
male subject
9/16/2008
who was vaccinat
was reported by a physician (also the subject) via a sales representative and described the U occurrence of a young adult female subject of u
was reported by a healthcare professional and described the occurrence of wrong route of administration
N 10/1/2008
in a 38-year-old
10/1/2008female subject w
was reported by a consumer and described the occurrence of foot pain in a 8-year-old female U subject who was vaccinated with hepatitis B
was reported by a healthcare professional and described the occurrence of a subject of unspecified
U age and gender not responding to ther
was reported by a physician and described the occurrence of hepatitis b antigen positive in an adult subject of unspecified 8/1/2008gender who was
was reported by a healthcare professional, who was also the vaccination subject, that described N the occurrence of not responding to thera
was reported by a healthcare professional and described the occurrence of rash on trunk in a 35-year-old 8/21/2008
female subject
8/21/2008
who was vaccina
was reported by a consumer and described the occurrence of injection site pain in an adult female
N subject
8/19/2008
who was8/19/2008
vaccinated with ENGE
was reported by a consumer and described the occurrence of injection site soreness in an adult Y female 7/19/2008
subject who7/19/2008
was vaccinated with E
was reported by a pharmacist and described the occurrence of hepatitis B surface antigen positive
N in a 2-month-old
7/28/2008 8/28/2008
male subject who was
was reported by a healthcare professional and described the occurrence of hepatitis b antibody U negative1/16/1998
in a 49-year-old
8/1/2008
female subject w
was reported by a health care professional and described the occurrence of swelling of knees Y in a 26-year-old
6/25/2008 male6/26/2008
subject who was vacci
was reported by a pharmacist and described the occurrence of elevated liver enzymes in a 48-year-old
N male
8/14/2008subject
8/26/2008
was reported by a healthcare professional and described the occurrence of hives in an infant Y female subject who was vaccinated with hepa
was reported by a physician via a nurse and described the occurrence of allergic reaction inUa subject of unspecified and and gender who w
was reported by a consumer, who was also a GSK sales representative, that described thatNoccurrence 7/16/2008 of irritability 8/6/2008
in an adult male subje
was reported by a healthcare professional and described the occurrence of hepatitis B antigen Y positive in8/1/2008
a 50-year-old8/4/2008
male subject who w
a 72-year-old8/4/2008
male subject who w
was reported by a healthcare professional and described the occurrence of hepatitis B antigen U positive 4/30/2008
in a 45-year-old5/5/2008
male subject who
was reported by a healthcare professional and described the occurrence of arm burning in an U adult female 7/1/2008
subject who was vaccinated wit
was reported by a healthcare professional and described the occurrence of arm burning in an U adult male 7/1/2008
subject who was vaccinated with
was reported by a healthcare professional and described the occurrence of arm burning in an U adult male 7/1/2008
was reported by a healthcare professional and described the occurrence of hives in a 3-year-old Y female subject ###
who was ###vaccinated with E
was reported by a nurse and described the occurrence of allergic reaction in an adult femaleUsubject of unspecified age who was vaccinate
was reported by a healthcare professional and described the occurrence of swelling of knees Y in a 26-year-old
6/25/2008 male6/25/2008
subject who was vaccin
was reported by a healthcare professional and described the occurrence of low hepatitis b antibody
U level in a male subject of unspecified a
was reported by a healthcare professional and described the occurrence of hepatitis b surface antigen positive6/10/2008 in a6/11/2008
27-year-old female sub
was reported by a physician and described the occurrence of fever in a female subject
Y of unspecified
Y age who was vaccinated with hepatit
was reported by a pharmacist and described the occurrence of nausea in three subject of unspecified
N ages
7/10/2008
and genders
7/10/2008
who were vaccina
was reported by a pharmacist and described the occurrence of nausea in three subjects of unspecified
N ages
7/10/2008and genders
7/10/2008who were vaccin
was reported by a pharmacist and described the occurrence of nausea in three subjects of unspecified
N ages
7/10/2008
and genders
7/10/2008
who were vaccin
was reported by a healthcare professional and described the occurrence of a false positive hepatitis
N test6/16/2008
in a male subject
6/19/2008aged between 5
was reported by a pharmacist and described the occurrence of decreased therapeutic response U in an unspecified number of subjects of un
was reported by a healthcare professional and described the occurrence of an adult male subjectU (a dentist) not responding to therapy follo
was reported by a pharmacist and described the occurrence of an adult male subject (a physician)
U not responding to therapy following vac
was reported by a pharmacist and described the occurrence of an adult male subject not responding
U to therapy following vaccination with H
was reported by a pharmacist, who was also the consumer, that described the occurrence ofY fever in a 22-year-old male subject who was v
was reported by a healthcare professional and described the occurrence of Hepatitis B antibody U negative 1/22/2001
in a 23-year-old
6/12/2007
female patient w
was reported a physician, via sales representative and described the occurrence of not responding
U to therapy in a subject of unspecified ag
ct was in clinic for day 180 on 03 October 20005. Pre-injection vitals were normal with blood pressure (BP) 10/3/2005
of 114/84.
10/3/2005
The subject did not h
was reported by a physician via a representative and described the occurrence of HEPATITIS N B antibody negative in a 13-year-old subject
was reported by a healthcare professional and described the occurrence of vaccination errorUin a subject4/14/2008of unspecified
4/15/2008
age and gender wh
was reported by a healthcare professional and described the occurrence of metallic taste in Ya 57-year-old4/4/2008male subject4/4/2008
who was vaccinate
was reported by a healthcare professional and described the occurrence of possible HEPATITIS Y B in an elderly
3/1/2007 female subject who was va
was reported by a physician and described the occurrence of not responding to therapy in aUmale subject of unspecified age who was vacc
was reported by a healthcare professional and described the occurrence of low Hepatitis B antibody
Y level1/1/2001
in an adult male subject who was
was reported by a healthcare professional and described the occurrence of HEPATITIS B antibody U negative in### a 63-year-old
3/27/2008 male subject
was reported by a healthcare professional and described the occurrence of a subject of unspecified
U age and gender not responding to ther
Y and described the occurrence of rash in a femaleNsubject aged3/1/2008 between 20 and 29 years old wh
was reported by healthcare professional and described the occurrence of hives on head in aY29-year-old2/26/2008 female subject
2/26/2008
who was vaccinate
was reported by a physician and described the occurrence of a 43-year-old male subject notNresponding to therapy ### following vaccination w
was reported by a consumer and described the occurrence of diarrhea in a 31-year-old female U subject who 3/23/2008
was vaccinated
3/23/2008 with ENGERIX
was reported by a healthcare professional and described the occurrence of not responding to U therapy in an adult female subject who was v
was reported by a healthcare professional and described the occurrence of hepatitis B antibody U negative in an adult female subject of unsp
was reported by a physician from a blood center and described the occurrence of HEPATITIS U B surface antigen positive in a subject of uns
was reported by a physician and described the occurrence of Hepatitis B surface antigen positive
U in a subject of unspecified age and gend
was reported by a healthcare professional at a dialysis unit and described the occurrence of HEPATITIS10/1/2006 B antigen positive in a 77-year-old
was reported by a healthcare professional at a dialysis clinic and described the occurrence of U HEPATITIS 2/23/2008
B antigen2/26/2008
positive in a 52-year-o
was reported by a healthcare professional and described the occurrence of non-seroconversion U in a subject 1/8/2008
of unknown age and gender w
was reported by a healthcare professional and described the occurrence of strange taste in Ya 25-year-old 1/24/2008
male subject
1/24/2008
who was vaccinate
was reported by a healthcare professional and described the occurrence of injection site redness
N in a 23-year-old
2/22/2008 female
2/23/2008
subject who was
was reported by a consumer and described the occurrence of flu like symptoms in a 32-year-old N female 2/15/2008
subject who 2/15/2008
was vaccinated with E
was reported by a pharmacist and described the occurrence of not responding to therapy inUa 54-year-old female subject who was vaccina
a 79-year-old
2/12/2008
male subject who w
was reported by a physician and described the occurrence of HEPATITIS B surface antigenYin a male subject 1/1/2008aged between
2/1/200830 and 40 yea
a 78-year-old
2/6/2008
female subject who
was reported by a healthcare professional and described the occurrence of Hepatitis B antigen Y positive in2/2/2008
a 76-year-old
7/2/2008
female subject wh
was reported by a consumer and described the occurrence of bruise injection site in a 60-year-old
U female 1/27/2008
was reported by a physician via a sales representative and described the occurrence of not U responding to therapy in a subject of unspecifie
was reported by a physician and described
Y the occurrence of hepatitis B surface antigen positive
Y in a 48-year-old ### male subject
### who was va
was reported by a pharmacist via a sales representative and described the occurrence of discomfort
U at time of injection in an unspecified n
was reported by a healthcare professional and described the occurrence of low hepatitis B antibody
U level in a subject of unspecified age an
was reported by a healthcare professional andYdescribed the occurrence of vaccination failure Y in a 53-year-old female 9/1/2007
subject who was vac
was reported by a healthcare professional and described the occurrence of stomach pain inUa male subject 10/1/2007
of unspecified
10/1/2007
age who was va
was reported by a healthcare professional and described the occurrence of not responding to U therapy in an unspecified number of adult su
was reported by a physician and described the occurrence of decreased therapeutic response U in an adult male subject who was vaccinate
was reported by a physician and described the occurrence of HEPATITIS B surface antigenUpositive in an 11/1/2007
adult female
11/1/2007
subject who was va
Y the occurrence of hair loss in a 53-year-old maleN subject who6/2/2007
was vaccinated
9/1/2007
with ENGERIX B
Y via another manufacturer and described the occurrence
U of not responding to therapy in an adult
Y the occurrence of pain in arm post vaccination inNa 29-year-old 11/8/2007
female subject
11/8/2007
who was vaccina
was reported by a healthcare professional and described the occurrence of nausea in a 15-year-old
Y male 10/1/2007
was vaccinated with
was reported by a physician and described the occurrence of not responding to therapy in aUsubject of unspecified age and gender who wa
was reported by a healthcare professional via Merck and described the occurrence of not responding
U to therapy in an unknown number of
was reported by a physician via sale representative and described the occurrence of alopecia Y in an infant male subject who was vaccinate
was reported by a healthcare professional via sales representative and described the occurrence
U of not responding to therapy in several su
was reported by a pharmacist and described the occurrence of allergic reaction in a subjectUof unspecified age and gender who was vacci
was reported by a healthcare professional and described the occurrence of hepatitis B surfaceY antigen positive in a female subject of unsp
ptember 2007 the subject received a birth dose of ENGERIX B (10 mcg, unknown). On September U 2007,9/18/2007
same day 9/18/2007
as the vaccination with
was reported by a healthcare professional and described the occurrence of hepatitis B surfaceU antigen positive
8/7/2007 in an8/9/2007
infant male subject wh
was reported by a healthcare professional and described the occurrence of inappropriate dose U of vaccine 6/27/2005
administered
6/27/2005
in a 21-year-old ma
was reported by a healthcare professional and described the occurrence of hive-like rash overN the body9/22/2008
in a 6-month-old
9/23/2008
male subject who
Y and described the occurrence of swollen thigh (injection
Y site) 8/20/2008
in a 5-year-old
8/21/2008
male subject who w
was reported by a physician and described the occurrence of injection site reaction in a 2-year-old
U male subject
5/1/2008 who5/1/2008
was vaccinated PEDI
was reported by a healthcare professional and described the occurrence of fever in a 5-year-old
Y female subject
8/6/2008 who 8/7/2008
was vaccinated with P
was reported by a physician and described the occurrence of lethargy in a 2-month-old subjectU of unspecified gender 7/10/2008
who vaccinated with
was reported by a physician and described the occurrence of injection site hives in a 6-month-old
Y female subject who was vaccinated with
was reported by a pharmacist and described the occurrence of apnea in a subject of unspecified
U age and gender who was vaccinated with
was reported by a pharmacist and described the occurrence of an unspecified adverse event U in a child subject of unspecified gender who w
was reported by a healthcare professional,
Y via a GSK sales representative, that described the
Y occurrence 7/16/2008
of inconsolable
7/16/2008crying in a 2-mon
was reported by the mother of a consumer and described the occurrence of nausea in a 2-month-old
N male
4/29/2004
subject who
4/30/2004
was vaccinated wit
reported by a physician, via GSK representative, that described the occurrence of high fever in a 4-month-old subject of unspecified gende
was reported by a physician, via a GSK representative, that described the occurrence of high U fever in a 4-month-old subject of unspecified
was reported by a physician via a sales representative and described the occurrence of cryingU uncontrollably7/25/2008
in a 2-month-old
7/25/2008 female subje
Y the occurrence of hypotonia in a 2-month-old male
Y subject who 7/21/2008
was vaccinated
7/21/2008 with PEDIARIX
was reported by a physician and described the occurrence of wrong route of administration U in a subject of unspecified age and gender who
Y and described the occurrence of swelling at the injection
N site 6/16/2008
in a 2-year-old
6/17/2008
male subject who w
was reported by a physician and described the occurrence of a lump on leg at injection site Nin a 7-month-old4/15/2008
female5/12/2008
was reported by a healthcare professional and described the occurrence of soreness in a 11-year-old
U male6/5/2008
subject who
6/5/2008
was vaccinated wi
was reported by a consumer and described the occurrence of fever in a 13-month-old female N subject who was vaccinated with PEDIARIX.
was reported by a physician and described the occurrence of a lump at the injection site in aN7-month-old 4/11/2008
male subject4/14/2008
who was vaccinated
was reported by a physician, via a GSK sales representative, that described the occurrenceYof excessive 3/28/2008
screaming3/28/2008
in a 4-month-old subje
screaming 2/8/2008
screaming3/14/2008
was reported by a physician and described the occurrence of generalized petechiae in an infant
U subject who was vaccinated with PEDIARI
was reported by a healthcare professional via a representative and described the occurrence Y of swollen lips in a child male subject who wa
was reported by the mother of a consumer and described the occurrence of irritability in a 16-month-old
N male
3/3/2008
subject3/3/2008
who was vaccinated
was reported by a consumer and described the occurrence of high fever in a 17-month-old female
N subject1/24/2008
who was1/24/2008
vaccinated with PEDIA
Y and described the occurrence of swelling of legs Y
in a 4-month-old female ### subject ###who was vacci
was reported by a physician, via sales representative and described the occurrence of bulgingU fontalle in a 4-month-old subject of unspecif
Y via a sales representative and described the occurrence
Y of bulging
1/7/2008
Fontanelle
1/10/2008
in a 4-month-old
was reported by a consumer, and subsequently confirmed by a physician, that described theY occurrence11/8/2007 of prolonged11/8/2007
crying in a 2-month-
was reported by a healthcare professional and described the occurrence of crying in a 6 week-old
Y male 5/18/2007
was vaccinated with P
was reported by a physician to a sales representative and described the occurrence of feverUin a subject of unspecified age and gender wh
was reported by a healthcare professional and described the occurrence of hepatitis B antibody
U negative 9/23/2004
in a 60-year-old
6/12/2007female subject w
ious spontaneous report of administration to a seven-month-old has been received from a physician
Y concerning
12/1/2008 a seven-month-old
12/1/2008 male w
ious spontaneous report administered expired FLUMIST was received from a nurse concerning Y a four-year-old
12/2/2008male.12/2/2008
The patient received F
eous non serious report of stuffy nose, fever, green mucus coming out of her nose and coughing
U was received from12/2/2008
the patient's mother co
ious report "given FLUMIST to 19-month-old" was received from a doctor's medical assistantYinvolving a 12/4/2008
19-month-old 12/4/2008
male. On 14-Dec-20
ous report of "gave FLUMIST to an 11-month-old" has been received from a registered nurse Y concerning an 11-month-old
### ###
male. Medical h
ious report of administration of expired product has been received from a registered nurse concerning
Y a four-year-old
### male###who received FL
ous, spontaneous report of administration of FLUMIST to a seventh month-old was receivedYfrom a nurse. There ###was no adverse
### event as
accine used (Expired drug administered) A non serious, spontaneous report of gave expired YFLUMIST to a three-year-old### ###
female patient wa
ous spontaneous report of influenza A, fatigue, fever, sore throat, and stomach ache has been Y received from a### physician ###concerning a four
ous report of a child under two years of age who received FLUMIST was received from a registered Y nurse concerning
### a 23-month-old
### fema
ous report of administered expired FLUMIST was received from a registered nurse concerning Y a four-year-old ### female. Medical ### history and
ous, spontaneous report of administration of expired product was received from a nurse concerning N a two year-old
### female### subsequent to F
ious report of administration of expired product was received from a registered nurse concerning Y a 38-month-old ### female. Neither
### medical hi
ious report of administered expired FLUMIST was received from a medical assistant concerning Y a 36-month-old ###female. FLUMIST,
### which e
ious spontaneous report of expired FLUMIST given to this child was received from a certifiedYmedical assistant### in a physician's
### office conce
was reported by a healthcare professional via sales representative and described the occurrence U of swelling arm in a subject of unspecifie
swelling, itching, pain and tenderness and slight bruising at and around injection site on second N day after vaccination
### lasting
###about five day
s history of seizures. She had been seizure free for over 3 months after switching drugs. She U had two seizures
1/7/2009 3 days
1/10/2009
after vaccination.
bble 2 inches by 4 inches surrounded by a flame red 3 inch in circumfance rash. 1/17/2009,Y2 weeks after 1/3/2009
the injection,
1/3/2009
a flat redish brown
x 10cm long, redness, warm to touch (L) upper arm. Y 1/15/2009 1/17/2009
was reported by a pharmacist (also the subject) and described the occurrence of feeling woozy Y in a 60-year-old
10/9/2008 male
10/9/2008
subject who was vac
ffered Severe back pain, Tingling ofYlower extremities,
Y Loss of sensation,
14 Y Band like Y feeling around
N torsoe, Unable ###to stand,### resulted in perm
ankle,and foot were swollen. Painful hives on ankle, and on top of foot. smaller hives across Ylower back,on back ### of neck,and ###top of head.th
ctivity, lower paralysis, exhaustion,
Y nausea
Y andYvomiting, brain fog,15difficulty
Y concetrating, low
N blood pressure,
8/24/2007
Painful9/15/2007
periods and off cycle,
ely after receiving shot,severe pain in Y injection arm.Had to rest for 10mins in office.BeginningYthe next day,1/6/2009
had a painful 1/7/2009
knot in back, pain i
d crying spell for hours after vaccine. Has remained more fussy and easily cries for several days. U Wakes1/13/2009
at night more 1/13/2009
often.
hy red rash area across belly Y ### ###
Y 1/19/2009 1/19/2009
FELT LIKE HER HEART WAS RACING. SHE HAD A MINOR LOCAL REACTION TO NEOMYCIN Y IN THE1/19/2009
PAST. BASCIALLY,
1/19/2009 WE CALM
ported slight rash across back following a shingle vaccination. Y ### ###
ately 6-8 hrs after taking third pill of Y
Vivotif on 1/12/09, pt had generalized whelps/hives. Pt works Y in an ER,1/8/2009
was seen 1/12/2009
by a fellow physician
s after vaccine developed chills, progressed to numbness, tingling of lips and palate, increased Y BP and heart1/19/2009
rate. 1/19/2009
d MMR on 1/10/09. On 1/18/09 at 2am, Y Pt noted with 103F temp at home, with tonic clonic U seizure and 1/10/2009
macular body 1/18/2009
rash. Taken to ER,
et right hemisphere ischemic
Y strokeYwithin 12 hours
Y of vaccine administration.
6 3/11/2009
Y Received
N vaccine
1/14/2009
records1/14/2009
& PCP medical record
ped Myocardial infarctionYand MI a week Y after administration
Y of Anthrax
1 Y vaccination enroute Y to Germany 4/21/2008
after leaving5/7/2008
Ft Hood Texas. Pt did
07, my son was treated in the Emergency Y Room at St. Claire's Hospital in New Jersey.
Y He had
N recently developed
4/4/2006 4/13/2006
a high fever (103. 2) alo
ure 104.1, heavy chest congestion, Y wet hacking cough, chills, sweaty. 3:00 AM 5 ml Childrens Y tylenol 7:001/16/2009
AM temp1/17/2009
103.9 7.5 ml childrens
was considered medically important. Information regarding PREVNAR was received from aUconsumer regarding a 6-year-old male patient
### N ### ###
(+) Stool Guaiac, screaming with eating. Difficult Y to have BM. Intussusception
6 - admitted 1/11/09
Y after reduction ###with1/15/2009
air enema. (+) recurre
ld male, received shots by mistake; Hep A (HAV) and FLUZONE. No adverse reaction occurred. U 1/8/2009
ates "eye lids swelling, and severe stomach cramps". Was not seen by physician in office after Y symptoms9/19/2008
occurred. 9/19/2008
d to office on 1/9/09 c/o "rash". 10 days post vaccination hospital + eruption consistent with H. ZOSTER RT TIV### Denmatine
1/7/2009 treated with AC
z on 1/16/09 - started seizuring, eyes Y open wide, then shaking all over, then fell asleep for approximately
Y 1/13/2009
1 hr. Had1/16/2009
2nd febrile episode sho
redness, lump, tenderness at right thigh. Fever 99-102.6. Vomiting x 1 on 1/14/09. Irritable and Y cranky. Treated
1/13/2009 with1/14/2009
TYLENOL-MOTRIN. S
ined of pain in muscle around site ofY injection within days of receiving vaccine. The pain hasNradiated up9/30/2008and down10/1/2008
arm, has affected sleep
pt to administer dose: Unable to get plunger down (resistance) so gave 1/2 dose same arm similar N area and
10/1/2008
was able 10/1/2008
to give dose. Pt state
Y ### ###
apprx 3" immediately after receiving V2V- wheel baded after 24 hrs after 24 hrs - 3 days after Y a red/blue1/15/2009
discoloration.1/15/2009
l immediately after giving V2V 31/2"x4" - Wheal faded after 24 hrs- 3 days later and red/blueYdiscoloration 1/15/2009
remains. 1/15/2009
at eye of 50 cent piece pink for at 5-6" from there. 1/13/2009 1/16/2009
ew hours after immunization with influenza
Y in the left arm the patient started to experience painU to the slightest
1/8/2009
touch 1/8/2009
in the left arm between
e in "forehead". Nausea - no vomiting. Onset 01/05/09 U 1/3/2009 1/5/2009
inistered R deltoid 1/16/08. Pt describes site becoming swollen & red up to 4 cm circumference Y with a burning
1/16/2009sensation.
1/16/2009 She felt dizzy & w
ours, injection site swelled, reddened, itched, hot to touch and was extremely sore in area covering Y 6 inches
1/15/2009
by 6 inches.
1/16/2009Pharmacist recom
en dose of adult hep A. Client was 2 - 3 mos pregnant at time dose given. Client has not reported U an adverse
1/13/2009
reaction.
CAME INTO OFFICE ON 10-11-2008 DESCRIBING COMPLAINT OF COUGH, SLIGHT SWELLING Y AND DIFFICULTY
### SWALLOWING
### AF
l changes, encephalopathy, change in eye contact, speech delays, social regression Y 3/17/09-records
N received-evaluation
2/20/2007 2/20/2007 8/31/07-Impressi
he symptoms started after the second Y dose. Delainey has been having fainting spells where Ushe gets dizzy 4/28/2008
and sees 5/15/2008
black with white spots
ministered vaccine Wed - SorenessYturning into acute muscle pain around injection site and U spreading through
1/6/2009back and1/7/2009
torso. Thur - breat
mplains of excessive swelling and redness at injectio site, site all is hardened and feels hot to U the touch.1/14/2009 1/15/2009
me in on Friday 16 Jan 2009 complaining of excessive swelling at site of injection, redness, U hardness, and1/14/2009
hot to the 1/15/2009
touch.
me in complaining of excessive swelling, redness, hardness, and hot at site of injection. U 1/14/2009 1/15/2009
mplains of lump, hardness, and redness at injection site. U 1/14/2009 1/15/2009
mplaining of fever. U 1/14/2009 1/15/2009
LOPED ,MACULOPAPULAR RASHY1/19 ON FACE THAT SPREAD TO TRUNK AND ARMSUAND LEGS TODAY. ITCHY
RECIEVED VACCINATION ON 01/15/09. HAD RED WELT AT INJECTION SITE APPROXIMATELY U 3 INCHES
1/15/2009IN1/16/2009
DIAMETER WITHIN 24
wollen and hot Y 1/19/2009 1/20/2009
STARTIED TO BREAK OUT IN HIVES ON FACE & CHEST UPON ARRIVAL AT HOME APPROX Y 30 MINS AFTER### VACCINE. ### NO COUG
OCALIZED HIVE REACTION AT THE PPD SITE IN 24HOURS. BY 36HRS DEVELOPED ITCHY Y RED BUMPS
1/13/2009 WITH
1/14/2009
HALO & SOME HIV
en the slightest symptoms since the Ybegining of her chart. Consant sinus infections Y acompainedN by a weeze 1/15/2009
and cough.
1/20/2009
She also is haveing
ter I received my flu shot I fell ill with a severe flu?/viral infection? that took me six weeks to recover
Y from.12/9/2008
Symptoms: On the ###first day, seve
ceived 2 varicella vaccines (2/23/05, 1/28/08). Patient presented to the office on 1/14/09 withYscattered pox-lke 1/28/2008 lesions.
1/14/2009
Varicella titer obtai
an 17th mom noticed welts & bruising Y on child'sYside. She took her to 2 the ER. Seen by MD + Y welts & bruising
1/8/2009
spread 1/17/2009
down body to ankles,
izure (grand mal) lastingYover 3 hours. Y Life flighted and hospitalized for 5 days. Results-permanent
Y N brain damage ###to the left ###hippocampus.
X 2 1-5-09. First time seizures. 1/23/09 Y ReviewedY hospital medical 1records of 1/5-1/6/2009.YFINAL DX: new onset ### seizures
1/5/2009 Records revea
AP vaccine on 10/29/08, exhibited expected
Y s/sx
Y after injection "knot
1 at side, pain, fever, headache".
U Two weeks ###later had### lymph node on c
Contests Rash 1/12/2009
e out in lesions mostly on trunk. U 2/22/1999 1/19/2009
eg weakness / had to use crutches for Y weeks / had weakness, numbness / tingling in legs. Still U with some6/19/2008
symptoms. 9/1/2008
1/23/09 Received PC
mmunization unable to maintain LUE advection above 90 Y 1/13/2009 1/14/2009
30 sec post injection, laid down that-ammonic inhalant. 15 min later again syncope episode Y ammonia, inhalants
1/20/2009 & crackers
1/20/2009 & juice given
ffuse in location, reddish and fine papular, no skin thickening, induration or subcutaneous nodules Y , noted
1/15/2009
after the vaccines
1/16/2009were given.
l from patient stating a possible reaction to shingles vaccine. Three days after arm had swelling, N huge welt, 1/14/2009
itchy, painful,
1/17/2009
no fever, lasted fo
ceived 1st Tdap in L upper A, then MENACTRA in R upper Arm. I turned around for no moreYthan 6 seconds 1/19/2009
to throw1/19/2009
needles away in shar
old girl with one day history of emesis, Y starting on the morning following her first series of vaccines.
Y 1/12/2009 1/13/2009
ve, unresponsive for NSR. Took 1 hr before could vagal episode - No LOC. Y 11/4/2008 11/4/2008
er ZOSTAVAX - developed herpes zoster L ant chest, near arm. N 1/12/2009 1/13/2009
induration, just below deltoid area L arm began 24 hrs after injections of influenza & pneumonia Y vaccine. Achey ###& aneretis ###at onset, + 48
fter GARDASIL #3 developed syncopal Y episodes- recurrent, over course of 6 mos. Neuro and Y cardio work- 2/4/2008
ups WNL. 2/28/2008
1/22/09 MR received
se symptoms known-3rd MMR given. U 1/14/2009
- 2x2, Erythema - 5x3 left arm warm Y compressor. U 1/9/2009 1/9/2009
ceived call from mother she states that about 34 hours post vaccination hives appeared on arms, Y BENADRYL
1/10/2009 given1/11/2009
with relief. On 1/12/09
4/08 received flu shot 10pm 12/14/08 throat started feeling tight and full. Also had red, watery eyes and swelling ###of the eye###lids. Treatment,
d fainted about 2-4 min post vaccination with GARDASIL and VARIVAX. As family signed out Y in waiting 1/15/2009
room. Regained 1/15/2009
consciousness, 5
veloped fever, irritability and rash on Y 12-31-08. Parent took child to ER. ER MD noted fever Y and maculopapular### rash diagnosed
### viral exanth
x 2 approx 6-8 hours after receiving vaccines. Running 101 degree fever although parent states Y has given1/5/2009
fever reducer.1/5/2009
Next morning no n
/23/2007 pain at site of GARDASIL injection #2 5 week past GARDASIL. Myalgias, hip pain,Yelbow, wrist, 7/18/2007
hand, finger,
8/20/2007
knee, foot pain, fatig
se reactions. Child was given influenza vaccine at 4 mo of age- though to be 7 mo when it was U given. Infant had### no ill effects.
ld male, received shots by mistake; Hep A (HAV) and FLUZONE. No adverse reaction occurred. U 1/8/2009
en in office today for seizure yesterday Y after vaccines; took child to ER for fever of 104.3 andY developed1/12/2009
seizure. 1/12/2009
U 1/7/2009 1/7/2009
as given Td vaccine and in about 4 to 5 minutes later he was given PNEUMOVAX. After PNEUMOVAX, U patient### stated that###he felt very hot,
U
mmunization at 11 am temp. started 4 or 5 pm. Cheeks red, eyes blood shot. 1-10 rash on face N and arms,1/9/2009
7 am left arm 1/9/2009
painful. Rash sprea
n- fever, chills, abdominal pain, diarrhea
Y lasting 3 days. Symptoms subsided-she then felt well. Y No reaction5/29/2008
at site of 6/1/2008
injection. She was in c
n has been received from a physician Y assistant concerning an 18 year old female who on unspecified
U dates
2/29/2008
was vaccinated
2/29/2008with a first, sec
n has been received from a physician concerning a female patient who was vaccinated with Uthe complete series of GARDASIL (lot not repo
n has been received from a sonographer Y concerning her daughter, who an on unspecified date Y was vaccinated with the first dose of GARD
n has been received from a nurse and Y later a physician concerning a 13 year old female patient U with asthma11/3/2008
and allergies to codeine, and
n has been received from a physician
Y and a medical assistant concerning a 14 year old femaleN with a history of### asthma
10/1/2008
and recurrent otitis
Y concerning a 26 year old female who on 28-OCT-2008 Y was vaccinated with ### the first###
dose of GARDA
n has been received a consumer through
Y a Merck pregnancy registry concerning herself, a 41
Y year old female
10/1/2007
with 10/1/2007
allergies to Sulfa and ir
Y from a nurse practitioner concerning a 26 year old female
Y patient
1/29/2008
with no pertinent
3/3/2008 medical history
n has been received from a health care professional for GARDASIL regarding a 15 year old Yfemale who 2/29/2008
on 29-FEB-2008
2/29/2008
was vaccinated w
rmation and follow up has been received from a pharmacist and nurse for the Pregnancy Registry
U of GARDASIL ###concerning
3/11/2008a 24 year old f
n has been received from a nurse practitioner (N.P.) concerning a 1 year old female who was U inadvertently vaccinated with a first dose of G
n has been received for the Merck Pregnancy
Y Registry for GARDASIL from a health department
Y nurse and5/30/2007
from a registered
1/30/2008nurse concern
n has been received from a medical assistant and a nurse practitioner, for the pregnancy registry
Y for GARDASIL,
11/8/2007concerning ###a 23 year old
Y concerning an 18 year old female patient who on 11-DEC-2008
N was vaccinated
### with###
the second dose
n has been received from a registered
Y nurse concerning a 19 year old female patient with asthma
N and no known ###allergies###who on 11-DEC-
Y concerning a 19 year old female patient who 1.5
N year ago, 7/1/2007
approximately8/1/2007
in July 2007, was v
n has been received from a pharmacist,
Y concerning a female patient with hyperlipidaemia and
N no known drug reactions
### or###
allergies, who on
n has been received from a registered nurse concerning a 23 year old female patient with drug
N hypersensitivity### who a month ###ago was vacc
Y nurse concerning a 22 year old female with no medical N history and allergy to10/4/2008
KEFLEX, who on 02-O
n has been received for the Merck Pregnancy
Y Registry for GARDASIL from a Registered NurseU concerning 12/5/2008
a 14 year
12/5/2008
old female patient wh
n has been received from a physician concerning an approximately 15 year old female who Y in November11/1/2008
2008, was11/1/2008
vaccinated with a dose
n has been received from a physician concerning a 24 year old female who "more than a year N ago" was vaccinated11/1/2008with GARDASIL, 0.5 m
n has been received from a physician concerning a 15 year old female patient, who was vaccinated
N with the first dose of GARDASIL,
### 0.5m
n has been received from a nurse, for
Y the Pregnancy Registry for GARDASIL concerning a 23 U year old female
10/6/2007
patient who on 06-APR-200
Y concerningY a 13 year old female patient who was vaccinated
N with 11/6/2008
the third dose
11/6/2008
of GARDADIL vaccin
n has been received from a healthcare
Y worker concerning a 20 year old female patient with N no pertinent4/28/2008
medical history and with allergic re
n has been received from a physician concerning a 20 year old female who on 12-DEC-2008 N was vaccinated with ### a second ###dose of GARD
Y concerning a 16 year old female with no medical
N history of12/9/2008
allergies, who on### 09-DEC-2008 w
Y concerning a 21 year old female with a penicillin allergy and no medical
### history
### who on 14-O
Y worker concerning an 18 year old female with no medicalU history and allergies,
### who ###on 18-JUN-200
n has been received from a physician concerning a male patient who on approximately 03-DEC-2008
U was
12/3/2008
vaccinated12/3/2008
with 1 dose of GARD
n has been received from a 16 yearYold female patient with no drug reactions/allergies, who Non 09-DEC-2008 12/9/2008
was vaccinated### with the first
n has been received from a registered nurse concerning a 19 year old female patient with idiopathic
Y thrombocytopenia 5/29/2008
and no drug reactio
Y concerning a 20 year old female patient who on 17-JUN-2008
N was6/17/2008
vaccinated6/17/2008
with the first dose of G
Y concerning a 16 year old female patient who on 14-AUG-2008
U was8/14/2008
vaccinated with the first dose of G
Y concerning an 18 year old female patient who on 6-DEC-2007
N was4/9/2008
vaccinated4/9/2008
n has been received from an office manager at the physician's office, concerning a female patient,
N who was4/7/2008
vaccinated with ###first, second a
n has been received from a medicalYassistant concerning a 23 year old female with no medicalY history, allergies
1/11/2007or drug reactions who on 1
Y nurse concerning a 14 year old female patient with seasonal
N allergy
9/17/2008
and no known pertinent medica
n has been received from a nurse concerning
Y a 129 year old female patient who was vaccinated
Y with the first dose of GARDASIL vaccine (
Y concerning a 14 year old female patient with no known Y drug reactions or allergies, who in 2008, "a fe
n has been received from a physician concerning an adolescent female patient who on an unspecified
U date, was vaccinated with GARDAS
n has been received from a physician concerning an adolescent female patient who on an unspecified
U date, was vaccinated with GARDAS
Y nurse concerning a 26 year old female who on 25-SEP-2008
Y was vaccinated9/28/2008
with a first dose of GA
Y concerning a 21 year old female patient with no pertinent
U medical history and no drug reactions/allerg
Y concerning a patient who on an unknown date was vaccinated
U with a dose of GARDASIL, (site, route
n has been received from a medicalYassistant concerning a 25 year old female patient who in N approximately 9/1/2008
September
9/1/2008
2008, was vaccina
n has been received from a registered nurse concerning of her 22 year old daughter with noNknown allergies and ###a history###of contact derma
Y nurse concerning a 12 year old female patient with noNknown allergies and ###sickle cell###anemia who 10
n has been received from a registered nurse concerning her 23 year old daughter who "about U one month11/1/2008
ago" was 11/1/2008
vaccinated with the first
Y medical 7/17/2008
history, no drug
9/5/2008
reactions/allergies
n has been received from a nurse concerning a female patient who was vaccinated with a dose U of GARDASIL (lot # not provided). Subseq
n has been received from a physician concerning a 25 year old female with no pertinent medical
N history or allergies
### who on ###21-NOV-2008 w
n has been received from a licensedY practical nurse concerning a 11 year old female patientNwith no drug/reactions### allergies,###who on 17-DE
Y concerning a 14-15 year old female. On an unknown Ydate, the patient was vaccinated with her first d
n has been received from a physicianY concerning an 18 year old female who on 14-AUG-2008 N was vaccinated
8/14/2008 with a second dose of GAR
n has been received from a physicianY concerning a 12 year old female patient with no pertinentN medical history### who11/1/2008
in the end of October 2
n has been received from a patient's mother concerning her 7 month old son who was vaccinated U with a dose of GARDASIL instead of the
Y nurse and the patient's mother concerning a 14 year N old female patient
3/23/2007 with no5/1/2007
allergies and no pert
Y concerning an 18 year old female patient whoNon 10-OCT-2008 ### was vaccinated### with first dos
n has been received from a nurse practitioner concerning a 22 year old female patient with hypothyroidism
Y 10/7/2008
and no know
10/8/2008
allergies who on 0
n has been received from a medical assistant concerning a 19 year old female patient for the Y pregnancy12/8/2008
Registry for GARDASIL ### with no kn
n has been received from a medicalYassistant concerning a 19 year old female patient with no N pertinent medical
8/13/2008 history and ###a history of an
n has been received from a physicianY concerning a 23 year old female patient with depression, N who on an unspecified ### date, was vaccinate
Y worker concerning that "many patients complained ofUburning at the injection site whey ### they get a d
Y concerning a 16 year old female with asthma Y and no allergies who ###was vaccinated
### with the t
n has been received from a physician concerning a patient who was vaccinated with GARDASIL U (dose, site and route not reported) on uns
n has been received from a registered nurse concerning a 24 year old female patient with noUknown drug reactions/allergies
### ###or medical his
Y nurse concerning a 13 year old female patient with noNprevious medical 11/8/2007 history reported who in 2007
n has been received from a physicianY for GARDASIL vaccine, concerning an 18 year old female U patient 11/5/2008
with no previous medical history re
n has been received from a medical assistant concerning a 20 year old female patient with no Y pertinent medical
8/4/2008 history,
8/4/2008
no drug reactions/a
Y worker concerning a 25 year old female patient who N received second dose ### of GARDASIL and was f
n has been received from a medical assistant concerning a patient who may had received aUpartial dose of GARDASIL. The patient did not
Y concerning a 14 year old female who on 30-DEC-2008
Y was vaccinated
### with###
the first dose of
Y a 19 year old female with asthma, hirsutism and
N polycystic ovarian ###syndrome ###and no known
follow-up information has been received from a registered nurse and pediatrician concerningUa 7 month 12/9/2008
old male who 12/3/2008
on 09-DEC-2008 wa
n has been received from a registered nurse concerning a 30 days old patient who on 04-NOV-2008,
U was vaccinated
### with###
a dose of rotavir
n has been received from a registered nurse concerning a patient "greater than 32 weeks ofUage", who on an unknown date was vaccinate
n has been received from a physicianY concerning a 9 month old male patient with a history of N birth weight 10/2/2008
low, who on 28-JUL-2008,
### was v
n has been received from a registered nurse concerning a 4 month old patient, who on 16-OCT-2008,
U was vaccinated
### with###
the first dose of
n has been received from a physician concerning a 13 month old female who on 02-DEC-2008 U was vaccinated
12/2/2008 with12/2/2008
ROTATEQ vaccine. co
n has been received from a registered nurse concerning a 2 month old male patient with no U illness at time of vaccination
### who
### on 11-DEC-2
n has been received from a physicianY concerning an 8 week old patient who was vaccinatedYwith the first dose of ROTATEQ vaccine 2ml o
n has been received from a MedicalYAssistant concerning a 16 week old female patient whoNon 21-NOV-2008 12/5/2008was vaccinated
12/5/2008 with first dos
n has been received from a physician concerning a patient who was vaccinated with ROTATEQ U vaccine, oral, (lot # not provided). The pati
n has been received from a physician concerning a female who on 05-DEC-2008 was vaccinated U with her
12/5/2008
first dose12/5/2008
of ROTATEQ (lot# not
n has been received from a physician concerning an "about 9 weeks old" female who in October Y 2008, was
10/1/2008
vaccinated
10/1/2008
orally with a 2 ml do
medical records were received an reviewed concerning an 4 month old male baby patient with U a history of 8/28/2008
mild respiratory
9/1/2008
distress syndrom
welling and pain. Took Cephalexin 500Mg
Y 4x/day for 10days. Patient c/o pain periodically. Y 1/2/2009 1/4/2009
ouple hours of receiving the Tdap booster
Y (following a routine physical in which my daughterUreceived an1/13/2009
excellent bill
1/13/2009
of health), she devel
recieved comvax. Nurse was instructed to go give 1st hep b but instead gave comvax. No known U symptoms.
9/17/2008
mom never called stating her
reaction because patient never returned or called stating she had a reaction to the immunization
U that was given ###to her. She recieved a Dta
m symptoms. She never called to say she is having a reaction to the immunization that was given.U Dr ordered to### give a Tdap but the nurse g
fter infant was given Tdap instead of Dtap he was irritable. Y 1/16/2009 1/17/2009
IVED EXPIRED FLUMIST DURING WELL CHILD CHECK. NO REPORTED ADVERSE EVENTS U TO DATE OF ###
COMPLETING REPORT.
IVED EXPIRED FLUMIST DURING WELL CHILD CHECK. NO REPORTED ADVERSE EVENTS U TO DATE OF ###CMOMPLETING REPORT
HPV vaccine on January 15. Aunt called on Jan. 16 and reported that her niece had swelling Y and redness 1/15/2009
from site of injection to her elbo
ately 1100 1-20-08 given smallpox immunization w/o authorization by provider and with dx ofNeczema. 1/20/2009
plaining of post smallpox reaction 18 Apr 2008 (8 months) Pimple and nodule formation 2 wks U ago 7 Jan4/18/2008
09 around site 1/7/2009
of skin on abdomen and legs. Draining blister lesions on left side of back at beltline and LeftUleg blister lesions.
1/6/2009 From1/8/2009
Shingles vaccine by M
arms were sore. 17 Jan 09 felt conjested.
Y 18 Jan 09 more conjested 19 Jan 09 felt conjested and run down. 1/16/2009
20 Jan 1/19/2009
had conjestion fever w
CAME IN OFFICE ON 1-7-09 WITHYCHICKENPOX Y ### 1/5/2009
veloped herpes zoster on 12.26.08. Patient presented with grouped blisters on the right posterior
Y neck, right
7/1/2008
upper chest ### and right upper b
ctions on upper Lt. arm, red area, hot to touch, with some swelling in the area noted. 1/9/2009 1/13/2009
ived the Flu vaccine between 9am & 10:30AM left the building with her mother and in the parking
Y lot c/o1/20/2009
being itchy1/20/2009
and scratchy all over in
D VARICELLA VACCINE ( SECOND DOSE) LOWER PART OF LEFT UPPER ARM 1/19/09. Y SEEN 1/21/09 1/19/2009
WITH 1/21/2009
9CM BY 7 CM AREA O
of 104.8, B/P 168/80, ache all over-lastedY for 24 hrs. Y 1/13/2009 1/13/2009
FLUMIST GIVEN TO CHILD DURING WELL CHILD EXAM. NO REPORTED ADVERSE EVENTS U TO DATE ### OF COMPLETING VAERS.
ned today 01/21/2009 @9:24am with c/o pt. was very tired last evening. She did well through the night. Mom 1/20/2009
states 1/21/2009
that today patient would
ately 12 hours after vaccination; an onset of myoclonus Y seizures began.
3 During the first hour,
N as many as 16. ### This continued ### from 10/15/0
ficulty breathing, lips swelling, red face. About 10 minutes after vaccines were give dad noticed Y above symptoms
1/21/2009patient1/21/2009
was still in clinic. D
e, Nausea, Vomiting, Diarrhea, Severe Y stomach ache, Chills, Body Aches. I was unable to performY usual 9/12/2008
activities and 9/13/2008
required medical atte
weakness, fatigue, dizziness, severeYmood changes, anxiety, low grade fever, severe headaches, U chills 1/30/09
1/20/2009 Received
1/21/2009 PCP medical rec
after shot. 6 hrs later site of injection was very painful. Next day it was so painful she could Y not get dressed,
1/19/2009
could not
1/19/2009
go to work. Not swo
veloped large area of erythema and induration at 48 hrs, s/p booster dose of varivax (given U on 1-19-09).1/19/2009
Area measured 1/21/2009
7 cm x 4 cm and p
orts noticing itching and soreness @Y right arm injection site and a "quarter-sized" area that felt Y hard and was 1/7/2009
yellowish 1/8/2009
in color @ 5PM on 1
ut immediately after HPV shot. Had stinging on right side above pelvic bone for a couple of days Y after. Had1/5/2009
full body1/5/2009
muscle soreness for a
8/31/2007 N 1/3/2007 8/31/2007
seizures (repetitive head turning andYpossible salaam seizure) occuring Jan 14, 2009 over a Y 10-15 minute1/9/2009
time span.1/14/2009
No fever at that time,
n, swelling, redness to right deltoid. No exudate. Dx: cellulitis Y 1/19/2009 1/20/2009
eloped; Right arm red, swollen, hot from upper deltoid to mid humerus- started KEFLUX & ROCEPLIN Y 2gm1/7/2009
1mx 3 days 1/8/2009
-> improvement is
ceived vaccine (Anthrax) in L arm. No pain or erythema. Pt woke up Jan 18 with inability toUleft arm and1/16/2009 paresthesia 1/18/2009
over the lateral aspec
ported a lot of pain in left arm and couldn't even sleep on it. The next morning he thought heYwas blacking 1/20/2009
out. Left message
1/20/2009on patient's an
ew hours of shots pt developed low grade fever. Subsequently the next day got profuse watery Y diarrhea1/16/2009
(only 1 episode
1/16/2009of blood in stool).
arm 6 inch by 9 inch erythemous plaque, firm,warm to touch with discrete? clusters of vesicles U in center1/19/2009
medial, lateral
1/20/2009
area of left deltoid a
got swollen or red. Just very painful. Continues to throb, hurts to raise arm up above head after U few seconds gets ### a shooting ### pain from the
iatric dose of HEP A was supposed to give adult dose. U 1/7/2009
ived PENTACEL, HEP B, PREVNAR, ROTAVIRUS & flu vaccines, instead of PEDIARIX, HIB, Y PREVNAR, 1/21/2009
ROTAVIRUS 1/21/2009
& flu vaccines. No
d red rash around injection site on thigh within hours of vaccines (8 cm X 8 cm in doctors office) U man reported1/21/2009prior to
1/21/2009
arriving @ doctors of
tly warm to touch, swelling right upper Y arm approx 8in x5in. Patient applied "anti-itch" cream.U 1/19/2009 1/20/2009
n has been received from a registered Y nurse concerning a 22 year old female with penicillin Y and amoxicillin
6/19/2008
allergy who6/19/2008
on 19-JUN-2008 wa
Y and a certified nurse midwife, for the pregnancy
Y registry for2/15/2008
GARDASIL, 3/3/2008
concerning a 21 yea
n has been received from a physician Y concerning a 11 year old female with no pertinent
Y medical
N history 9/12/2008
who on 12-SEP-2008 ### was vaccina
n has been received from a physician concerning a 9 weeks old male who on 10-NOV-2008Ywas vaccinated oral ###with the ###first dose of ROT
n has been received from a consumer concerning his daughter, a 6 year old female with no N medical history 7/1/2004
who "at 18 months of age" was
n has been received from a consumer concerning her 20 month old son who was vaccinatedUwith MMR II. Secondary suspected vaccine in
veloped erythematous papules on his low back (#12) and his face (#3) following the administration Y of VARICELLA
1/12/2009 vaccine
1/17/2009
s were swelling. Patient was going to call primary doctor. Patient called me on Sunday 1/18/2009 U in the afternoon.
1/14/2009 Patient
1/18/2009 did receive other
ized erythema around injection siteYslightly warm no discharge. Y 1/7/2009 1/11/2009
and pruritis on forehead & neck some blistering Y 1/7/2009 1/15/2009
n has been received from a 61 yearYold femaleYpatient with no pertinent 4 Y medical history and Nno known drug12/9/2008
allergies12/9/2008
who on 09-DEC-2008
ain. 2. Some time weaken of lower limbs. 3. Some time numbness of lower limbs. 4. Shoulder U pain once
6/23/2008
in a while.
7/23/2008
5. Body ache- 3 w
d vaccination- shortly after the site Y became red and inflamed. The size increased following Y day and became1/16/2009
warm 1/16/2009
to touch. Size approx 4
oy (WM) seen 1/9/2009 for 1 yr old health Y steps exam. Mild rhinorrhea reported and nose congested.
Y Exam
1/19/2009
otherwise 1/19/2009
normal. Afebrile. 1x 1
reaction to VARIVAX given SC to Left upper arm 12/15/08- 2x3 cm area arm sl, red, sl warmYand swollen. Treatment: ### warm ###compress, OTC
ceived 2nd dose of Rotateq on 10/27/08. Pt has diarrhea x 10 days, watery stool 3-4x/days. ### ###
ea erythema, warm, tender, slightly hard, Left deltoid. 2 days s/p immunization with DTap, fluYIM and polio 12/3/2008
SC in left 12/4/2008
arm.
n has been received from a pharmacy technician concerning a patient who on 14-JAN-2009 Y Nwas vaccinated
1/14/2009
with a 1/14/2009
dose of ZOSTAVAX (O
n has been received from a physician Y concerning a 76 year old female patient who Y on 05-JAN-2009
N was 1/5/2009
vaccinated 1/9/2009
with ZOSTAVAX (Oka
arm & shoulder; edema & warm with pain 6/10 with movement; itching; T 98.8 degree; tiredness; tender on palpation to underarm; motion
on small pox, left shoulder, excess redness est. 70 x 55mm; gauze dressing placed recommend U air dry 30min 1/5/2009
at hs; 1/14/2009
TYLENOL. Seen 16 JA
ng pain in upper arm, and shoulderYleft side. Onset 1 week after Tdap. Pain duration approx.Y 3 mo. Weakness 7/17/2008 of arm
7/24/2008
occurred approx. 2 w
n has been received from a 26 year old female who on 13-DEC-2008 was vaccinated with aUdose of VARIVAX### (Oka/Merck). ###The reporter s
econds: tingling & numbness down arm to fingers. Then, blurred vision, dilated pupils, wain Y skin, light headedness, shallowed breathing. A
subject was enrolled in the study 110870Y (MenACWY-TT-057).
Y On 027 August 2008, 22 October
N 2008 and 23 December ### 2008,
### he received
gree rash on left arm surrounding smallpox vaccination site. Started 2 days ago 14 JAN 09, spread U to axilla
1/5/2009
area, swelling
1/14/2009 in axilla area, ten
03.5, lethargy with crying off and on. Y Tx - IV fluids
Y and fever control1with TYLENOL, MOTRIN. Y 1/29//09-records
1/19/2009 received
1/20/2009
for DOS 1/20/09-p
as admitted to medical center.
Y Abdominal
Y CT was
Y performed. Patient 2 diagnosed with intussusception.
Y 1/29/09-records
### 1/11/2009
received for DOS 1
and 12/18 4-5 episodes where lips turned blueYand eyes seemed unfocused; 4 lasted 5-10 sec.U on 12/19 11:30 am ###turned blue,### stopped brea
ort received on 12 March 2008 from the patient's parent. A 17-year-old male patient, with no illness at the 3/10/2008
time of vaccination,
3/11/2008 had received
n has been received from a representative
Y as reported by a colleague concerning a 13 yearUold female who on an unspecified date was va
n has been received from a physician concerning a 14 year old female who was vaccinated U with her first 0.5
7/1/2008
ml dose7/1/2008
of GARDASIL toward
n has been received from Y a nurse practitioner concerning a 22 year old female who on 14-JAN-2009 N was1/14/2009
vaccinated 1/14/2009
with a first and only d
n has been received from a physician Y concerning a 19 year old female who in approximatelyU2009 was vaccinated with a 0.5 ml second do
n has been received from a physician Y concerning a 70 year old male with hypertensionY who Non 05-JAN-2009 1/5/2009
was vaccinated
1/7/2009 with a dose o
n has been received from a healthcare worker concerning a 34 year old female who on 02-MAY-2008 Y was5/2/2008
vaccinated 5/2/2008
with the first dose of
onset juvenile diabetes.YVaccine givenY 8/8/08 Ypt developed symptoms 4 consistent with diabetesN over the 8/8/2008
next few months.
12/2/2008 Presented with
r Gardasil, pt developed fever, malaise, confusion.Y Admitted to hospital 4 and Dx'd with ADEMNvs. cerebral9/19/2008 vasculitis.9/25/2008
Has made nearly full r
2009 APPROXIMATELY @ 9:20 PM PATIENT RECEIVED A SHOT OF GARDASIL 0.5 ML IM. Y PATIENT 1/21/2009
WAS ADVISED 1/21/2009 TO STAY FOR 2
Y AFTER INJECTION, 2 SMALL RED/ RUFF DRY PATCH SHOWED UP ON HIS STOMACH, Y COUPLE1/15/2009
DAYS LATER 1/16/2009
ONE SHOWED UP
se event, just diagnosed with Rotavirus Y after 3 doses
Y of Rotateq...Vomiting
3 and diarrhea, stoolY positive for 5/16/2007
Rotavirus.1/27/09-records
1/15/2009 receive
ite swelled about the size of an eggYwith redness x approximately 3 days. She developed itching Y all over her body
### day 2 after### shot that las
scribed area around vaccine as red,Y warm, and swollen on 1/21/09. I instructed her to see the physician1/19/2009 as soon as1/20/2009
possible. I followed u
as vaccinated on 01/08/2009 with Zostavax
Y (LOT 1553X) in the right tricep. On 01/14/09, theNpatient received 1/8/2009
a follow-up
1/16/2009phone call and re
hots (HepB, Rotavirus, Pneumococcal, Polio, Hib, Y DTaP) were given2 on 1/15/2009. On the morning N of 1/17/2009
1/15/2009(approximately
1/17/2009 9:30 AM),
d pain in my Deltoid area the entire muscle since 11/05/09. I have had itching in that area asUwell as in the 11/5/2008
back of the11/5/2008
shoulder.I have pain
2009, pt was administered the Influenza vaccine, Flulaval, instead of Afluria (approved for the U pregnant populaton).
1/15/2009
hts after the inject I was very uncomfortable
Y and wakeful. The third day, I began noticing a soreness
U in my left breast
### which### during the next
nted miniutes after the injection was given. Pt came to and we monitored pt and rechecked blood Y pressure
1/22/2009
and heart 1/22/2009
rate. Patient stayed a
ing/erythema at injection site U 12/1/2008 12/2/2008
hot flushing, sweating, blurry vision 5 minutes after vaccination. Pt did not pass out but did Y fall to ground.
1/22/2009
Pt felt better
1/22/2009
immediately upon b
e event at this date and time. patients parent notified 1/22/2009
ately 10 minutes after receiving immunizations
Y (listed below) the patient C/O difficulty breathing.
Y Upon examination
1/16/2009 1/16/2009
patient was anxious an
ella disease, less than 50 pox, with fever,
Y diagnosed 01/22/09, started 01/20/09 by mother's U history. PO 1/12/2009
Benadryl prn 1/20/2009
itching
nt became lightheaded then fainted several minutes after receiving immunizations. LOC approx Y 1 min. and color ###pale. Remained
### nauseous
lling, erythema, warmth and tenderness. 1/20/2009 1/21/2009
ek following the vaccination, patient states he felt very tired. In the second week, he had a sore Y throat. In 11/5/2008
the third week
11/7/2008
he had a cough, n
hrs after vaccines, mild dizziness, weakness,
Y fever, pain @ injection site no treatment 1/15/2009 1/16/2009
iven 6 days ago Pt noticed soreness in shoulder to elbow area. Then spread to Flexor portion U of Forearm 1/15/2009
only describes as "Arthritic. like p
02, maculopapular rash on trunk, cranky. Y 1/8/2009 1/19/2009
mal, supple, no lymphadenopathy, no meningeal signs. Respiratory exam: normal, no intercostal Y retractions,
1/19/2009
movements
1/20/2009symmetrical, no w
eaking out 1/19. Itches - rash. No known exposure. No fever. DX: Varicella Y ### 1/19/2009
arm - hot and swollen, redness to injection site. Y 1/13/2009 1/15/2009
ceived VARIVAX (chicken pox) vaccine on 1/8/09 and came in 1/21/09 complaining of a rash. Y Dr diagnosed 1/8/2009
the rash1/21/2009
as chicken pox caused
vaccine 1-16-09 - On 1-21-09 came to office c/o mild fever for 1 day- Friday not feeling well Y post injection-1/16/2009
falling a lot-
1/16/2009
Generalized rash- d
ceived ZOSTAVAX shot on 01/09/2009. Five days later, on January 14, 2009 she has noticed U a spreading 1/9/2009
rash at the 1/9/2009
sight of injection. Sh
ped fever to 102 degree a chickenpox Y like rash Y 1/7/2009 1/15/2009
hing at site & next day arm red, swollen. Reactions in arm VARIVAX given. U 1/14/2009 1/15/2009
of 101-102 X 24 hours - se & eating otherwise Review of sy-neg. Y 1/20/2009 1/21/2009
in the hours after vaccine. Mother reports patient has typical reaction similar to other vaccination
Y in past.
1/12/2009
arm feel affected. Cannot lift arm without pain. Pain goes up to neck. I waited to send this in N to see if pain10/6/2008
subsided.10/7/2008
It did not. I cannot lift m
oblems with AVA #1 and # 2. He reportedY that 2 days following vaccination with AVA # 3 heYhad mild joint pain### that12/6/2008
persisted for one day.
night that vaccines given. VaccinesYgiven 1-17-09 @ 3 hours am (approx. Seen at ED 1-12-09 Y @ 11pm1/12/2009with 105 fever.
1/12/2009
n both wrist, itching on palms of hands and soles of feet. Welts on hip bones and on one breast. 1/5/2009 1/7/2009
a of erytheima & edema & pain (10 cm diameter) ice, BENADRYL, TYLENOL/ALLEVE for pain Y 1/21/2009 1/21/2009
(HEP A) vaccine/left office - went to wait for bus/reported by doctor that child suddenly turned Y pale (lasted 1/15/2009
few sec)1/15/2009
taken back to office/ch
minutes of vaccination c/o not feelingYwell pallor observed, full body seizure with unresponsiveness Y to shake1/8/2009
and shout. 1/8/2009
positive pulse but co
fussiness X 24 hrs, vomiting, resolved Y after 24 hours. Y 1/14/2009 1/14/2009
ped temp to 106 degrees about 4 hrs Y after vaccines. Y 1/12/2009 1/12/2009
st ava #1 broke out in a rash in his axilliae.
Y No itching, or pain. Photo's-confluent maculo-papular
N light pink
11/8/2008
rash, with few### descrete distal le
mplains of pain in left deltoid of site of influenza injection Y
Y Y 1/16/2009 1/16/2009
fect, patient was fine. Y 12/3/2008
ule. 7 cm erythema + induration. R deltoid. Y 1/15/2009 1/16/2009
iving 3 shots, client became pale & "passed out in chair approx. 5 seconds. Assisted to floorYby nurse + 1/13/2009 father. Had1/13/2009
not eaten yet that day
Y 1/9/2009
1/12/2009
10/31/08 said had blurring vision, earache, itching, & hives. in our conversation pt stated had. Y hives, & itching previous
### to ###
shot. I attribute "
6 Patient noticed pain in her left arm/ shoulder that has not resolved since injection. on 1/21/09 N she saw Dr who ###has noticed ###inflammation
n has been received from a physician Y concerning Y a 13 year old female
12 who was vaccinated N with the first dose ###of GARDASIL, 0.5ml. Subse
n has been received from a physician Y concerning a 17 year old female with no drug Y allergiesYwho had recent1/12/2009
urinary1/12/2009
tract infection and com
n has been received from a physician Y concerning Y a 15 year old female0 Y patient who
Y on 15-DEC-2007
N was6/9/2008
vaccinated6/9/2008
n has been received from a healthcare Y worker Y concerning a 9 week0old female with a historyNof "reflux" who 1/8/2009
on 08-JAN-2009
1/8/2009 was vaccinate
n has been received from a physician and a nurse concerning a 10 weeks old female patientUwith a possible 1/8/2009
"reflux 1/11/2009
issue" prior to oral vacc
n has been received from a 27 yearYold femaleYpatient with no known 0 allergies and no pertinent
N medical history, who was vaccinated with t
d angio edema of face, large wheal Y @ inj site of MMR @ 10 minutes. Uricaria over truck & limbs Y by 20 minutes### & some drooling
### -> im epin
occurred evening of vaccination of left arm. Patient states it resolved in 2-3 days". Y 10/1/2008
ke up following morning with right ankle swollen so much he could hardly walk. Used heat, TYLENOL, U MOTRIN### with relief.###No recent injury
of day HEB B# 3 received Pt developed hives on arms/face/stomach. No resp distress. Pt takes U allergy shots ###weekly. Pt has ### taken Benadr
HBV #1 patient experienced a migraine Y HIA stabbing pain radiating from back of head through Y to the front. With ###chest pains ###and SOB
ccurred on 7/16/08 and again 8/21/08 with 2 different nurses as vaccinations. 11/24/2008 - Y client reports8/31/2008
with 1st injection
8/31/2008 on left arm 4-5 h
TDAP on 11/24/08 for travel to Brazil. Y Returned to clinic on 11/28/08 for an arthur-type reactionU left deltoid, 10### x 10 cm, warm ### tissue than s
had significant vomiting day after HPV with all three administrations. 3/23/09 Received PCPY medical records 9/19/2007
of 9/19/07-
9/20/2007FINAL DX: viral g
X 4" circular swelling red, no Cellulitis,
Y past 2 days vaccine's. applied ice pack which minimized Y swelling. 1/5/2009 1/7/2009
s after TdAP in left deltoid, pt. developed swelling at site, fever, chills and lymph node enlargement,
Y supraclavicular
1/16/2009 1/16/2009
area. Now is resolved.
tions given (Hib in upper RVL, Prevnar in lower RVL) Injection sights were cleansed with alcohol Y and aspiration1/8/2009done1/8/2009
prior to injection of va
iving immunizations the patient ate lunch and took a 1/2 hour nap. Awoke suddenly screaming Y terriby-lasted
1/13/2009
15 minutes,
1/13/2009
calmed down even
day after MMR. Parent consulted primary Y care provider at pediatric clinic and was advised toUuse Benadryl. 1/20/2009
Presented 1/21/2009
to our facility on day
iven in error. PCP ordered a Varicella vaccination and I administered a Zoster Vax. Error identifiedY on 1/22/2009.
7/28/2008 7/30/2008
Patient returned for PPD
RSE REACTIONS NOTED Y 1/23/2009
very pale, fainted getting out of theYbath father caught patient before he hit the floor. U 1/22/2009 1/23/2009
s of hand and legs, cough, dizziness, Y nausea, malaise, muscular pain, gastrointestinal disturbance,
Y face an throat
### rash. ###
ent came into the Immunizations clinic Y on the 12Jan09 to receive the MMR, Varicella, IPV, DTAP, N and the 1/12/2009
HEP A vaccine,
1/13/2009 waited 15 minute
n itching sensation in the back of the right arm. PT was rubbing the site and noticed a red rash Y like reaction1/23/2009
going from1/23/2009
the shot site which w
wollen and warm to touch, pink upper left arm. Benadryl Y
ed rash noticed approximately 8 hours after receiving vaccine.lotion applied to rash at time noticed.U called1/22/2009
OMS on 1/23/09
1/22/2009 to report rash an
9 at the time of immunization, baby Ywas seen and diagnosed with URI/(L)otitis media. Afebrile. Y During night 1/21/2009
of 1/22 1/23/2009
developed fever of 102
over night (Dec 16th 2008),
Y my baby Y wake up, Yfussy, did not wanna5eat, start vomiting yelowY liquid, got pale, went ### to doc.### and told us it cou
ely following venipuncture pt said it hurt. Pt supported and encouraged to provide post-injection N pain relief methods. ### She said ###it still hurt whe
MCV4, Hep.A, Varicella on 01/20/2009. On 01/21/2009 her lower L. arm (just above the elbow) Y became1/20/2009
swollen, red,1/21/2009
very sore and warm
e body and neck, has been running fever (around 100.5F) for 3 days already. U 1/13/2009 1/21/2009
arrhea, dehydration, 1 week Y following Y 2 month Y immunizations: DTAP, 30 YHIB, PCV7,YROTATEQ. Y (+) intracerebral
10/7/2008
bleeding with ###stroke and sei
ved her immunizations on 1/16 and developed urticarial rash 1/21. Patient had 0 previous hxUof reactions1/16/2009 to vaccinations
1/21/2009
and had 0 previou
ematous left upper arm, slightly warm and tender. 2 days s/p DTap, flu IM injection Left deltoid Y and Polio 12/3/2008
SC.
after influenza and HAVRIX were given Y in the left thigh, patient developed a warm, red, firm, Ytender area surrounding
1/8/2009 1/9/2009
this site. It was measu
both MENACTRA and BOOSTRIX 1/23/2009 Y in left deltoid approx 1 cm apart. Area becameYred, hot and 1/22/2009
indurated1/23/2009
after next day. No SOB
oke out with a couple of red spots on back. Vaccine given on 1/16/09. Pt saw Dr on 01/17/09. Was diagnosed 1/6/2009 with1/17/2009
shingles. Treated wit
opped by the clinic and stated since this flu shot on 11/24/08- He has had left sided neck pain U and left arm soreness.
### He denied any chest p
erythema multiform. Y 1/22/2008 1/28/2008
hrs after giving immunization another noted maculo-papular rash all over the body. Follow up check up rash 1/21/2009
all over1/21/2009
the body. Given Bena
.3 Febrile seizure X 5 min Y Y 1/21/2009 1/22/2009
orts shortly after the shot, it is hard to
Y pinpoint when it started a knot came up on (L) arm whereN the injection
10/2/2008
went in and had some swelling
ks like measles. No fever kopeck spots. Y 1/12/2009 1/22/2009
GARDASIL shot series. It didn't cause major problems, but when I took the second shot around the above date I noticed 1/20/2008a change in my v
ort received from the patient's parentYon 12 November 2008. A 39-year-old male patient complained of weakness, ### loss of ###appetite, night sw
ort was received 08 May/2008 from a Y health care professional. A five-year-old female patientUwith no known 5/2/2008
allergies, had received a subcu
ort received on 02 September 2008 from a healthcare professional. A 68 year old male patient Y developed8/26/2008
wheezing8/29/2008
72 hours after had rece
-old female patient experienced bilateral axillary rash and bilateral ear redness and itching within
Y hours after
11/5/2008
receipt11/5/2008
of an intramuscular left
ort was received from a health care provider on 09 January 2008. A 55-year-old male patientYwith no pre-existing ###medical ### history, had rece
d rash within 24 hours of administration of her 2 month shots. Diagnosed by the pediatrician N as eczema. 12/6/2000 12/7/2000
ated pain began 4 hours after the immunization
Y was administered on October 6, 2008, and has U never been 10/6/2008
the same 10/6/2008
since. She went to he
ours, after the vaccines, Ymy daughter Y started making moving in a weird way I had never seen U before. I put
1/16/2009
her in her1/16/2009
crib because she I tho
o navy recruit that present after yellow Y fever vaccine.
Y Pt noted sweating,
1 palpatations, weakness,
Y dyspnea,1/8/2009
and hives1/8/2009
immediately after yel
lled to report reddened area on date of injection at injection site. Increased redness and lump Y at injection 1/8/2009
site noticed1/8/2009
on second day follow
on thorax. Lasted for 5 days. No treatment necessary. Y 1/9/2009 1/20/2009
itis of arm. 3/3/09 MR received fromYreporter including vax rec (no lot #s). Pt presented 1/26/09 U with c/o increasing
1/15/2009 redness
1/24/2009 around SP vacc
rmation received on 21 January 2009 Y from a health care professional. A 27 year old female patient
N with a1/19/2009
history of 1/20/2009
tonsillectomy received A
hronic resp. congestion, myalgia, skin lesions acute to chronic, headaches to migraine, Y neuropathy
N pain, 2/6/2002
diarrhea, brown
2/6/2002urine, chronic fati
esday had sore throat, runny nose and developed into cough. fever of 100 degrees taking aspirin U helped.1/21/2009
Today feeling
1/22/2009
the worst.
history of shingles, but in the days following vaccination - vaccination on 12/20/08 - he developed pain on the back ### or his ### scalp in the right
the vaccine ZOSTAVAX. I had all the side effects listed, except I had an outbreak on my arms like chickenpox. Was1/15/2009 this normal
U 1/8/2009
pprox 16 hour after immunization. Fever increase recent. Y 1/15/2009 1/16/2009
ng in office for 15 minutes after receiving GARDASIL vaccine. Patient complain of left knee feelingY hot, painful.
1/23/2009I assessed
1/23/2009 left knee, knee w
nt soreness let deltoid subsequent to vaccine. N
s after I received the ZOSTAVAX injection , I broke out with a rash on my right arm. It was 2-3 Y cm wide, consisted ### of pruritic###small red papu
after injection developed red hard areaY no painful quarter size. Resolved without sequelae.U ### ###
attached. Called patient 1/23/09 return Y call from patient. Swelling decreased still sore and itchy,
U still taking1/19/2009
BENADRYL 1/20/2009
and antibiotic.
had an immediate reaction at the MMR injection site. With moderate erythema, warmth, in duration Y patient
1/6/2009
was stable1/6/2009
and activity unchang
jection site- plus erythema approx 2 cm with hard papula pustule next to each other. U 1/6/2009 1/20/2009
d hives 12 hrs after receiving vaccine. Y 1/21/2009 1/22/2009
eft thigh with redness around site ofYinjection. Rx BENADRYL swap 2 tsp q 6 hrs. PRN. Y 1/20/2009 1/23/2009
n has been received from a nurse and Y her 79 year old mother (the patient) who had Y a historyNof shingles on July ###2008 with### the rash localize
n has been received from a registered Y nurse and Y physician concerning
0 a 54 year old patientUwho on 14-JAN-2009
1/14/2009 was 1/16/2009
vaccinated with a in
Health Department this am stating she had a reaction from her Pneumonia vaccine. Pt stated U that she has1/23/2009
a "itchy, 1/23/2009
prickly" rash to both arm
shots given,alert and oriented x 3 2:18pm - c/o "ears numb I can't hear", swaying in chair,alert Y x 1(person 1/23/2009
only), blowby
1/23/2009
oxygen given @10
ed, hot and swollen Pt. to take Advil and benadryl Y 1/20/2009 1/21/2009
vaccine at 9:30 am, stated feeling chilled approx 2.5 hours later. Then started to have dry cough and expiratory 1/23/2009 wheezes
1/23/2009at night starting la
ut with seizure like behavior. Y 1/26/2009 1/26/2009
of arm and itching one day after vaccine admin
d his 1 yr well-baby check-up on Friday,Y January
Y 16, 2009 and everything
1 checked out perfectly
Y for him.1/16/2009
He was given1/20/2009
his vaccinations of
Developed severe case of Y pneumonia Y with fever - no cough or cold prior. Was sent to hospital
N for chest 1/23/2007
x-ray. Was7/16/2007
given inhalation therap
9 pt received a Tdap inj booster in LYdeltoid in belly of the muscle. Several hours later she developed
Y swelling
1/12/2009
and pain
1/12/2009
in the deltoid. No di
eived Engerix B vaccine on 1/13/09. On 1/26/09, client reports symptoms of sweating, itchingYon upper extremities,1/13/2009 pain1/15/2009
in knees,and fatigu
e fol shot. Woke up the next morning, couldn't move arm, "hives" at site, red, warm, swollen,Yvery painful,1/21/2009
pain at joint.
1/22/2009
Was instructed to co
SED WITH SHINGLES 01/26/2009 PATIENT HAS ONLY RECEIVED ONE DOSE OF VARIVAX LISTED9/11/2000 ABOVE 1/26/2009
ed and diagnosed with Guillian-Barre Syndrome. Y Weakness in upper 16 extremities. 2/10/09 Received hospital medical
### 1/20/2009
records of 1/20-1/30/2
s started two days after recieving the Y vaccine. Experienced muscle pain, spasm,Yand weakness. N Have seen multiple
### doctors
### for treatment
ports high fever (104.7, severe diarrhea,Y and shortness of breathe four hours after vaccines.YWas seen in local### ER was observed
### and given
s after the vaccine the patient develop severe migraine headaches, accompanied by nausea. Y She was medicated
1/24/2009 with1/24/2009
pain medication bef
lled to report swelling of right arm thirty six hours post injection. Patient stated hurt in muscleYand "itched like
1/8/2009
crazy".1/10/2009
She also reported vag
ceived the Varivax on Saturday 1/24/2008. The following day she noticed the area was red and hard and1/24/2008 itchy. It continues
1/25/2008 today, she has
iving vaccination at 11am on 1/21/09, pt went out to lunch and had a hamburger and a beer.YAround 1pm, 1/21/2009
developed 1/21/2009
Headache, nausea, a
alling to report possible reaction to vaccines. Traveling abroad, yellow fever area. On 1/16 receivedU 5 vaccines.
1/16/2009 Tdap,
1/22/2009
Flu, HepA, HepB an
after being vaccinated pt. began having
Y SOB and
Y then palpitations 5 with heart racing. Pt. taken
Y to ER and1/7/2009
admitted with
1/7/2009
tachycardia and BB
with erythema and edema. Mom brought baby in. Advised to ice x20' q hr. Motrin 5mg prn. Y 1/5/2009 1/5/2009
swelling, warmth to site fever (100.2), chills, fatigue, achy. Y 11/5/2007 11/6/2007
ately 24 hrs after injection, a hard reddish lump formed at injection site. it was painful to touch Y and very hot. ### ###
hot. Red, sore. Bump 3 to 4 inch in diameter-lasting about 2wks and still have a bump aboutUdime size. NO pain ###, no redness. Hep B shot,
warm, painful area 2"x4" around injection area. Y
ot given-is red and warm to the touch and a little sore. Y 11/5/2007 11/6/2007
headache with fatigue approximately 16 hours after flu shot. Duration was approx. 24 hrs. I rarely Y have a headache.
### ###
ng, hives, feverish. N 12/2/2008 12/4/2008
d. got shot. Thursday the 11th small nickel size red area and hard, warm to touch knot. VeryNsore to touch. Friday ###morning### golf ball size kno
und, fever, swollen area, tender to touch right upper arm 24 hrs after shot given. Noted givenUposterior mid upper ###arm not deltoid.
(severe vertigo) vomiting, nausea. Y Y ### ###
nset right flank rash-itchy vesicular anterior and posterior. U 1/24/2009 1/24/2009
ythematous maculopapular on both cheeks and all over trunk and extremities. Swollen-nontender Y (R) thigh.
1/9/2009 1/20/2009
rned to clinic 2d after vaccination & Y voiced pt had been to ER for febrile seizure post vaccination.
Y 1/26/2009
er back - few small red raised bumps. Left front chest 1 small / pinpoint raised red bump. Mom Y gave Benadryl P.O. ### after onset### of symptoms
d ADACEL RA upper deltoid, PNEUMOVAX RA lower deltoid. On 11/4/08 since vaccinations Y febrile, chilling.
11/4/2008Has not
11/5/2008
felt well since. Nega
eft shoulder, et with deep breath -dizziness assisted to lie down-ice bag applied to shoulder-skin Y w/d, BP11/7/2008
100/60 P-72 11/7/2008
regular. Encouraged
e, chills, fatigue, fever (highest 103.2 F). These symptoms lasted 4-5 days. Still had headache Y 8/18/08. 8/12/2008 8/13/2008
with erythema, warmth + swelling - vaccines given 8-6-08, signs and symptoms started 8-7-08. Y Motrin, Benadryl
8/6/2008icepacks.
8/7/2008
mediately began to feel tired. He also developed a headache and a low-grade fever (99.0F) Ywithin 2 hours 8/12/2008
of receiving
8/12/2008
immunization. Patie
e, fever 101.0F, neck ached, slight sore throat, very tired. Hold not feel well for 2 days. Y 7/22/2008 7/24/2008
3/05-1445- after receiving immunizations on 7/21/08. C/o pain in LUE. Pts. LUE had an area Y of approx 7/21/2008
5 in x 3 in around
7/23/2008 injection site that
ul - Hyperventilating - trembling before injection. Became faint approx 3 min after inj. Placed Yin shock position,7/2/2008
color returned
7/2/2008slowly, got pa
mother reported that child had a small bleed after needle was removed pressure and cotton ball U was applied by RN. The child removed ban
ates developed muscle and joint aches Y the following day after receiving a Tetanus vaccine. StatedN by 4:001/5/2009
PM on 1/4/091/6/2009
his joints began to
ates" child can not move her RUE at all: C/O RUE being very sore C/O nausea +HA. Temp 99 N f. Given children
7/9/2008Ibuprofen.
7/10/2008Mother states mi
n HPV during her pregnancy she was apx 6wks gestation. She was also given varicella at hospital. U When9/25/2008
she was apx 9/25/2008
5 week gestation
g MMR patient eyes rolled back, PtYslumped and became unresponsive and dusky. O2 put on U Pt after trying to###revive and### EMS called. B/P
nation 10-27-2008. 10-29-08 arm started aching. 10-30-08, arm swollen clear down into handNand up thru shoulder ### into neck. ###
e, weakness, decreased concentration, writing illegible, chills, stiffness lower extremities, muscle Y aching, fever 101 ### (although ###this was taken
Tenderness, difficulty breathing. U 10/1/2008 10/1/2008
at swelling from top of knee up leg on next day. U 9/24/2008 9/25/2008
mmunization administered TRIHIBIT/DTAP/HIB given instead of ACTHIB HIB U 8/25/2008 8/25/2008
Rash immediately around MMR at varicella injection site. Y 7/31/2008 7/31/2008
lled clinic at 5:15 pm 7/8/08 stating child had temp 101F this am. She has given Motrin and YTylenol and now 7/7/2008
at 5:15 7/8/2008
Pt temp 101.2 even th
s after administering vaccine patient c/o dizziness. H20 given and Pt jacket removed with recovery. Y 6/9/2008 6/9/2008
ministered 6 mo too soon per vaccination scheduling guild lines Y ###
ticed last NOC right thigh to knee swollen + red. 0 hot to touch, but is tender child does walk,U but with slight limp. ###Advised ### to give Ibuprofen
Temp- eyes matted - clear nasal discharge
Y - cough - Sx lasted 2 days - to ER Fri, Amoxicillin, and cough med- Dr ###said ok to### proceed with ne
se broke out in hives, w/2nd dose lips swelled as well as mouth. Y 6/27/2008 10/9/2008
tous Maculopapular rash appreciated Y in the L2-L3 distribution of the R leg. Largest patch 6cm U in diameter.
8/16/2007
DX shingles.
1/20/2009
TX Acyclovier 300m
r abdomen, onset 1-22-09. Y 1/15/2009
and VARIVAX vaccine were administered.Y Pt c/o chest pain at home. Pt returned to office, BP
U was taken 1/22/2009
and was monitored.
1/22/2009 c/o rash on b
f 1-16-2009 noticed back pain, throughout that morning developed what felt like a mild fevers Y and generalized
1/5/2009
muscles
1/16/2009
aches "flu-like" feeli
s about 2in erythema and slight swelling advice to apply ice pack patient denies any pain U 1/20/2009 1/21/2009
ceived pediatric dose of ADACEL. No adverse reaction. Y 12/8/2008
DPH and IPV. Reporting medication error. To date , no reported adverse reaction from IPV over U vaccination. Born ### 3wk's premature.
up at 5pm with vomiting. Feels like she could faint. Complains of ears ringing and continued Y nausea.-1. 1/19/2009 1/20/2009
tching-blistering at injection site at about 12 hours after injection-warm compress. BENADRYL Y PRN. 1/8/2009 1/8/2009
en arm - about size of baseball, hot tender. Started 1day after shot and lasted 4-5 days. Y 12/9/2008 ###
nausea, dizziness within 30 sec of vaccine administration (HPV) symptoms persisted for full 48hrs Y per Pt1/20/2009
symptoms 1/20/2009
were severe.
Tdap in left upper arm-IM 12/15/08. Pt called Tues - achiness Monday night-on AM Tues-L arm Y red, warm, rash, ###swelling took BENADRYL
vaccine was administered by the office nurse on the morning of 01/22/09. Exceptional itching, Y pain, tenderness,
1/22/2009 and1/24/2009
soreness at the sight o
ort received on 13 January 2009 from Y another manufacturer, report number A0761372A. The N initial reporter
9/29/2008
to this manufacturer
9/29/2008 had been
ort received on 15 January 2009 from Y a consumer. A 65-year-old patient, who had no concurrent U illnesses, but ### who has allergy
### to tree polle
ort was received 16 January 2009 from Y another manufacturer; document number 927258. The Y other manufacturer ### received ###the report from
n has been received from a physician Y concerningY a 14 year old female12 who on 17-NOV-2008 Y was vaccinated with ### the second### 0.5 ml dose
n has been received from a physician concerning a female patient who on 25-FEB-2008 wasUvaccinated2/25/2008 with the third8/1/2008
dose of GARDASIL.
n has been received from a physician Y concerningY a patient who was 11vaccinated
Y with a dose Uof ROTATEQ (Lot### not provided)###although it wa
Y N
edema of the eye, distorted vision;Ypossible auto-inoculation
Y 4 Y ### ###
minutes after patient had the shot, we were standing at the receptionist's area and she faintedYand fell down. 1/26/2009
She remembers
1/26/2009getting very d
wheezing, hives, dyspnea occured Yat 12 noon.Ytourniquet applied when 1 patient had first cough
Y and saw1/27/2009
first hive on1/27/2009
arm. injected epinephr
Hepatitis B #2 and TdaP. Developed Y rash on neck, right and left upper arm. Denied rash prior Y to injections. Denied ### itching, ###SOB, edema.
tes after vaccine administered client was standing ready to leave, and client later reported felt Y extremities1/26/2009
getting numb.
1/26/2009
Client sat down in
irst injection on 7/10/2008. Since my Y second injection (9/26/2008), I haven't had a regular menstrual
N cycle,
7/10/2008
even while
9/26/2008
on birth control. I am
mach, sore Muscles, joint pain Y 1/12/2009 1/16/2009
eived two vaccines after older sibling received vaccine. Client standing and awake and alert Y and putting on 1/26/2009
coat to leave
1/26/2009
facility when sibing
arm pain that remains severe in mid Y upper arm where the injection was given on left since 10/20/2008
N flu shot. ###
NSAIDs nto ###helpful. US ne
itis and soreness in left arm, where vaccine administered. treated with Tylenol and cold packs. Y 1/21/2009 1/22/2009
minutes of receiving the Tdap immunization, patient had passed out on the floor and started seizureing.
Y She
1/23/2009
convulsed1/23/2009
for approximately 45
ately 6 minutes after receiving the Tdap vaccine in left arm, patient had difficulty breathing and Y felt dizzy,1/23/2009
nauseous,1/23/2009
and light headed. I laye
MS TO HAVE FLU AFTER 3 DAYS OF RECEIVING VACCINE AND ABOUT AFTER 5 DAYSUSHE DEVELOPED 11/5/2008 TINNITUS ###
AND PATIENT
ed Anthrax vaccine 10 Dec 2008, # 3 of 6 shots. Pt found that she was pregnant on 13 Jan 2009. Pt had no reaction ### to the Vaccine. Repor
swelling, heat, bruising & pain at injection
Y site, along with headache. Patient also stated a red band from 1/21/2009
injection site
1/23/2009
down the back of he
ately 3-6 wks after vaccination number Y 2 in september 2008. i had migraines, nausea, vomitting, U fatique with 9/20/2008
no probable cause
### that lasted
inflamation at injection site, with increasing
Y cellulitis 1/24/2009 1/24/2009
n area of redness + swelling +warm painful to touch on Rt med thigh esp where TETNUS / ADACEL Y was given
1/6/2009GARDASIL
1/8/2009 suspect + TDAP
d injury to left arm and came to clinic requesting a TD. U 1/22/2009
swelling at injection site; some itching in body. Recommended Benadryl and then pt to medical U center if1/23/2009
anything else.
1/24/2009
esented in Health Department one day after receiving Tdap. C/O back pain in Left deltoid. Slightly Y red at1/26/2009
injection site.
1/26/2009
No swelling noted.
ministered 1-21-09 pt wife notified us that w/in a few days he had broke out in rash on trunk which Y then spread,
1/21/2009 treated w/OTC Benadryl.
ver on arms and legs 1/21, woke upY1/22 with very bad rash on right lower leg. Seen by PCPY 1/22 treated 1/20/2009
with BENADRYL
1/22/2009 for rash and TY
th redness on 01/23/09 and severe pain and redness which increased with time. Was very red, swollen and 1/22/2009
painful 1/23/2009
and spread to elbow 1/2
swollen area at injection site, hot toYtouch very itchy- 104 degrees-105 degrees Temp. Y 1/22/2009 1/23/2009
reaction to MMR & VARIVAX - Lo causing erythema onis Y 1/27/2009 1/27/2009
ction to Tdap U 1/20/2009 1/22/2009
fussy and very gassy for 2 days following vaccine. Day 3 brought diarrhea 10-15 times a day, Y watery, green,
1/15/2009
positive
1/18/2009
for occult blood, no f
nflammation and pain at injection site extending 4" from site and half-way around arm. Pt told Y to apply cold 1/5/2009
compresses 1/7/2009
x1 day then warm c
d 1/27/09 with Zoster L1 dermatome.Recieved Varivax 4/27/04 and ProQuad 11/14/06 1/27/2009
ella rash started 1/27/2009. Y Y 3/21/2005 1/27/2009
n has been received from a physician concerning a 79 year old white female patient who onY05-DEC-2007 12/5/2007
at 13:4510/7/2008
pm was vaccinated into
n has been received from a physician concerning a 65 year old male who on 05-NOV-2008 Y was vaccinated 11/6/2008
with PNEUMOVAX ### 23 (Lot #66
n has been received from a physician concerning a 49 year old male with asthma and allergic Y rhinitis who 11/6/2008
on 06-NOV-2008
11/6/2008 was vaccinated
n has been received from a pharmacist Y concerningY a hospitalized patient
0 Y who on an unknown U date was vaccinated with a dose of PNEUMO
n has been received through the Merck Pregnancy Registry from a healthcare worker concerning Y a female
4/15/2008
(age not4/15/2008
reported) who on 02-JU
n has been received from a physician Y concerning an approximately 15 year old female patient N who was mentally handicapped who in 2007
N age
1/1/2000
was reported by a lawyer and described the occurrence of muscle weakness in a male subject N of unspecified
5/25/2000
was reported by a lawyer and described the occurrence of joint pain in a male subject of unspecifiedN age 6/2/1999
ho received flu and ZOSTAVAX
Y vaccine
Y on 11/6/08
Y began to notice12lethargy, myalgias, arthralgias
Y that gradually
11/6/2008grew 11/9/2008
worse. Was seen in
st vaccination: dizzy, dimming vision, Y nausea. Recovered
Y in clinic: In1 P.M: Client experiencedY loss of vision,
1/22/2009
loss of 1/22/2009
muscle control, swelling
with ESRD on HD, HTN, and Y DM presents to ER from HD center via ambulance after receiving N PNEUMOVAX 12/4/2008
and developing
12/4/2008sudden SOB.
ccination 1/20/09, and 1/22/2009 c/o painful knot, erythema 2 1/4 in on Right Deltoid. U 1/20/2009 1/22/2009
ate that infant cried screaming episodes for 3 hours per episode, for 24 -36 hours after receiving Y immunizations. ### Increased ###T. Eyes and fac
after the injection patient noticed a red wheal approximately 1" in diameter. It was itching andUburning. The 1/22/2009
rash increased
1/23/2009in size to 3 1/2-2
FLUZONE 1/15/09. 1 week later noted pain in both forearms & later both legs. 1/22/09 Mainly U myalgias. 1/15/2009
Still being1/22/2009
evaluaated.
after administration, a 2 inch strip ofY hot, painful whelps developed on middle of the torso, on N the left side.
1/16/2009
The next1/21/2009
dayit spread to the fron
TIS TO LT. DELTOID REGION. Y Y 1/20/2009 1/22/2009
2 of the 3 Gardisil shots. One on 10/16/07 andYone on 2/2/08. In April 4 2008 I had a virus thatUlasted for 4 2/6/2008
weeks and5/23/2008
was treated with antib
cieved vaccines on 1/16/09 on both upper outerY thighs. On 1/17/09,2patient's father phoned Ydoctor on call, 1/16/2009
stating right
1/17/2009
thigh was swollen.
perienced swollen, red, hot upper arm at side of injection, patient took benadryl to relieve theYsymptoms;1/21/2009 symptoms1/22/2009
were dissipating after a
after 1st PCV, baby's thigh feels hard and small red area around injection site. Baby extremely Y irritable and1/27/2009
drowsy 24 1/28/2009
hours after as well.
ash; about 2 dozen lesions Y Y 5/14/2008
1/21/2009
ers of up to 103.2, body aches, malaise,
Y cough,small pustules on skin Y 1/22/2009 1/24/2009
YTHEMATOUS LESIONS WITH VESICLES Y IN DIFFERENT STAGES. 2-3 LESIONS NEW TODAY. Y ERUPTIONS
1/6/2009 BEGAN1/19/2009 ABOUT 72 HOU
IPV GIVEN AT 12 MONTHS U 1/20/2009 1/20/2009
welling 10.5 cm x 9.5 cm, firm, and warm to touch with pain. Y 1/26/2009 1/28/2009
veloped a rash 7-10 days later. Rash has been diagnosed as pityriasis rosea. The dermatologist informed me### that PR may ###be associated
inic with 5 yo with concerns about swelling/redness to R thigh. Received vacc 3d in bil thighs U and mom states
1/23/2009R thigh had lump next d. with
SHOT WAS GIVEN DIRECTLY IN TO Y MY LEFT SHOULDER, UP VERY HIGH, AND BEHIND. N I NOW HAVE A### TEAR ON### MY SUPRASPIN
as on target with speech and gross motor skills approaching his first birthday. He Ysaid about N 10 words, knew 6/29/2007
the signs 7/6/2007
for cup, food, mom a
g x 3 weeks. 2. Local pain where shot or injection was given. N ### ###
es temp 102.2 F orally several hours after injection. Also complained of nausea and vomitingY but was also 1/26/2009
taking Flagyl
1/26/2009
for Vaginitis.
c/o headache, nausea, vomiting, fever, rash on arms, neck, chest, abdomen and pain and swelling N at injection
1/26/2009 site.1/26/2009
neck muscles, onset 24 hours later. No other physical events to potentially cause this no fever U or constipation
1/23/2009
symptoms.
1/24/2009
Rx: muscle relaxa
accine given. 1-22-09 at 6pm beganYvomiting. At 9:40pm c/o knees "killing me". Mom carriedYto bed 1-23-09 1/16/2009
and 1-24-09,
1/22/2009
child home playin
d localized reaction with redness, swelling and itching. Y 1/26/2009 1/27/2009
o right upper arm swelling, localized to immunization site. Hot, painful. Patient seen in clinic, U states it feels1/27/2009
much better, 1/27/2009
swelling decreased
, Hyperemia and edema at injectionYsite R thigh and oral lesion measuring 10x7cm U 1/26/2009 1/27/2009
y Dr via telephone and advised to go Y to emergency room. Patient was triaged by Dr. Y 1/26/2009 1/26/2009
redness with the left shoulder/arm where shot was given. Y 1/21/2009 1/21/2009
as diagnosed with shingles. Y 1/7/2009 1/19/2009
, 2006 I went to the Hospital for my Y annual physical.
Y When the Doctor 3 discovered that I had NAtrial Fibrillation
5/12/2006
and kept5/12/2006
in the hospital for my
le SM referred to hospital from ED for Y f/u evaluation of chest pain S/P primary SPV and AVAY#2 1/31/2008. 1/31/2008
Symptoms: 2/6/2008
Dyspnea, Diaphor
ort received on 21 January 2009 from a health care Y professional. A 2-year-old
0 child, who hasUpast medical 10/1/2008
history of respiratory
1/1/2009 syncytial vir
ort received on 15 January 2009 from a physician. Y A 7-month-old female 0 patient who had no Nconcurrent illnesses, ###pre-existing### medical cond
n has been received from an investigator
Y concerning
Y a 12 month old0 female with nasal congestion
Y and a history ###of a recent ###cold and methic
n has been received from a pharmacist concerning a female who in 2008 was vaccinated with Y a dose of GARDASIL. The patient experienc
n has been received from a physician Y concerning Y a 24 year old female 6 Y who on 22-JAN-2009Uwas vaccinated 1/22/2009
with a1/22/2009
0.5 mL third dose of GA
n has been received from a consumer concerning Y the 15 year old daughter
0 of her friend whoN"months an months ago" was vaccinated with
vaccine given 12/31/2008. Onset of painful genital ulcerations- two total- on approximately 1/14. Evaluation in### office1/16/2009
revealed two isolated
ported rash and itching around injection site starting a couple days after receiving the ZOSTAVAX injection. 1/19/2009 1/19/2009
eltoid region with redness, warmth and itching per patient, upon return to office on 1/22/2008,Ywhere ADACEL 1/19/2009
was given.
1/22/2009
Pneumonia Vaccine R arm Flu vaccine Y and 7 hours later, L arm pain so severe + decreased U mobility, went to the ###ER. ER Dr. ###was "uncaring
ed on 1/15/08 at 11 am, states child's Y left arm red and swollen post vaccine. Was advised to Y go to PMD. 1/13/2009
On 1/19/08,1/15/2009
called MOC, states too
veloped a facial palsy on right side Y that started on or around 12/23/2008. Patient was evaluated Y for Lyme which ###was negative.
### No other c
FLUSHOT 12/15/08 AND MOTHERYSPOKE WITH ON CALL PHYSICIAN 12/16/08 AND STATED Y SHORTLY AFTER ### FLUSHOT
### PATIENT
Y 1/22/2009 1/22/2009
G AT INJECTION SITE Y 11/3/2008 11/3/2008
9 pt report n&v, confussion,HA,lip swelling
Y & numbness. 2/23/09 MR received for several OVs U beginning 1/26/2009
1/8/09. Seen
1/28/2009
prior to vaccine for
nations, including rotateg, received on 1/26/09 at 2mo. of age. mother called clinic to report that U baby had1/26/2009
8 episodes 1/29/2009
of diarrhea 1/28/09 an
ith, I was never alergic to anything in my life until they adminestired that flu shot that they toldN me I had to 3/13/2000
have to keep
3/13/2000
on working, althoug
09- received vaccination. 21 Jan 2009 Y had chills and weakness. 23 Jan 2009 had chest pains. Y Went to Aid 1/20/2009
Station was
1/20/2009
told he had gas. Co
9 after clinic visit, and @ 7:30p felt dizzy,
Y faint, sensitive to light and mom states pt. got really
U pale. Mom1/20/2009
gave tylenol1/20/2009
and went to sleep. W
ng for 12 hours. 10 days later subjective sx of swollen tongue and difficulty swallowing. Did not Y seek medical1/13/2009
care for1/14/2009
condition.
y 1 week after HPV #3 vaccine U 1/22/2009 1/28/2009
ours of receiving vaccine had fever greater than 102F, chills, sore throat, muscle aches, fatigue, Y and dee12/9/2008
non-productive
12/9/2008cough. lasted 4 d
eived HIB #1, Prevnar #1, Pediarix #1. Y Started to show sytmptoms of vasovagal response but Y then moved 1/28/2009
into very1/28/2009
shallow, slow respiratio
ction, erythema, induration noted 2 days after vaccine administered U 1/27/2009 1/29/2009
post Injection patient experienced swelling,tenderness and warm to touch at injction site, leftYdeltoid. Symptoms
1/27/2009intensified
1/27/2009 for 48 hours af
days after injection, 2 cm firm tender, non-erythematous soft tissue mass appeared appeared N at injection1/15/2009
site. Lump 1/19/2009
enlarged and develop
ter immunization, patient projectile vomited
Y and stopped breathing. Went to children's Hosp.Y2/4/09-records received ### for DOS ### 11/17/08-pre
m Reddened Raised area @ injection site Y 1/19/2009 1/21/2009
d neck pain/stiffness radiating up upward to right side of head. Started day after injection given N in right arm. Continues
### to date. Referred to
dose of ROTATEQ pt. had vomited in the office and then contiued diarrhea at home. After 2nd Y and 3rd doses 4/4/2008
vomited 4/4/2008
the next day and the
hat in 2004 she received the flu shot while on duty as an RN at the TriCare clinic. Within 15 minutes she had itching ### at the ###
site that then sp
ea of redness. Left shoulder at injection
Y site. Warm to touch. U 1/21/2009
VARICELLA reaction - redness @ the site started 1-28-09 in evening. Y 1/19/2009 1/28/2009
mplaining of rash on right side chestY wall, some pain in his back through his anterior chest +Nin that same 1/13/2009
band of derma
1/17/2009tone. Aching, irrita
m eriphan with pain, itching developed at site of injection within 24 hours of administration. 1/27/2009 1/28/2009
rash on both thighs. No fever, vomit or any other complications. Patient to follow up with Dr in U 1 week. 1/26/2009 1/27/2009
d lump in R. arm circumference size of 2 silver dollars. Very red and sore. Y 1/26/2009 1/28/2009
red ZOSTAVAX IM instead of subcutaneous. No information regarding correct route found on U product vial1/20/2009
nor in VIS1/20/2009
sheet.
ministered IM instead of Sub Cu nothing indicated route route on product bottle nor on his sheet. U 1/21/2009 1/21/2009
was reported by a lawyer and described the occurrence of skin lesion(s) on multiple body sites N in a male subject aged between 50 and 59
ceived ROTATEQ on 1-27-09, Y developed intussusception
Y on 1-28-09,
2 required surgical repair
Y 1-28-09. 2/9/2009
1/27/2009 MR1/28/2009
received for DOS 1/28
eived FLUMIST in previous years. Received
Y FLUMIST
Y 1/15/09. Seen20 in ER 1/17/09 for presumed
N viral illness.
1/15/2009Admitted
1/19/2009
to PICU 1/19/09 w
ceived injection 6-9-08. Exposed to Yfamily with in last 1 month with severe chicken pox. Patient Y in our ED 6/9/2008
with other concerns. Presumed ch
oped erythematous, pruritic lesions at Y site of primary SPV inoculation approximately 6 weeksYpost vaccination. 9/16/2008 Symptoms:### Dermatitis, foca
1/28/2009 N 1/27/2009 1/28/2009
lled our office approx 30 minutes after getting ZOSTAVAX injection. "on her way home stated Y she felt like
1/26/2009
on. she got1/26/2009
a shot of morphine".
U 1/8/2009
started in 1/14/09, had to be woken Y up for feedings. Fever 100.5. Symptoms subsided 11/5/09. Y Went to ER 1/14/2009
1/14/09 1/14/2009
because couldn't get hi
Flu shot 10/14/08 Fry's. That nigh had hallucinations + feet extremely sweaty - wringing wet-Y2nd night same thing ### hallucinations
### not feeling
ut, tremors, eyes rolling in the back ofY her head Client sent to ER via ambulance. Y 1/20/2009 1/20/2009
reaction. KINRIX accidentally administered instead of HEP B. Y 1/23/2009
she gets frequent breakouts of "shingles"-about 3X/yr for the last 6 yrs. MD recommended ZOSTAVAX. Y 1/14/2009
Pt was clear1/26/2009
of any symptoms. Sh
08 increased temp 105.8 and febrile Y seizure. Y 12/8/2008 ###
ely after the 2 vaccines admin., student said he was becoming faint. He fainted sitting in chair Y supported1/28/2009
by 2 staff and
1/28/2009
transfer to cot. Stud
d VARIVAX vaccine on 09-22-01 at clinic & now is seen at other clinic & developed a rash that Y was cultured9/22/2001
& positive
1/22/2009
for varicella zoster.
Swelling, itching, warmness on left deltoid Y 1/28/2009 1/28/2009
swollen. Cold compress applied. U 1/28/2009 1/29/2009
rsday morning fever of 100 and leg was red, but is better now. Y 1/27/2009 1/30/2009
CONVULSIONS FOR A DURATION OF ABOUT 20 SECONDS; HE DOESN'T REMEMBER Y ANY OF THAT 1/29/2009
TIME; HE1/29/2009
WAS EXTREMELY P
ccured 1/2/09 mid-morning. Zostavax was situated in the freezer next to Varivax and unfortunately Y I mistakenly
1/2/2009 grabbed
1/2/2009
Zostavax instead
hat the Last flu vaccine caused difficulty breathing and tighness in his chest for 3 days. He said that he did 10/1/2008
not go to10/1/2008
the doctors because th
ours, patient began coughing and sneezing.
Y Eyes and lungs began to hurt. Patient advisedYto contact personal ###physician### who prescribed
esented to BHC 237 with rash 24 hrs Y post multiple vaccinations. Patient presented with urticaria
Y with large
1/20/2009
red blotches
1/21/2009with flat raised are
en 1/14/09 in L arm Patient states an initial 2-3 days of sore arm, 2 days of no symptoms, then U 1/20/09 awoke 1/14/2009with excruiating
1/20/2009 pain in L arm
.7 degrees, chills, body aches, swollen lymph glands, nausea, pain at injection, unable to lift/move
N arm, 1/27/2009
headache, 1/28/2009
backache, burning sens
REPORTED TO SICK CALL C/O NOSE Y BLEED Y X 2 DAYS, WITH RASH 8 AROUND HIS WAIST U LINE, CLINIC### ON 1/20/2009
BASE DID BLOOD TES
d 1/21 morning. Rash to neck 1/22 evening,
Y extending to chest and trunk, very itchy, rash worsened
Y 1/231/21/2009
to almost 1/22/2009
entire body, went to ER
9 Pt. awoke with flu like symptoms, Ypain in arms and purpura-like rash on legs. Received prescription
N for 1/2/2009
steroid pack 1/8/2009
(pt. could not be mo
HAS IMMUNIZATIONS ON 1/23/2009. Y ON 1/24/2009, PARENTS WOKE UP TO CHILD HAVING Y DIFFICULTY
1/23/2009 BREATHING,
1/24/2009THEN PAREN
perienced soreness at the site where the Pneumovax was given (left deltoid). Client reportsNchills, fatigue, and### fever of 103 ###degrees for ab
ports fever of 100-103 for 3 days fllowing
Y immmunization. afebrile today in clinic Y 1/26/2009 1/17/2009
tes post administration of DTaP and MMR, patient's arm began to swell at injection site. Patient Y also developed1/30/2009 a hive
1/30/2009
like rash, redness a
swelling, pain & redness 2 days after administration of vaccines U 1/28/2009 1/29/2009
ur office on 1/22/09 and reecieved 4Yyear old boosters. Woke up 1/23/09 with red and swollen Y left arm. Diagnosed
1/22/2009 with 1/23/2009
cellulitis left arm tre
after administration of Varivax, dose #2, the patient developed a warm, itchy, red area on leftUthigh (site of1/27/2009 injection).1/28/2009
The patient was seen
ING TO MOTHER, CHILD DEVELOPED Y CELLULITIS
Y IN THE LEFT2ARM WITH A TEMPERATURE Y OF 1/22/2009
104.8 AND1/23/2009
NEEDED IV ANTIBIOT
h extremely sore arm limiting movement Y 1/27/2009 1/28/2009
max 102F 2 days after shingles vaccine administration) and redness, warmth, tenderness at injection U site.1/26/2009
Fever deffervesced
1/28/2009day 3 after inj
dministered around 11 June 2008 prior to deployment. Pregnancy diagnosed during deployment. Y Pt returned
6/11/2008 upon dx of pregnancy. No k
all over the body, mostly in the torso regions. N 1/15/2009 1/22/2009
f 7/22/2008 child had a prolinged
Y febrile
Y convulsion.
Y He was admitted 1 to Hospital around midnight
Y 7/22/09.7/22/2008
He was 7/22/2008
observed and did not ha
n my upper left arm is something I'v never experienced before. It isn't like a sore muscle, it is worse. It is a disabling ### 1/8/2009
pain. For the past 3-4
was reported by a healthcare
Y professional
Y and described the occurrence of diarrheaY in a 6-month-old
U female
1/6/2009
subject1/6/2009
th lower back progressing into thighs and having difficulty walking a lot of joint pain. Started U next day and1/27/2009
also had rash
1/28/2009
on left thigh, contin
ning after his shot, he developed a fever of 100 degrees. The next day, his fever was 101 degrees, Y he had 1/26/2009
a bad headache,
1/26/2009a stiff neck, an
arge red, warm, painful area around injection site. Y 1/27/2009 1/28/2009
x15 cm. edema, erythema, induration. Y 1/19/2009 1/20/2009
2-23-08 for vaccines to travel Jan 9 or 10th, 2009 awoke with severe pain in "every" joint. Took N aspirin, pain gradually### 1/9/2009
decreased. Felt much
d area red, swollen, warm to touch 1-29-09. Child active, alert, good movement with arm. NoYfever marked 1/27/2009
redness 1/28/2009
with pen. Advised mom
dness some swelling at site. Noted reddened area about 13 mm in diameter. Pt. started to Y feel itchiness 1/28/2009
on L arm 1/30/2009
in the evening after rece
hea and aching approximately 2 hrs after Adacel shot given - symptom progressed with severe Y myalgias 1/14/2009
lasting approximately
1/14/2009 72 hrs.
ceived TD vaccination on 1/8/08, approximately
Y 3 hours after, the patient developed a low-grade
Y fever of 100.7F.
1/8/2008Patient1/8/2008took TYLENOL fo
nt received a routine booster shot with Td-170 on Friday, 02/01/2008. Immediately, she felt aUburning sensation, 2/1/2008 and 2/1/2008
then developed a large
ceived TD-171 on 01/25/08. He developedY flu-like symptoms, including cough, ear pain, pharyngitis,
U and1/25/2008
muscle aches,1/29/2008and a local reactio
ceived TD on 03/12/2008. Patient came Y back to the doctor's office on 03/14/08 with flu-like symptoms
Y and
3/12/2008
redness,3/14/2008
tenderness and a nodu
as vaccinated on 02/01/08 and the symptoms
Y of the event started on 02/08/08. Patient experienced
Y a variety
2/1/2008
of symptoms
2/8/2008 over a period of
perienced a high fever of 101.3F, body aches, chills and headache after receiving TD booster Y shot. Called 6/9/2008
the physician's
6/10/2008 office and was a
ceived TD vaccine on 6/12/08 as a routine
Y booster. Later that day, the patient visited his cardiologist
Y for6/12/2008
an unrelated 6/12/2008
reason and was not i
tient received vaccine on 06/04/08 Y and on 06/08/08 patient went to ER, where he was diagnosed Y with cellulitis
6/4/2008in the6/8/2008
area of injection site.
patient received vaccine on 06/09/08 Y and on 06/13/08 she came to doctor's office with symptoms Y of cellulitis
6/9/2008
- swelling,
6/13/2008
redness, warmth an
tient received vaccine on 6/11/08 and Y 6/13/08 patient come to doctor's office with complaintsY of fever, chills, 6/11/2008
muscle6/13/2008
aches, along with sym
patient received vaccine on 06/11/08 Y and on 06/18/08 she came to doctor's office with symptoms Y of cellulitis
6/11/2008
- swelling,
6/18/2008
redness and a knot
ved TD vaccine on 06/20/08 and started to experience pain on 06/21/08. C.K. described hisYreaction as6/20/2008 feeling a significant
6/21/2008amount of pain
ceived TD vaccine on 06/20/08 and experienced pain at injection site and general achiness on Y 06/21/08.6/20/2008
Patient took 6/21/2008
TYLENOL for the ad
ceived Td injection intradermally, instead
Y of a PPD test, two to three years after receiving herNregular Td booster6/9/2008 shot.6/9/2008
Patient was suppose
tient came to doctor's office to receive TD and MENACTRA vaccinations for admission to college. Y Patient7/14/2008
was administered
7/14/2008TD IM/left delt
as administered TD vaccine on 06/25/08 Y and developed a local reaction of swelling, warmth Y and redness6/25/2008
at injection6/25/2008
site during the same d
as administered Td vaccine on 7/30/08 Y and developed a local reaction of swelling, warmth and Y redness at 7/30/2008
injection site
7/30/2008
during the same day
ceived TD injection on 04/15/08 andYdeveloped redness and hardness at the injection site. Patient Y was treated
4/15/2008 for cellulitis
4/15/2008 with AUGMENT
ceived TD injection on 10/16/07 andYdeveloped cellulitis, redness and induration at injection Y site. Patient was treated### with###BACTRIM for 10
08 TD was administered to the patient intradermally, in the left inner forearm, instead of a PPD Y test. The8/25/2008
patient immediately
8/25/2008 experienced p
veloped induration at injection site, Ythe site was warm to the touch, as well as a swollen lip andY swelling 7/15/2008
in the mid corner
7/15/2008 of eyes. Follow u
ported not feeling good after Td injection
Y and developed swelling at injection site. Follow up onY 10/28/2008: 7/16/2008
As the patient
7/16/2008 did not return to
veloped induration and redness at injection
Y site, and a headache. Follow up on 10/28/08: AsYthe patient did 7/7/2008
not return7/8/2008
to the medical office
ceived TD vaccine, lot TD-183 on 09/24/07
Y due to a scrape and developed an itchy rash on arms,
Y abdomen,
9/24/2007
legs, face
9/24/2007
and scalp couple of
weating, migraine headache, rapid heart
Y beat, paresthsia in fingers and toes, localized swellingY at injection site.### Patient was### examined by a
was reported by a healthcare professional and described the occurrence of incorrect route of N drug administration
11/2/2008in11/2/2008
an adult female subjec
11/2/2008in11/2/2008
Y and described the occurrence of fever in a 15-month-old
Y male11/4/2008
was vaccinated with
Y the occurrence of pain radiating down arm in a 65-year-old
N male subject
### who vaccinated
### with F
Y the occurrence of erythema in an adult female subject
N who was vaccinated
### with
###FLULAVAL (G
Y and described the occurrence of bilateral conjunctivitis
U in an adult female
### subject ###who was vacc
Y and described the occurrence of leg rash in an adult
Y female subject### who11/1/2008
was vaccinated with FL
Y describe the occurrence of leg rash in an adult female
Y subject who ### was vaccinated
11/1/2008 with FLULAV
Y male subject who ###was
11/1/2008
vaccinated with FLU
Y and described the occurrence of leg rash an adultY subject of unspecified ### gender ###
who was vaccin
Y and described the occurrence of leg rash an adultY subject of unspecified ### 11/1/2008
gender who was vaccin
N subject of unspecified### 11/1/2008
gender who was vac
was reported by a healthcare professional and described the occurrence of shoulder bursitisNin a 37-year-old female ### subject who was vacc
Y the occurrence of generalized itchy rash in a 35-year-old
N female
11/7/2008
subject11/7/2008
Y and described the occurrence of pain in shoulderNjoint in a 30-year-old ###female subject who was
Y the occurrence of high fever in a 60-year-old female
U subject who was vaccinated with FLULAVA
was reported by a healthcare professional and described the occurrence of injection site pruritus
Y in a 57-year-old ###female subject
### who was v
was reported by a healthcare professional and described the occurrence of local reaction inUa subject of unspecified age and gender who w
was reported by a pharmacist and described the occurrence of a product complaint in a subjectU of unspecified### age and gender
### who was va
U in a female
10/1/2008
subject10/1/2008
of unspecified age wh
U in a female
10/1/2008
subject10/1/2008
of unspecified age wh
N in a 82-year-old
10/1/2008female
10/1/2008
subject who was v
Y and described the occurrence of hives in a 69-year-old
U female9/24/2008
was reported by a physician and described the occurrence of diffuse itching in a 77-year-oldNfemale subject who ###was vaccinated
### with FLUL
was reported by an allergy physician
Y and described the occurrence of rash-pruritic in a 68-year-old
Y female subject### who was ###vaccinated with
was reported by a healthcare professional and described the occurrence of swelling injection U site in a 29-year-old ### female subject who was
Y and described the occurrence of injection site pruritis
U in a 68-year-old ###female subject
### who was v
Y the occurrence of ears clogged in a 58-year-oldUfemale subject who ###was vaccinated
### with FLUL
was reported by a physician and described the occurrence of low temperature in a 20-year-old N female subject ### who was vaccinated
### with FL
was reported by a physician and described the occurrence of incorrect storage of drug in a 52-year-old
U male subject
### who ### was vaccinated w
reported by a healthcare professional via a inside sales representative and described the occurrence
Y of black spot at injection### site in a subje
Y in a 65-year-old### female ###subject who was
N in a 21-year-old### female ###subject who was
was reported by a consumer and described the occurrence of nerve disturbance in a 64-year-oldY female subject ###who was### vaccinated with F
Y the occurrence of injection site redness in a 34-year-old
Y female subject
### who was ### vaccinated w
was reported by a physician and described the occurrence of allergic reaction in a 62-year-old
U female subject ### who was vaccinated
### with FLU
Y and described the occurrence of arm redness in a U 34- year- old female ### subject who was vaccina
Y and described the occurrence of high fever in a 37-year-old
N female ###subject who### was vaccinated
Y and described the occurrence of injection site painN in a 36-year-old ### male subject ###
who was vaccin
was reported by a mother of a consumer and described the occurrence of injection site soreness
Y in a 8-year-old
10/8/2008 female
10/8/2008
subject who was v
Y in a 13-year-old
10/8/2008male 10/8/2008
subject who was va
Y in a 17-year-old
10/8/2008male 10/8/2008
who was vaccinate
was reported by a healthcare professional (also the consumer) and described the occurrence N of chest rash10/2/2008
in a 42-year-old
10/2/2008female subject
was reported by a healthcare professional and described the occurrence of injection site redness in a subject
10/1/2008of unspecified age and gend
U in a subject
U in a subject
Y in a subject
10/1/2008of unspecified
10/5/2008age and gend
Y in a 33-year-old
10/1/2008 female
10/1/2008subject who was
was reported by a healthcare professional that described the occurrence of injection site burning U in a subject of unspecified age and gende
was reported by a healthcare professional that described the occurrence of injection site burning U in four to five subjects of unspecified ages
Y the occurrence of swelling arm in a female subject U of unspecified10/2/2008
Y and described the occurrence of arm pain in an adult U male subject who was vaccinated with FLU
Y and described the occurrence of arm pain in an adult U male subject who was vaccinated with FLU
Y and described the occurrence of arm pain in an adult U female subject who was vaccinated with F
was reported by a healthcare professional and described the occurrence of injection site soreness Y in an adult male subject who was vaccin
was reported by a healthcare professional and described the occurrence of injection site soreness Y in an adult female subject who was vacc
Y and described the occurrence of lost consciousness Y in a 15-year-old
10/4/2008 female
10/4/2008
subject who was va
was reported by a pharmacist and described the occurrence of radiating pain in the arm in aU39-year-old female ###subject who was vaccinate
was reported by a pharmacist and described the occurrence of increase in migraine in a 25-year-old U female
12/1/2008
subject12/4/2008
was reported by a healthcare professional and described the occurrence of nausea in a female Y subject of unspecified### age### who was vaccin
was reported by a consumer and described the occurrence of red rash on stomach in a 39-year-old N female subject
### who was ###vaccinated wi
was reported by a healthcare professional and described the occurrence of rash in a male subject U of unspecified
11/6/2008age who was vaccinated
was reported by a healthcare professional and described the occurrence of rash in a male subject U of unspecified
11/6/2008age who was vaccinated
was reported by a healthcare professional and described the occurrence of rash in a femaleUsubject of unspecified 11/6/2008 age who was vaccinate
11/2/2008in11/2/2008
11/2/2008in11/2/2008
ry 8, 2009, patient recieved intranasal life attunated influenza vaccine. In about 3 days, he started Y having1/8/2009
flu symptoms
1/11/2009
including fever, bod
E UPPER BODY MUSCLE ACHES, HEADACHE, NAUSEA,PHOTOPHOBIA,PAIN 8/10. TX: Y TYLENOL, 1/1/2009
PHENERGAN, 1/1/2009
BEDREST X 48 H
ad a seizure the day after (11/11/08)Yhe had the yellow fever vaccine (11/10/08). It was during U nap time at school. ### He was### rushed to the em
ceived the vaccine on 1/30/09. The next day, 1/31/09, he vomited twice. He also didn't eat very Y much that 1/30/2009
day, prompting
1/31/2009 me to think he d
vleoped herpes zoster on the left side of the body, where vaccine was administered. U 1/28/2009 1/29/2009
2008 first shot experienced
Y headaches,Y dizziness, Y back pain, soreness 15 Y at injection site (still feels
U pain in arm2/7/2008
today). April
2/7/2008
2008 after second
rst HPV vaccine, and 1 hr later, I developed
Y a fever
Y of 102.0, was vomiting,
2 and had
Y a severe N headache.9/20/2007
Ever since9/20/2007
9/20/07, I have had a c
ed ZOSTAVAX IN; approx. 6 months ago at a local retail pharmacy (not at one facility). Pt presented to an ED with other problems, and on
th PCV7 instead of Hept A vaccine. Hept A vaccine then administered. MTR notified of event. 1/23/2009
ed & warm spot just below injection site pt reports not painful U 1/27/2009 1/29/2009
ema, swelling L upper arm, pain, tenderness, low fever, hallucination at nights, belly ache- no vomiting or diarrhea.
or redness 3x4 1/2 in elevated in duration
Y 1 1/2in initial 0 dc 0 Adenopathy. U 1/26/2009 1/27/2009
ving RATATEQ by mouth, noticed that pt. started having redness around mouth, eyes, right Y ear & blotchy 1/26/2009
redness on 1/26/2009
scalp. Gloves were la
ills, and cramps, vomiting Y 1/13/2009 1/13/2009
as given 0.5 ml pneumoccocal vaccine. Developed swelling at injection site. 11/3/2008 11/3/2008
atient received tetanus/diptheria injection. Returned 1/19/09 with complaint of injection site swelling - left12/1/2008 deltoid- Reported
1/17/2009 increased redde
ort received on 07 October 2008 from Y a physician. A 41-year-old male patient, with no concurrent N illnesses,
4/19/2008
no known 4/23/2008
allergies, and no use
n has been received from a registeredY nurse for the Pregnancy Registry for GARDASIL concerning Y a 2810/5/2007
year old female
4/19/2008
patient with no pe
n has been received from a registeredY nurse concerning a 20 week old female patient who on U an unspecified date was vaccinated per oral
n has been received from a physician Y concerning Y an approximately 15 Y month old female patient Y who on unspecified dates was vaccinated
n has been received on Y request from the FDA Y under Freedom of Information
0 Act regarding aUreport from a physician ### concerning
### a 3 month
next day after receiving injection herYdeltoid was swollen, hot to touch, knot @ injection site. NThe knot went away ###and the ###hot feeling. Swel
swollen underarm muscle with pain traveling up and down to below the elbow and into the lymph Y nodes of 1/27/2009
the arm. 1/28/2009
welling, cold sweats, vomiting, fingerYnumbness, point tenderness at site of injection, severe fever Y for 5 days 1/8/2009
post injection;
1/9/2009followed by 10 d
FTER INJECTION, SHE DEVELOPED Y PAIN, REDNESS AND SWELLING AT INJECTION SITE. N ALSO1/30/2009
FEVER AND 1/31/2009
GENERALIZED RE
es child had a seizure 1/31/09 around Y 5am, lasting approx 3 minutes (stiffness, then body shaking), U temp1/30/2009
99.8 F. Called
1/31/2009
911. Child taken to
ER INJECTION-FEVER ACHES WHICH RESOLVED IN 24 HRS BUT DEVELOPED LARGEURED WHEEL 1/30/2009
AND INDURATION
1/31/2009 AT INJECT
ps , throat and very itchy rash all over the body Y 1/30/2009 1/30/2009
e 6 hours after injection lasting 24 hours, pain, itching and redness at injection site starting 8 Y hours after injection
1/28/2009 and1/28/2009
continuing at this time
ld in for immunizations. Began administration with oral RotaTeq. Infant had not even taken Ythe entire amount 2/2/2009
when 2/2/2009
she began vomitting.
oss tonic seizure, mild rash Y 1/20/2009 1/29/2009
fever and dizziness. 8:00 p.m. vomiting chills and cough. 12:00 a.m. awoke with body achesYwhich lasted for 72 ###
hours. It felt
###like an actual
vaccines on 1-12-09. Symptoms started on Sunday, 1-25-09, with a fever, "just not feeling well" Y Took ibuprofen
1/12/2009and 1/25/2009
slept. On Monday, Ja
ts to the emergency room on Sat 1/31/09 Y complaining of painful, itchy rash on torso. During Ureview of systems 1/22/2009and 1/30/2009
physical exam, pt noted
g WF received 0.5ml Pneuomvax injection Y IM in her left deltoid at 0930 1/27/09 with no complaints
Y or complications.
1/27/2009 1/27/2009
This was her first expo
ng the MMR, Hep A, and Varicella vaccines my daughter woke up the next morning with herYright eye looking 1/23/2009
red and1/24/2009
half closed. It took 3
mately 6:00 pm on 1/24/09 He was unable to lift his right arm due to severe pain. Pain then moved to left 1/27/2009
shoulder 1/27/2009
then both knees began
e fever (100-107 F) multiform rash on Y face only. No (grand or trunk) or est or surface. U 1/23/2009 2/1/2009
seen in office with redness, swelling 8 x 10cm with soreness to injection site. 2 x 2 cm ecchymotic Y right arm
1/30/2009
about inj.
1/30/2009
site. Encouraged res
eived shots. 2:08pm- developed hives. Y EPINEPHRINE given at 2:10, BENADRYL given at Y 2:15. 2/2/2009 2/2/2009
-09 reported 1-30-09 L arm sore, itchy, warm to touch with erythema. After exam per doctorYno cellulitis.1/27/2009 Hx D.M. Tx 1/29/2009
with Cephalexin 500 m
2 X 48 degrees. Fever decreased with TYLENOL & IBUPROFEN. Q 4 degrees. Y 1/26/2009 1/26/2009
e received on 1/30/08 here in the office at 430 pm - over the past 3 days pt c/o R arm swelling N at site with 1/30/2009
redness 2-41/31/2009
cm non-puritic bump
injection, in 24 hours, hot, red, swelling. These symptoms dissipated, then pain into arm toNwrist and under 1/15/2009
arm. TX:1/15/2009
arm sling, cortisone
n in upper outer arm where vaccine administered. Persisting from time of injection, on/off to 1/13/09 was12/9/2008 seen - note 12/9/2008
worse again. Hurts to
w pustules on trunk (small vesicular lesions). Y 8/4/2004 1/31/2008
er following injection patient states sheY had erythema and slight burning of right upper arm where Y the ZOSTAVAX
1/13/2009vaccine
1/13/2009 was injected. Ery
N 10/4/2008 1/4/2009
1/22/2009 Y Y Y N 1/21/2009 1/22/2009
RA + VARIVAX given on 1/19/09. On Y 1/20/09 seen
Y in office for vertigo
1 feeling of weakness in N legs, headache,
1/19/2009
vomiting.
1/20/2009Was seen in ER in
hed) seizure - like episode. Y Y 1/27/2009 1/28/2009
6pm he received his two vaccines HAVRIX Y and FLUZONE. He was well and with his mother.YAt 4am that night### he woke up### in extreme pain
er arm swollen and warm-tender to touch. MEDROL dose pak ordered per Dr. Encouraged patient Y to alternate
1/28/2009
heat 1/28/2009
and cool compresses to
4-6 hr > 24 hrs post vaccine red, warm, swollen 3 X 5 cm around shot site Y 1/27/2009 1/28/2009
rhea, mottled, decreased cap refill required. Suspect Y mild virus infection.
4 Note: stool sent to office
Y for dsRNA
1/23/2009
rotavirus
1/26/2009
genome testing. 2/1
Y concerning a 16 year old female patient who on Y 03-JUN-2008 6/3/2008
was vaccinated
n has been received for the pregnancy Y registry for GARDASIL from a 20 year old female patient Y who was vaccinated with the first dose of G
n has been received from a physician Y concerning Y a 10 year old female 3 Y patient with
Y anterior and
N posterior 5/8/2008
endometriosis6/1/2008
and SYNAREL alle
n has been received from a physician Y concerning Y a child who was vaccinated
0 with a dose ofUROTATEQ (lot# not available) orally. Child dev
n has been received from a physician Y concerning Y a child who was vaccinated
0 with a dose ofUROTATEQ (lot# not available) orally. Child de
n has been received from Y a physician concerning Y a patient who was5vaccinated
Y with a "booster"
U dose of PNEUMOVAX ### 23###
(Lot # not provid
orted in a published article, title as stated above that a 15 month old patient was vaccinated U with a first and second dose 1/1/2008
of PEDVAXHIB at
n has been received from Y a registered
Y nurse concerning a 22 week old female patient Y who on
N 06-JAN-2009 1/6/2009
was orally
1/6/2009
vaccinated with the
n has been received from an investigator
Y concerning
Y a 3 month old 0female
Y who was vaccinated
U with a first dose of ROTATEQ. This report
n has been received from a licensed practical nurse for the pregnancy registry for GARDASIL Y concerning a pregnant female ###patient with he
n has been received from a nurse and the patient's mother for the pregnancy registry for GARDASIL, Y concerning ###a 11/8/2008
15 year old female with
n has been received from a registered nurse concerning
Y a 14 year old
3 Yfemale patient who onY 16-OCT-2008 was ###
vaccinated ###with the first do
n has been received from a healthcare Y worker concerning a 17 year old female patient with N no known drug reactions/allergies
### ### and medical
n has been received from the mother concerning Y her 13 year old daughter
0 who on 16-OCT-2008
N was vaccinated ###with a dose ### of GARDASIL
was received on 27 November 2008 via a search Y of the VAERS database (VAERS Id Number: 317893). 5/8/2008 It was originally
5/8/2008reported to VAER
Y Y 2/2/2009 2/3/2009
very light headed, as though
Y I was going to lose consciousness. My finger tips began to tingle, Y as though1/9/2009they were 1/9/2009
asleep. Then my feet
on was administered 11/5/2008, pt presented to the clinic on 11/14/2008 with a rash to the injection Y site that
11/5/2008
was diagnosed
11/7/2008 by Dr. as a loca
ceived MMR vaccination on 1/16/09. 4-5 days later patient developed rash. Patient's HbA1c U is elevated but1/16/2009
unsure if1/20/2009
patient was diagnosed
disease, resulting with the Y tx of IVIG,Yafter 6-7 days
Y of various invasive 7 testing to rule out other
U illnesses. 2/28/2008
2/4/09 ER note3/5/2008
received for DOS 3
oulder of same side as vaccine administration starting 24 hours after given. Exam consistent U with subdeltoid
1/30/2009
bursitis
1/31/2009
and rotator tendinitis.
ed Zostavax on 01/06/2009. She developed Y an itchy painful rash on her neck and an itchy sensitive
N area on
1/6/2009
right scapula
2/1/2009and under her rig
o the office on 01/31/09 for inconsolable crying. No cause for the crying found on exam. NoYredness or induration 1/29/2009 at1/30/2009
either injection site. N
s later high fever. Next day more serious-
Y letahrgic, high fever despite several doses of Tylonol U and Motrin, 1/30/2009
vomiting,1/30/2009
listless, non communic
diagnosed 1/09 Y ### 1/22/2009
after administration - Fever, Chills, Swelling
Y at Injection site, Aches, Diahreah for 6 days. DR.Yvisit then sent to ER ###for fluids###for dehydration.
RSE EVENTS, SYMPTOMS, OR TREATMENT REQUIRED Y 1/26/2009
AY, JAN 30 PAT CALLED STATED YHE FELT ILL, DIZZY, ANXIOUS AND LOSING CONTROL Y OF HIS BLADDER.
1/29/2009 WE 1/30/2009
INSTRUCTED PAT
after receiving the pneumonia vaccine Y he had redness appear on his left arm. There is minimal Y pruritus and no pain. The redness is at the s
jection site after varicella vaccine in left thigh U 8/19/2008 8/19/2008
es symptoms started at 10 PM on 2/2/09 Y he was trembling, and muscle twitching. then aboutU5:30 AM on2/2/2009 2/3/09 woke 2/2/2009
up sick, dizzy, got up
REPORTS CHILD DEVELOPED MIDABDOMINAL Y PAIN, DIARRHEA, AND VOMITED ONCE U STARTING 1/21/2009
1/23/09. 1/23/2009
IT BECAME INCREAS
REPORTS TINGLING RIGHT ARM WITHIN 5 MINUTES OF ADMINISTRATION OF IMMUNIZATION Y BY2/2/2009
TIME PATIENT2/2/2009GOT HOME WIT
Varicella shot given on 1/21/09. HeY had a very bad cold with congestion at the time of injection, U he developed
1/21/2009 an ear
2/2/2009
infection 3 days later
hronic headaches that began very soon Y (within days) after first vaccination of Gardasil. HeadachesN became progressively
### ###
worse and curre
n, severe swelling, hives. Told to iceY and take motrin. Still discolored, swollen and painful 2 weeks
U later. 1/20/2009
I was offered 1/20/2009
the vacine in the hos
ped vasculltic lesions on legs/feet withY pain/swelling & polyarthralgia onset approximately 11Ndays following 1/8/2008
receipt of
1/21/2008
AVA# 3; diagnosed w
broke out in welts. Entire body covered
Y above hips, including groin, breast, scalp, ears, face, N back. Accompanied
1/21/2009 by 1/29/2009
intense burning and it
ge cluster of pinpoint vesicles with clear fluid on right posterior trunk with surrounding erythema.Y DX: Herpes11/5/2001
Zoster 1/7/2009
d used topical Neosporin 2 + times per year for many years for minor skin abrasions etc. Patient received9/1/2007 ZOSTAVAX 1/1/2008
9/07 and 1 month la
n 12/23. Pt had ache front to back 12/30 and reported to MD. Rash break out under left breast Y 1-2-09, patient said ### all symptoms
### gone exce
U ###
NG SGT who noticed a single 4mm Yvesicular lesion on her left forearm one day following receipt U of ANTHRAX ### (AVA#4), influenza,
### & typhoi
screaming x 48 hrs. Y ### ###
staring spells vs sandifer's syndrome. Head tilt and head bowed and eyes rolling back in head U - lasts no more than ### 7-10 seconds. No sleep
upper arm flu shot 46 X 44 mm left DTAP 65 X 39 mm right Y 1/7/2009
d a little red immediately after shotsYwere given, area gradually enlarged. By 1/15/09 (2 daysYafter shots)1/13/2009 the area covered
1/15/2009 her left thigh + h
er the vaccine neck started to ache. Pain went away for 30 to 40 min. Then pain came back. until now. Pain 2/3/2009
located at
2/3/2009
site. Almost after th
ort received on 23 January 2009 through Y literature that in 2008, one child aged 5 months hadYreceived two doses of 11/1/2008ACTHIB (date of vaccin
ort received 28 January 2009 from a consumer Y who is the patient's aunt.
0 A four-month-old patient
U with a history of respiratory problems, had
dates of adverse events were not recorded
Y by me. they started in early December, Y 2007 after
N a series of shot ### given12/1/2007
by his pediatrician. My
e T 24 hours after shots. Y 1/29/2009
pain, fever, vomiting, perioral- rash, YItching (scalp) > -acetaminophen (rectal) - warm compresses U - ZYRTEC 2/3/2009 2/3/2009
n Tues eve (2/3) pat experienced itching
Y woke up w/blistering rash on waist, under breast & U arm pits - itchy2/2/2009
& red 2/3/2009
vaccine 1/23/09. Febrile seizure 1/30/09
Y Y 1/23/2009 1/23/2009
degree F the day after Tdap vaccination. No other symptoms. Y 1/22/2009 1/23/2009
ZOSTAVAX vaccine approx. 1pm 1/22/09 went to bed approx. 1030 pm that night-had bout Y of very fast,hard,
1/22/2009
heart 1/22/2009
palpitations lasting app
adaches, rash prior to immunization documented by doctor at medical center. Not resulted from Y MENACTRA. 1/26/2009Student
1/26/2009
did not report any s
eginning w/; 24 hrs- fatigue. Panesthesia hands on 2/4/09. U 1/28/2009 1/29/2009
ient was given DTap at 10 years of age). 11/5/2008
tous maculopapular spots on torso, legs and arms. Not itchy. Occurred about 5 days after vaccination. Y Resolved ###without treatment.
### No feve
p, Hep A at well child cheek 1/7. Screamed all night and again next night. No fever. No other Y source. 1/7/2009 1/7/2009
arrhea for 1 month. Y Y ### ###
30 p.m. I administered MMR and Varicella IM rather than sub q. There were no adverse reactions Y while1/23/2009
client here.1/23/2009
8/28/2008 N 8/27/2008 8/28/2008
p on arm at site of administration. Pt also diaphoretic and sweating all night Y 2/3/2009 2/4/2009
and crying for more than 3 hours. Y ### ###
MMR and Varivax on 1/30/09. Came to the office on 2/3/09 with a flat pinkish rash on chest U and legs with 1/30/2009
a temperature
2/2/2009
of 103.8.
ed headache, upper torso myalgia approx. 6 hours after vaccine. Symptoms lasted approx 48Y hours. 1/12/2009 1/12/2009
derwent surgical debridement of necrotizing
Y faciitis
Y at the site of immunizations.
7 Discharge to
Y home today 1/27/2009
on oral antibiotics.
1/27/2009
d vomitting, diarrhea, and low gradeYtemp withiin 12 hours of vaccine Y 2/3/2009 2/4/2009
ve weakness and muscle atrophy in lower extremities, Y L>R with intermittent
4 parathesias. 3rdNvaccine given 9/9/2008
around 9/12/2008
Sept. 9 and unusaly gat
eloped fever of 103 and vomiting on Wenesday 1-28-09 lasting until Thursday 1-29-09. Treated Y herself symptomatically
1/27/2009 1/28/2009 and did not seek m
urned to clinic 1/29/09 with child. Noted edematous/reddened upper Right arm. Extremity freely Y mobile;child 1/27/2009
complained
1/28/2009
of pain & itching a
ed of fever last night (2/3/09)and today complains of sore throat, red spots on neck,trunk andUarms. Acyclovir 1/26/2009
200mg 2/3/2009
every 4 hrs ordered. B
S A VACCINE WAS ADMINISTERED Y IN LEFT ARM, THEN GARDASIL VACCINE WAS ADMINISTERED Y 2/4/2009
IN RIGHT2/4/2009
ARM AND APPROXI
pneumococcal vaccine trial, with severe COPD, Y was hospitalized with COPD exacerbation. YVaccination took 1/2/2008
place 1/15/2009
on 1/02/2008. Accordin
NER L EAR AND CHEEK. LOCAL REACTION TO INJECTION SITE- REDNESS AND SWELLLING. TO TAKE 5CC OF BENDADRYL Q 6 H
nted after vaccines Y 2/4/2009 2/4/2009
ordered pneumo vaccine. patient given varicella Lot # 0994X Exp: 11 July 2010 U 2/4/2009 2/4/2009
o 104 24 hours after vaccine administered.
Y Also had runny nose and mild cough. No rash. U 2/2/2009 2/3/2009
er on the inside, left lower lip. No other adverse reaction noted approximately 24 hours postYinjection. 2/3/2009
VAX administered at 10:00a on 2/4/09 Y at Pharmacy to patient. Wife called at 3:30p and reportedN husband 2/4/2009
is experiencing
2/4/2009excruciating pain
cine administered IM in right deltoid instead of SQ 2 calls made to pt 2/4/09 for f/u - no answer Merck contacted-2/2/2009 indicated
2/2/2009
vaccine may be
wheezing 01 hour after Influenza vaccine.
Y 2/5/09-records received for 11/5/08-presented toYER with skin11/5/2008
rash. DX: 11/5/2008
acute allergic reaction t
redness and swelling in Lt arm. Had Tdap & flu vaccine in same arm. Y 1/26/2009 1/26/2009
rts that patient had sudden onset ofYepisode of "stiffness" tonic state x 2-3 sec. Followed byYgeneralized1/27/2009
clonic-like1/27/2009
seizure activity of abou
zed reaction Y 1/22/2009 1/22/2009
s after vaccine given (given 1/30/09). On 2/1/09 pt. developed "hot, itchy, burning flue rash U on thighs, abdomen
1/30/2009 & back
2/1/2009
of knees- Denies
raised tender erythematous reaction at injection site. N 2/2/2009 2/3/2009
of blanchable erythema across left thigh
Y spreading laterally to medially. Not tender no induration. Treated 1/29/2009
with antibiotics in ED- discontinu
was reported by a healthcare professional and described the occurrence of intramuscular formulation
U administered
1/23/2009 1/23/2009
by other route in a 2-m
was reported by a physician via a sales representative and described the occurrence of injection Y site redness in a subject of unspecified ag
was reported by a healthcare professional and described the occurrence of high erythema inY a child subject 1/1/2009
under the 1/3/2009
age of 6 years and o
was reported by a healthcare professional and described the occurrence of thigh erythema in Y a child subject
1/12/2009
under 1/13/2009
the age of 6 years and
was reported by a healthcare professional and described the occurrence of thigh erythema in Y a child subject
1/5/2009
under the1/6/2009
age of 6 years and
was reported by a pharmacist and described the occurrence of injection site redness in a 35-year-old
Y female subject who was vaccinated w
n has been received from a licensed Y practical nurse (L.P.N.) concerning a 24 month old premature
Y born 12/5/2008
male (2 month 12/6/2008
early) with asthma w
n has been received from a physician Y concerning a 42 year old female with multiple Y sclerosisN who on 29-JUL-2008
7/29/2008 was vaccinated with a d
n has been received from a 19 yearYold female patient who on 27-JAN-2009 was vaccinatedYwith first dose 1/27/2009
of GARDASIL
1/27/2009 (Lot # not reporte
ned in March of 1987 I wasY a healthy teenagerYwith records to prove it. SometimeY between March N and May3/20/1987
of 19873/20/1987
I received several vacc
eceived ADACEL vaccine Y on 11/20/2008 On 12/01/2008
Y he presented
6 with leg numbness
Y and tingling which was ###progressive.
### Urgent refer
me vaccine reaction. The injection triggered a flare up of pts underlying reflex sympathetic dystoptry.
n, hoarse throat 3 hrs after AFLURIA administration. Y Treated with BENADRYL and SOLUMEDROL U and felt better. ###
al reaction 10X18 cm around injection site. Area is red + indurated + warm to touch 1/28/2007
dness, swelling + warmth at the injection site (right upper arm) Y 2/3/2009 2/5/2009
ctivity at 3-4 minutes duration with eyes
Y rolled back, not responsive to parents. Temperature Y104.2 F rectal 1/30/2009
at urgent1/30/2009
care center. No preced
gic to eggs, and vaccine compoents.YSevere stomach cramping, vomiting, headache, dizziness Y which lasted for### 2-3 days ###
oped rash bilaterally over both thighs According to mom and maternal grand mother the maculopapularv
U 1/30/2009
rash started1/30/2009
from the the sites =o
dness and swelling in arm from injection
Y site into elbow Y 1/28/2009 1/30/2009
nted to the family practice clinic on 1/27/09 withYcomplaints of fever x1 1 day. Infant was fussy and
Y difficult to12/1/2008
console, 1/27/2009
and was refusing breas
rgic skin reaction. U 2/2/2009 2/3/2009
nset of lethargy and vomiting.
Y Hospitalized
Y for Y
lethargy, to rule out sepsis.
3 Continued vomiting
Y lead to diagnosis
1/29/2009of intussussception.
2/2/2009 Succ
ports adolescent having hives on hands,knees and feet that began approximately 2-3 days past N receiving1/22/2009
vaccines on 1/24/2009
1/22/09. Also reports
gan febrile episode on 1/31 with fever Y up to 102.4 F lasting 3 days. Patient was taken to physician
U and 1/30/2009
upon examination
1/31/2009 no signs of infec
arm erythema area on rt. arm extending from deltoid to elbow. no blisters. extends around arm. U Client has2/2/2009
red hair and 2/4/2009
very fair skin.
h pt on Tuesday 2/3/09 she was administered the HPV vaccine about 4 hours later a rash devloped Y on her
2/3/2009
back that 2/3/2009
grew to cover the maj
mplains of severe pain in left arm when lifts the arm, since first injection given N 12/8/2008 12/8/2008
ythematous tender reaction right arm Y 1/2 diameter. No complication Y 2/2/2009 2/3/2009
s administered Hep A in right deltoid and menactra right lateral arm and PPD implant right forearm Y at around
2/5/2009
4:55pm.Erythema
2/5/2009 and few pa
e localized reaction at injection site including erythema, hives, itching. Given benadryl 25 mgYp.o. and ice 1/29/2009
to area. Reaction
1/29/2009resolving 25 m
cieved HAV#2 on 2/3/09, went home Y and had aY3hr nap, mom woke1patient and noticed coughing Y and wheezing,
2/3/2009which 2/3/2009
continued through
generalized seizures with fever. He Y had one seizure by report previous to the vaccination. This
Y was a five-minute
1/29/2009 seizure.
2/3/2009 we had at least
TERED IN LEFT DELTOID ON 2/4/2009; Y WITH IN 3-4 HOURS EXPERIENCED SEVERE PAIN IN DELTOID 2/4/2009
MUSCLE, 2/4/2009
JOINT OF LEFT S
e client had within 24 hours: Fatigue, lethargy, loss of appetite and general weakness. Y 5/2/2008 5/3/2008
ble crying X 8 hours Y 12/2/2008
ver body. Got shot yesterday. RashY today. Y 2/3/2009 2/4/2009
warmth, swelling around site of 2 injections.
Y Started 2 days after vaccines given. No fever. UPrescribed oral 2/2/2009
antibiotics,
2/4/2009
BENADRYL, MOTR
nt dad who said skin was bumpy for a day or two but has gone away. No treatment. Y 1/13/2009
perienced a vasovagal response to HPV. Duration was 4-6 seconds. BP at 09:30 60/40 pulse-50, Y at 9:45 62/40 ###
p-52, BP at ### 10:00 72/40 p-
ox rash site 2/2/09 - No other symptoms. U 1/15/2008 2/2/2009
rm & chest with + urticarial patches Y+ 2 cm swelling @ injection site lungs clear- no wheezing Y Given SOLUMEDROL
2/2/2009 2/3/2009125 mg IM. ALBUTE
and lethargic and poor feeding. Hospitalized
Y - Hydrated.
Y 1/17/09 MR 2 received for DOS 1/29-30/2009
Y with
1/27/2009
D/C Dx: Sleepiness
1/27/2009 after immun
se reactions known patient was sent a letter by mail. Patient has no working phone number. U 2/4/2009
ight eye to be a "little pink". Went toYstation and was prescribed VIROPTIC and ILOTYCIN drops. 01/26/2009 1/15/2009the right
1/23/2009
eye was worse (sw
veloped hundreds of vesicular and papular lesions, described as "itchy", on trunk and LE. U 1/27/2009 2/2/2009
3, hearing loss, sleep disorders, neurological
Y problems,
Y headaches,1muscle jointYpains, fatigue,N muscle spasms, recurring 7/2/2008 skin lesions, chil
ent, hearing loss, scoliosis, sinus,high
Y blood pressure,
Y tinittus, rhinitis,
6 sleep disorder,
Y headaches,
N muscles
1/12/2003
joint pain, muscles spasm, recu
n has been received from a physician concerning a male patient who is 20 months at present Y who received his first dose of ATTENUVAX,
n has been received from registered nurse concerning a 42 year old female nurse who was U vaccinated with a second dose of ATTENUVAX
n has been received from a pharmacy student concerning an adult female patient who was vaccinated U with four doses of ATTENUVAX vac
n has been received from a physician concerning a 2 year old male who on 26-JUN-2008 was N vaccinated 6/26/2008
with ATTENUVAX
7/4/2008vaccine (Ende
n has been recieved from a consumer concerning her 8 month old son who on 29-APR-2008Nwas vaccinated 4/29/2008
with a4/29/2008
dose of MMR II. Suspe
n has been received from a 62-year-old female physician, with a history of hepatitis B and an U allergy to penicillin,
2/1/1997who 4/25/2008
in February 1997, wa
n has been received from a registered nurse concerning a 24 year old female who was vaccinated Y with ATTENUVAX. The nurse mentione
Y a 13 month old male with no pertinent medicalNhistory, drug4/4/2008
reactions or allergies who on 04-
Y a 16 month old male with no pertinent medicalUhistory and3/20/2008
a milk allergy
3/27/2008
who on 20-MAR-200
n has been received from a registered Y nurse concerning a 16-month-old male, with no pertinent N medical3/19/2008
history or allergies,
3/29/2008who on19-MAR
n has been received from a registered Y nurse concerning a 16-month-old male, with no pertinent N medical3/19/2008
history or allergies,
3/29/2008who on 19-MA
sy developed 17 DEC 08 2/17/09-records received Y for DOs 12/22/08-Released
6 form hospitalYafter exhaustive investigation
### ###
into sudden left f
n has been received from a Registered Y Nurse concerning her 22 year old daughter who on 27-OCT-2006Y was ###
vaccinated
3/2/2007with first dose of
n has been received from a doctor of Y pharmacy for the pregnancy registry of GARDASIL concerning U a female patient who on an unspecifie
### N ### ###
swelling due to tetanus toxoid. Vaccine was not administered at this facility, so very little information can be reported. Patient just reports a
got the vaccine I didn't have any pain Y or swelling. The next day (Saturday) I had a little soreness.
Y As the1/30/2009
day progressed
1/31/2009the pain got worse
received a Tdap vaccine in the left deltoid muscle on 02/02/2009 at 1100. The next day sheU had an approx 2/2/2009
6" red, 2/3/2009
swollen, warm to touch
hours after rec'ing the MMR shot our son began to run a low grade fever 99.7, vomiting, irritable U mood. We 2/5/2009
informed2/6/2009
the doctor's office and
und alert but shaking in bed at a groupY living setting and then vomited. Evaluated by medical Y staff there and
2/4/2009
sent by2/4/2009
ambulance to local ER
arted receiving Anthrax vaccinationsYin 2007 and has had a total of 4 shots. He has had jointUpain, in all joints, 3/1/2008
feeling "achy" after each inje
accination site and over entire body. U 1/26/2009 1/26/2009
Vaccines on 2/3/2009, and rash started 2/6/2009 from neck down. Advised mom to give patient U Benadryl 2/3/2009
every 6 hours.2/6/2009
f left thigh. Hospital admission IV antibiotics. 3/23/09
Y Received hospital2 medical records of 2/4-2/5/2009.
Y 2/3/2009
FINAL DX:2/4/2009
left thigh cellulitis Rec
B vaccine administered. 0845 Client still in building came to my office stating her RT arm was Y breaking in2/6/2009
rash and itiching
2/6/2009 real bad. Denie
noted to get red, swollen & splotchy in the evenings since Vaccine given - looks fine in the AM, Y when this 1/26/2009
is noted he
1/26/2009
states that entire thig
up with patient around 2-3AM on 01/30/2009
Y and
Y no problems. When 2 mom was up with patientY around 1/29/2009
6-6:30AM, 1/30/2009
he had a fever of 103.5
d a hard time walking the day after Y her immunizations,
Y she seemed3stiff and sore. Then again, U a week after 1/6/2009
her immunizations
1/12/2009 she had tro
vaccine, left deltoid became red andYswollen. Tender and warm to touch. Over the next several U days signs 1/9/2009
and symptoms
1/10/2009 progressively w
ented w. generalized hives on neck, chest and general body 3 days after immuniaztions Y 2/2/2009 2/5/2009
ven pneumovax shot (I.M. Right Deltoid) on 2/5/09 @ 1415 in his home. Pt. called clinic this morning and2/5/2009 left a voicemail
2/5/2009reporting that he
0 MIN. AFTER SHOTS, BABY BECAME LETHARGIC WHILE BEING HELD IN DAD'S ARMS, Y HEAD DROOPING
1/21/2009 DOWN.
1/21/2009 sHE WAS LAID
nted immediately after first shot. Has Y experienced
Y extreme fatigue,memory 2 loss, trouble concentrating
U and
8/20/2007
after the8/20/2007
third shot started exper
me of Gardasil vaccine, but one year later adverse immunune system problems that included strep throat, 10/9/2007
urinary tract6/1/2008
infections,treated fo
fter my 2 month old son received the Y rotavirus vaccine with his other 2 month shots he has had N bright green
1/19/2009
diarhea1/20/2009
since, on a daily basis
booster anthrax on 2/2/09. On 2/3/09 soldier presented with injection site erythema and itching. Y Treated with 2/2/2009
antihistimine.
2/2/2009 On 2/4/09, sym
ped L sided seizures 24 hours after receiving PENTACEL,
Y ROTATEQ 3 and PREVNAR. EEGUis abnormal, 2/4/2009so likely not2/5/2009
vaccine related. Pt w
arted to feel tingling sensations on back starting about 01/11/09. These symptoms Y continuedNto manifest until blotches
### 1/11/2009
appeared on the skin
se events. Medication given PENTACEL and ACTHIB given at same time, reporting medication. 2/2/2009
l pain within 5 min after vaccine & urticaria 10-15 min after vaccine. Used BENADRYL withYrelief. 2/6/2009 2/6/2009
rted severe local reaction at R leg, very red and swollen x 7 days, would not wear clothing over Y it and very 7/16/2008
bothered7/18/2008
with discomfort x 1 we
over. Hives. No respiratory problems. No other problems. 2/3/2009 2/4/2009
le pt. presents to clinic with "infection
Y at primary SPV site." Pt. reports receiving primary SPV (left upper7/14/2008 arm) on 7/14/08,
7/23/2008 at same time wit
irst Anthrax vaccine and a Typhoid immunization on 4 April 2008. That same night I noticedYa reddish, warm 4/4/2008
lump the5/14/2008
size of my fist on the
le with possible adverse reaction toYSmallpox Vaccine. 2/10/09 Office note received from reporting Y MD. Pt9/24/2008
seen 10/6/089/29/2008
with c/o L arm pain
nt is a 38 year old female. Source of patient information was patient. Source of patient information Y was 10/3/2007
medical records. ### Received second
male with hx of hospitalization s/p AVA #6 for Y pericarditis/pericardial
5 effusion July 2004, concerned
Y receiving
5/10/2004
further 7/1/2004
doses of AVA. PCP co
male, spouse of retired SM presents to FBVHC with report of developing a rash "hives" on both Y arms and5/19/2008
legs within5/20/2008
24 hrs of receipt of Tda
welling, discoloration, soreness, swelling would be three times the size of opposite shoulder. U 2/4/2009 2/4/2009
ceived ROTATEQ ON 1/12/09. She is breast fed. On 1/13/09 mucousy stools were noted. Y On 1/20/09 1/12/2009
stools were1/13/2009
dark, tarry and heme-p
d emesis and cyanosis a few hours Y after flu vaccine. Valvar pulmonic stenosis with 50mm gradient.Y 1/22/2009 1/22/2009
ent phoned in and report he had a reaction
Y to pneumonia injection given 2-5-09 here @ PCHD. U Instructed 2/5/2009
client to take
2/5/2009
BENADRYL OTC a
e, fever 104, red, swollen injection site-
Y less than 24 hrs. Patient irritable + crying frequently. YInfluenza site: 2/3/2009
Normal. 2/3/2009
symptoms began on 1-27-09 With client experiencing flushed face, tired, external chills, weakness Y + sharp1/26/2009
shooting 1/27/2009
aches + pains to all ext
IVAX vaccine, developed varicella 20 days later. U 1/15/2009 2/5/2009
izures, temp 103.2 degrees. Y Y 2/2/2009 2/3/2009
rm "tingling", numbness & difficulty Ywith any weight bearing L upper extremity. Symptoms started U approx 5-> 6### hrs after injection.
###
patient developed fever 101 @ home Y around 10pm 1/31/09- given dose of TYLENOL- shortly Y after pt had1/30/2009
jerking +1/31/2009
shaking, eyes rolled ba
Y ###
arm with 10x7 cm faint erythema surrounding 3x3 cm induration with control puncture mark.U Area is sensitive 2/3/2009to touch.
2/4/2009
et of redness, pain, swelling an painY with movement of RUE. Prescriptions of MOTRIN, PREDNISONE, N DIPROSONE
2/3/2009 2/5/2009CREAM, DARVOCE
, indurated area left arm. BENADRYL, Y IBUPROFEN, ice Y 2/4/2009 2/5/2009
s, arm pain, warm to touch, and swelling 2/4/2009 2/4/2009
large hive appeared first on leg, then hives spread over legs and trunk. Concomitant fever Y lasting 5 days.
1/21/2009 1/29/2009
ately 5 minutes after immunization was Y administered, pt. stated that he felt lightheaded, fell back Y against wall, 2/6/2009
and exhibited
2/6/2009 seizure-like act
ulitus requiring hospital admission for 1 1/2 days. Y r arm swelling beginning
2 48 hrs after administration,
Y DTap2/2/2009
and Var given
2/4/2009
in r arm. L arm w
cus in mouth, wheezing,difficulty breathing, fever behavior changes. fever showed up day ofUshot. and other 2/5/2009
symptoms 2/6/2009
showed up the next
t at least 25% of my hair. I have neverY experienced this type of hair loss before the shot, andNam not under 1/10/2008
any major stress. I had my last s
rmation was received on 29 OctoberY2008 from a manufacturer whose initial reporter was a health care professional. A patient experienced
rmation received on 29 January 2009 Y from a health care professional. A female patient with a history of diabetes, asthma, and an allergy to
n has been received from a health professional concerning a 77 year old white female patient U with sulfonamide
3/1/2007 allergy
1/22/2009
who on 1-MAR-2007
n has been received from a physician concerning a 61 year old female with sulfonamide Y allergy
N who on 1/29/2009
29-JAN-2009 1/30/2009
was vaccinated SC w
n has been received from a pharmacist concerning Y a 71 year old female
0 Y with a history of shingles
N 2 years6/9/2008
ago and no 1/25/2009
allergies, who on 09-
n has been received via a literature article regarding
Y a case in litigation
0 Y concerning a male who U at 2 months of age was 3/30/1998
vaccinated with RE
n has been received from a consumer Y concerning her 6 year old son with no medical historyNand drug allergies who was vaccinated with th
n has been received from a consumer concerning a 7 year old male who was vaccinated with N a dose of MMR II on unspecified date. Soon
n has been received from a consumer who was the relative of a male patient whoY "about 50Nor 60 years ago" was vaccinated with a dose o
n has been received from a consumer concerning her relative who was now a 63 year old male N who was vaccinated with MMR II (mfr. unkn
n has been received from a consumer concerning her relative 3 year old daughter with symptoms U of autism who was vaccinated at 1 year o
n has been received from a physician's assistant concerning a 17 year old female Y who "withinU the last month and ###a half", on approximately
n has been received from a certifiedYmedical assistant concerning a 22 year old female Y allergic
N reaction 1/11/2009
to LEVAQUIN 1/18/2009
who on 17-NOV-200
n has been received from a nurse and Y a physician for the pregnancy registry for GARDASILYconcerning 8/31/2007 a 15 year old4/9/2008
female student with n
0 the pt received HepB #1 and the Meningococcal Y Vaccination in preparation
1 for college entrance.
U On 7/17/00
6/16/2000the pt7/17/2000
suffered a seizure and
RDASIL shot series, It didn't cause major problems, but when I took the second shot around the above date I noticed 1/20/2008
a change in my vagin
had second shot of GARDASIL and is having bad headaches, pain in the abdomen, nausea,Unight sweats, 2/3/2009
depression, 2/3/2009
lower back pain. H
es, fever (>100 degrees), chills-onset 8 hrs. After administration of FLUZONE. Lasted over night, Y until next A.M.### Took Tylenol### po.
swollen, red, and hot to touch aroundY area where VARICELLA was administered. Pt statesYpain has worsened. 2/2/2009Advised2/4/2009
pt to go to doctor
f vaccination developed rash on trunk. Parent thought possible hives. Advised BENADRYLYpo dose. No 1/19/2009
other symptoms.
1/19/2009Rash resolved
es on both arms & trunk day after injection - resolving with use of OTC catesine cream Y 1/28/2009 1/29/2009
2008, family medicine--Got shingles vaccine around 2:00pm in my upper right arm; given by medical Y assistant II. ###She had ###taken my temper
r imm. child had fever 101, rash veryY red and much more prominent than usual. No vom or diarrhea. Y Took
1/27/2009
to doctors1/28/2009
office at 11 AM. Doc
complained of pain in her R arm with pain radiating from shoulder to hand the morning of 1/28/09. U This 1/26/2009
pain is still 1/28/2009
present > 1 week after v
complained of pain in her entire R arm the afternoon of 1/28/09, approx 2 days after vaccination. U No radiating
1/26/2009pain-just
1/28/2009
persistant pain in h
ent to receive the 3rd shot of GARDASIL. Y The person who administered the shot squeezed patient's arm1/21/2009and stuck 1/21/2009
the needle in her arm a
01 degrees F > Broke out in Hives > Pt. called into H. Dept 9/23 c/o of these symptoms did not U seek medical9/22/2008
care- Never
9/23/2008 returned phone c
swelling, pain. Y 1/20/2009 1/21/2009
Y Y 4/28/2008 1/22/2009
d dog bite in am and needed booster Y td was given tdap approx 10 am in rt delt im.pt states about
U noon his2/6/2009
rt upper arm2/6/2009
and rt shoulder star
s soon as injection given then later that day large reddened area looked like a hive about theYsize of baseball 11/4/2008
which 11/4/2008
lasted several days.
n Monday, February 2, 2009. Per patient: Y Tuesday night I could barely move. Sore all over, kinda
Y like a flu2/2/2009
ache but much
2/3/2009 worse. Wednesd
HROUGH CHICKENPOX FEBRUARY Y 2009. RECEIVED VARIVAX 8/1/2003 AND PROQUAD 8/18/2006. 8/18/2006 2/5/2009
d spread of smallpox due to drying self with towel that may have had possible contact with vaccination U area.
1/29/2009
2/10/09 Per
2/5/2009
reporter-pt was no
d yellow fever vaccination 05 Feb09. Y After recieving the injection, pt experienced dizziness, confusion,
N nausea,
2/5/2009 and blurred
2/5/2009 vision x 4 days.
ed in and states that child has chicken pox despite receiving the vaccine on 05/24/2002 Y 5/24/2002 2/8/2009
er vaccination, varicella-zoster virus-like rash and symptoms. Y ### 1/28/2009
nced shoulder girdle pain for 3 days followd by arm weakness and serratus muscle paralysisNwhich has 11/4/2008 not resolved as of### today. Pt had a s
started with "strangled cough"
Y and Ybody aches. Y 12/12/2008 Had severe
6 vomiting and diarrhea-
N extremely weak ###and12/3/2008
barely could walk-no s
per and lower extremity swelling and erythema when extemities are warm. Cyanosis of the swollen U extremities
2/5/2009when2/7/2009
they are cool. Also fac
r entire body that itches. Zyrtec 1/2Ytsp q12hrs. given to treat symptoms as needed to help with Y itching. 2/2/2009 2/8/2009
ntracted cellulitis in his left leg, afterYreceiving 3 vaccinations in that leg. He had to be treated U at the ER 38 2/4/2009
hours after
2/4/2009
receiving the vaccin
headaches and numbness in left arm, Y fingers, chest and leg starting after HPV #1(7/8/08), which
N were annoying
1/22/2009but 1/22/2009
tolerable. Now experie
esented to clinic with mother (MOC)Yto receive 4 month vaccinations. During the screening process Y MOC stated ###that infant ### became extrem
(48 hours later) Low-grade fever after Y treatment with Tylenol/Ibuprofen lasting at least 5 days, U Mild Rash, 2/3/2008
Lethargy, 11/5/2008
Listlessness, Fussine
slightly swollen red rash (approx. 1.5 inches in diameter) was noticed on my upper arm at theYsite of the vaccination 2/2/2009 about2/3/2009 24 hours after be
ed rash at injection site, fever Y Y 1/29/2009 2/5/2009
U 2/9/2009
swollen, & rash around vaccine area notice on 2/6/09 taking bath, on 2/7/09 & 2/8/09. The rash U went away 2/6/2009
redness 2/6/2009
swollen 7cm x 6cm on
1/10/2009, red bumps appeared onY back of hands + face - total E2Y changed to - 5 pustules Y resolved after one ###week
1/10/2009
s noted to have Red spots first on arms, Y trunk and then legs. Rash lasted 5-6 client was taken to ER with1/22/2009 104. fever,1/22/2009
client TX for pneumoni
elling, rash prescribed Orapred andYgiven Benadryl at ER Y 2/6/2009 2/6/2009
n 25-09 2-6-09 fever (elevated to 104.7 Y rectally - ER notes) lethargy > febrile seizure Y 2/5/2009 2/6/2009
ace, neck, groin area, back, and torso. Y Y 2/3/2009 2/3/2009
student came in with c/o R hand reddness at the nails. Started with 2-4 fingers then extended U to 4th + 5th1/16/2009
fingers, 1/21/2009
slight edema, mild tend
hills 5 hours after vaccine, lasted 4 days. Y 2/4/2009 2/4/2009
ays fever and runny nose. 12 days-rash-head, belly, arms and legs. Itching. Improvement atN15 days. 1/26/2009 1/30/2009
hargic 10 minutes after the infection chills immediately after injection. U 2/4/2009 2/4/2009
rs after vaccine pt broke out in hives all over hands and face on and off x 3 days. Given Benadryl Y with relief.
2/4/2009 2/7/2009
ministration the patient had a vasovagal response. She was sitting on an exam table was brought Y to a recombant
2/6/2009position
2/6/2009 and recovered w
ed clinic on 2/6/09 (injection given on 02/4/09) stating after third HPV injection she experienced U mild swelling 2/4/2009
@ site 2/5/2009
with moderate pain an
ates she had a S/E of right arm pain from upper arm down her arm which lasted 5 days, It was Y hard for her1/15/2008
to lift her1/15/2008
right arm over her shou
/09- Rx scarred immediately - dizziness, Y 1/31/09 Temp 103 redness- swelling and warmth. Decreased
Y appetite.
1/30/2009 Dizziness
1/30/2009 relieved by antiv
ted to ER c/o arm soreness radiating Y to head. Increased soreness over WE. Pt noted mobileYfirm module1/22/2009 (L) elest @1/26/2009
collar bone. MD's note
ted to office with erythema & ederma @ below the sight of the injection, pt also developed fevers Y for 2 days
1/23/2009
post injection-
1/23/2009 treatment was B
swelling at injection site. Y 1/14/2009
n has been received from a gynecologist, concerning a 21 year old female patient with history U of pollinosis
3/13/2008
who was3/28/2008
vaccinated with a third
dy aches, anxiety, high Cholesterol,
Y concentration difficulty, constipation, crampsYarms, depression, digestive problems,
### dry### mouth, energy
iving the vaccinations, the patient was hospitalized Y for six days. The6 patient's symptoms included
Y vomiting,
1/23/2009
diarrhea,1/25/2009
fever. 5/7/09 - Hosp r
rmation received on 02 February 2009 Y from a health care professional. A 14 year old male patient
N with no8/24/2007
reported past
8/24/2007
medical history rec
rmation received on 02 February 2009 Y from a health care professional. A 14 year old male patient
U received
1/31/2009
MENACTRA 1/31/2009
(lot number U2824
n has been received from a physician Y concerning Y a female patient who2 on unknown date was Y vaccinated8/16/2008
with the second ### dose of GARDAS
n has been received from a nurse who reported Y that she received an0 email from a former employee
U of theirs, who stated in the email that "a
n has been received from a physician Y concerning a 14 year old female who was vaccinated Y with the first dose of GARDASIL. Subsequently
n has been received from a consumer concerning her 5 year old daughter with penicillin allergy Y who was vaccinated with MMR II (lot numb
n has been received from a nurse practitioner and a female consumer with drug hypersensitivity
Y N (No otherwise
5/23/2008 specified)
6/30/2008who on unspecifie
2/4/2009 2/4/2009
n: PENTACEL. persistent fever- 3 days of 100-102 degrees. Red blotch around shot site 3 inches in diameter and beginning to spread to th
es child started becoming grouchy. Y Appetite decreased. Few days later noticed left side of face/jaw
Y swollen. Went ### to1/23/2009
Doctor-who was sure
09 patient presented to Urgent Care with c/o crying,
Y low grade fever,
7 vomiting, diarrhea. Was Y admitted to 1/20/2009
hospital with1/26/2009
diagnosis of Gastroe
es child was dizzy, nauseated and right Del red swollen, redness under arm as well and is painful. N 2/4/2009 2/5/2009
ceived KINRIX (DTap and IPV) to left medial thigh and Flu to left lateral thigh 2/6/09. MotherUnoticed itching, 2/6/2009
redness 2/8/2009
and swelling at media
notability, poor feeding, lethargy and Y sev. min. of 1 y twitching. T 100.3 F in office on 10/19/05,
Y and nl exam. Back ### to self### by 10/20/05 per
eadache pain. 2/18/09MR received Y from PCP including vax rec and numerous consultations.NInitially c/o 8/30/2007
with visual changes
9/1/200710/3/07. PE (+
eadache, head congestion, chills. N 2/5/2009 2/5/2009
at sight and swelling of leg - right leg Y 2/6/2009 2/7/2009
I am having an adverse reaction to the Anthrax shot I received on Sunday (8Feb09). I haveUbeen experiencing itching 2/9/2009
from the spot where
ccinated on Friday 2/6/2009 at 11:45am and then approx. 12 hours after vaccination at 1:30am, Y patient had 2/6/2009
102.5 temp2/7/2009
with chills, sweats,
ced redness around neck later in day Y after vaccinations.Pt has a pink-red collar-like ring around
U neck. Given 2/9/2009
Benadryl2/9/2009
in office.
stered on 01/29/09 left deltoid area.Returned to clinic 02/02/09 with complaint of left deltoid redness
Y 6in/5in,
1/29/2009
erythema 1/29/2009
with warmth and sligh
HAS A RASH ON HIS FACE, BOTH Y ARMS ON THE DELTOID AREA, AND A SMALL PATCH U ON HIS CHEST.
1/29/2009 2/8/2009
with 2 1/2" x 1 1/8" erythematous area, warm to touch. (+) pain when touched; (+) itching. Patient's
Y mother2/4/2009
noticed a2/5/2009
small erythematous a
nt present with a Swollen and red upper left arm that felt hot to the touch. She denied having Y a fever but1/30/2009
stated her arm 2/2/2009
really hurt a lot. S
ately 2 hours (10:00 AM) after receiving 2 immunizations (hepatitis b and Tdap) the back of Y her left leg began
2/9/2009to have2/9/2009
a burning sensation.
m firm cystic lesion on Rt leg at sight of injection Y ### 2/4/2009
event fifteen minutes after vaccine admin. Y 2/7/2009 2/7/2009
ry lymphadenopathy: swollen, tender. Y There was no source of infection, so I had mammogram Y plus ultrasound
1/28/2009 done. 2/6/2009
Multiple suspicious no
gan having frequent UTI's after firstYHPV. Then after second got yeast infections every 2 weeks and tingling 1/17/2008
in fingers
1/17/2008
and toes. After third
ates had problems with "legs
Y giving Y
out and weakness."
Y Noticed symptoms
5 on 1/27/2009 and Y went to emergency
1/15/2009room. 1/27/2009
Patient states was
ed 1 Jan 1992. Approximately
Y 30 minY after receiving
Y Typhoid vaccine,
5 member developed severe Y headache,
1/11/1992
vomitted,
1/11/1992
and notable respirat
ain after injection. Few minutes later severly dizzy and disoriented. Blurred, splotchy vision. UStill have pain 2/9/2009
in arm to 2/9/2009
which it was administe
started on face 8 days after MMR shot, fever, runny nose. Rash spread to back and then next N day to the 1/29/2009
stomach. Today 2/6/2009
he has been claw
hour of arriving home from the vaccines,
Y patient went down for a nap. He woke up screaming. U As I tried 9/11/2008
to console him, 9/11/2008
give him tylenol, an
h: The HPV vaccine GardasilY was administered
Y Yon January 15, 2009.10 Y
Thirteen days later andYfor 3 days has1/15/2009
vomit, dizziness
1/28/2009and cephalgia
was reported by a law office and described
Y the occurrence of shoulder pain in a Y male subjectU of unspecified
6/23/2000
age who8/1/2000
was vaccinated with
ately two hours after receiving Tdap right arm became numb from shoulder to the hand. No redness Y or swelling
2/10/2009 noted.
2/10/2009
ght child to office 4 days after 1 z given child L thigh was pale red over entire upper area (5"x5")
Y stated wasn't 2/5/2009 hard but
2/7/2009
mom stated that be
to right upper arm Y 2/6/2009 2/7/2009
shots on Feb 02, 2009 - namely PEDIARIX #3, YHIB #3, PREVNAR #3, 3 ROTAVIRUS #3 and Y FLU #1 - 3 days 2/2/2009
later with
2/6/2009
fever, resp. problem
miting x 2 days, lethargic,Y poor PO. Y Seen in hospital
Y ED 2/8/09. Admitted,
9 Y had diagnostic laparoscopy
Y with1/6/2009
ileocecectomy.
2/8/2009 Dx with intussusc
r headaches on 1/21/09 - Seen again Y on 2/7/09 when mother told dr she is concerned this isUrelated to the 7/11/2008
HPV vaccine.
11/1/2008got related inform
d to vomiting and diarrhea - But no fever. Y 2/9/2009 2/9/2009
area of ERYTHEMA U 2/9/2009 2/9/2009
trician who saw Pt in office on 2-5-09 Y - noted 4 cm round Erythematous area to upper (L) arm. Y No induration 2/3/2009
or pain with
2/5/2009
palpation- no crus
U 2/6/2009 2/6/2009
hite male ADSM is referred for persisting
Y lesion at initial SPV X6 months. Symptoms : Nodule, U subcutaneous,
8/13/2008 Erythema,
9/13/2008
Pain, Lesion, Pust
after receiving DTaP, HIB and Influenza,
Y patient had a febrile seizure. U 2/10/2009 2/10/2009
ped a pruritic rash starting the day after receiving 2nd GARDASIL vaccine. No work up done. Y Rash on torso
9/19/2008area. 9/20/2008
Treated with TRIAMCIN
dache for 2 days. -Welt at injection site, patient describes as 3 in long & 1 1/2 in deep, patient Y has taken BENADRYL
2/5/2009 2/6/2009& the welt has decrea
stration of vaccine. 2/10/2009
back to clinic with report of "some pain at (L) arm site" immediately after second injection + "around"
U 2am 2/2/2009
this morning 2/3/2009
(2-3-09) - Pt c/o ons
007 Child received DTP #4 Polio #3 at Pediatrician's office- seen in our clinic today- Red rash, large welts2/4/2008 torso & extemities
2/5/2008& face- started
suppose to receive MMR and received MENACTRA instead. This was done in error by the M.A. U Dr. has reported
2/4/2009this to our local health De
dose Amox 2-5-09. C/o HA + nausea Y on 2/6/09 with some soreness and stiffness to (R) armU- 2/7/09 C/o 2/5/2009
tiredness +redness
2/6/2009+ warmth to (R
ic Reactions - Redness, swelling, possible
Y development of blisters. U 2/6/2009 2/7/2009
ceived vaccines at approximately 1:45pm.
Y Mother reports "Child got really quick in back seat of car, mom 2/2/2009
turned to check2/2/2009
on him , his face
er became very ill when we left the office.
Y Complained of headache, stomache ache, had a fever, Y could not
1/26/2009
keep balance.
1/26/2009Within 8 hrs I had
Y with had hay fever who on 02-FEB-2009 vaccinated himself Y with a 2/2/2009
0.5 ml first dose
2/2/2009of PNEUMOVAX
n has been received from the patient'sY mother concerning her 12 month old female Y daughter,N who in 1999 was vaccinated with a dose of M
Y concerning
Y a 22 year0old
Y female patient with noN pertinent 8/13/2007
medical history12/1/2007
and allergic reactio
n has been received from a nurse concerning a female "born in 1983" with no pertinent medical U history who 5/29/2007
on 29-MAR-2007
7/1/2007 was vaccinat
n has been received from Y a Certified Medical Assistant
Y concerning13 an 18 year old female who N on 22-AUG-2007
8/22/2007 was12/1/2008
vaccinated with a first
n has been received from a healthcare Y professional concerning her 20 year old daughter who U was vaccinated with all three doses of GARD
n has been received from a medicalYassistant and a pediatrician concerning a 17 year old female Y patient for the ###pregnancy ###registry for GAR
n has been received from a registered Y nurse (R.N.), for GARDASIL, a Pregnancy Registry product,Y concerning
4/22/2008 a 154/23/2008
year old female patien
n has been received from a pharmacist Y concerning a 70 year old male with hypertension and Y allergic to morphine
2/4/2009and 2/4/2009
tramadol hydrochlori
ic rash, vesicles, fever X 2days 2/3/09 - given vaccine 1/27/09 U 1/27/2009
Red swollen left arm painful. 2/10/09 = Reddened area on arm, spreading painful. 2/11/09 = cellulitis.
U Pt has
2/5/2009
prior Hx staph
2/9/2009infections.
ain, vomiting, malaise, R/O sepsis-doubtful. Pt with prior diagnosis of staph infections Y 2/3/2009 2/4/2009
cm red, warm, swollen area left deltoid. Y 2/9/2009 2/10/2009
and swelling at site of injection U 2/9/2009 2/10/2009
es after receiving vaccine Pt. was getting
Y ready to walk out the door with parent - and faintedY- Able to keep 2/9/2009
standing 2/9/2009
and assisted into chai
after injection Y 2/9/2009 2/9/2009
ying/inconsolable and fussier X 2-3 Y days after vaccination. Y 1/26/2009 1/26/2009
1/2/2009
ed lesion Pt. had fever for 2 days of 101 F. Y 8/23/2007 2/9/2009
wsy and dazed lasting about 5 mins. Pt. was put back into the RM where Dr. check her andYbaby was doing 2/10/2009
better.2/10/2009
ed right arm (hyperimmune response). Y 2/10/2009 2/11/2009
ing, Rash spread all over body Y 1/29/2009 1/29/2009
greater than 5cm w/ erythema & pain. Y 1/30/2009 2/1/2009
h pain, Erythema, warmth and edema Y at and below site of vaccination within 24 hr of administration.
Y 2/4/2009 2/5/2009
ticed a 4 in by 3 in area of redness, warmth and tenderness on site where vaccine was administered,
Y 24 hrs
2/3/2009
after administration.
2/3/2009 Unchang
itching, redness at site 2 days after. U 2/3/2009 2/5/2009
ted blotchy rash at PNEUMOVAX site starting 1 day after immunization and cleared on 2-3-09 U (said she 1/30/2009
is sensitive1/31/2009
to many things). Feels
r shot she developed redness, swelling, itching and pain 5" X 3.5" around shot Y 2/4/2009 2/5/2009
ven 2/6/2009. patient states she noticed swelling. Today 2/11/2009 she reported it to the clinic. U She had2/6/2009
local swelling2/7/2009
at the site measurin
p at 1:00 am with chills, this continued till aprox 4-5:00 am. Pt denies fever and chills at this N
time.Today pt 2/10/2009
is feeling2/11/2009
unusually tired and rep
nt called the Dept of Health Services for guidance on the adverse event. She plans to self report U to VAERS soon. ### She is ### in good health, an
CM SWOLLEN SPOT ON RIGHT ARM, Y NOT RED, NOT WARM, MIDLY TENDER U 2/9/2009 2/10/2009
as in office for routine visit. Pt was ordered HPV vaccine, menactra (meningococcal) vaccine, Y and adacel2/10/2009
(tdap) vaccine.
2/10/2009Gave all three im
2-103, severe arm pain and injection site swelling, dizziness, sore throat, difficulty swallowing,Y cough, nasal 2/9/2009
congestion,2/9/2009
nausea, constipatio
ly had fever and redness tenderness and swelling of the left arm, site of administration the came U to involve 1/31/2009
the entire2/1/2009
circumference of the a
MA APPROX. 4 CM IN SIZE TO LEFT Y SHOULDER AT INJECTION SITE. PRESCRIPTION FOR Y KEFLEX2/2/2009
250MG\5ML-1 2/3/2009
TSP BID X 7DAY
in received 1st dose of JE vaccine. He presented to the office for his 2nd dose of japanese U encephalitis vaccine
2/4/2009at the 2/7/2009
1 week follow up int
diarrhea 4 days after 1st dose of Rotateq,
Y profuse,
Y presented 12-24 5hours later with dehydrationU (10%) 2/25/09-records
2/4/2009 2/8/2009 received for DOS 2/
ported increased swelling at injection site and increased redness "size of football". She stated Y that patient's
1/30/2009
father felt
1/31/2009
it might be "infected",
h weakness in right side of face four days after de vaccionation.PE: Mouth corner deviated to U the right. Non
1/30/2009
blinking right
2/4/2009
eye.Prescibed: Pr
d symptoms of severe headache, fatigue, dizziness, Y abnormal vision3and excessive sleepingYon about 5/2/2007,
3/28/2007 5 weeks
5/2/2007
after receiving HP
ours of getting Pneumovax vaccine R arm began to hurt, became very painful, 9/10, swollen,Y red areas 5-6" 2/9/2009
long. Started
2/9/20092/9/09 PM and re
ME BREATHING,NOT FEELING WELL Y WAS ADMITTED
Y TO HOSPITAL3 2/13/09-records received-for
U DOS 2/4-2/7/09-DC
### 2/4/2009 DX: Influenza A
and reported about 15 minutes after recieving Hepatis B immunization and Td, he had left side Y of head 2/10/2009
and face felt 2/10/2009
numb. This lasted for
STOOD WITHIN A MINUTE OR TWO OF GETTING 4 SHOTS, TURNED VERY PALE, THEN Y FELL AGAINST 2/7/2009 HER 2/7/2009
MOTHER AND RN W
at injection site. Y Y 2/9/2009 2/11/2009
accine given 1-6-2009. Had fever for Y 48 hours and fussiness after that vaccine. Had 2nd dose U of flu vaccine
1/6/20092-9-2009.
1/6/2009
Within an hour or
d on 02.02.2009 with rash and fever: had MMR and Varicella immunizations on 1.26.09; on 1.28.09 Y onset1/26/2009
of fever up1/28/2009
over 103 F and then tr
swelling, warm Fever 104.0, chills, nausea, increased Lymphodempathy, decreased ROM ofY extremity, pain 1/30/2009
L shoulder/
2/10/2009
arm/axilla
ting on exam table after vaccine and she felt dizzy. She was assisted to lying position on table Y by mother. 2/11/2009
A few seconds
2/11/2009later nurse arrive
ste in mouth, feeling of swollen lips, blurry vision, lethargy, nausea, headache, body aches. Y Started in am2/6/2009
of day after2/7/2009
vaccine received - 2/
Spasms (they look like infantile
Y spasm) But theyY have NO physical signs1 of the typical
Y infantile
N spasm. They started ### after ONE ### month shot
ap INSTEAD OF Tdap U 2/4/2009 2/4/2009
N HANDS< AND OVER FOURTY Y PERCENT OF BODY AFTER VACCINE>>NOW HAVE GUILLIAN N BARRE SYNDROME>
### 2/6/2007 12/13/09-office
aP: Sanofi Pasture Limited: Lot Number:
Y C2957AA
Y Exp: 21May10 and1 Hepatitis A: Glaxo Smith Y Kline Lot2/9/2009
Number: AHAVB320BA
2/11/2009 EXP: 25A
n 1600(Sun) by 1100 next day(mon)Y1/2" lump on right arm also entire arm and hand swelled,fever N 99.5,weakness,extreme
2/8/2009 2/9/2009 headache. Feve
ceived Merck's Gardasil Y vaccine 2 weeks
Y ago and since has been experiencing a variety of symptoms,
N headaches,
1/20/2009 seizures,
2/3/2009tingling, numb
was reported by a physician and described theYoccurrence of aseptic 0 meningitis in a 16-year-old
Y male subject ### who 1/10/2009
was vaccinated with HA
.3 (r) for 2 days morning after vaccinations. Child later diagnosed with Autism, aphasia,
Y developmental
N coordination
### disorder. ### 2/24/09 Dev
ble crying for 3 days after getting 1st set of vaccines at physician's office. Y ### ###
1-3 of ANTHRAX I felt hands burning and unable to write. From shot 4-6 felt burning at both N hands, arms, 2/3/2009
chest, face 2/4/2009
& back of head.
pular rash over trunk, face & extremities. 2/9/2009 2/10/2009
n has been received from a physician concerning Y a 55 day old male0who on 20-JAN-2009 was N vaccinated 1/20/2009
orally with 1/26/2009
a 2 ml first dose of RO
n has been received from a physician Y concerning a 10 year old female patient who was vaccinated U with a dose of GARDASIL (lot# not prov
pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 4 12/30/2008 for COPD exacerbation.
Y Vaccination
### took###
place on 12/11/
TER GETTING VARICELLA VACCINE Y SAID HIS THROAT HURT, COUGHING, ITCHING. IMMEDIATELY Y 1/29/2009
GIVEN 1/29/2009
ALBUTEROL, BENEDR
ed and reported L arm "purple" all theY way down and "itching all over" with tingling of L arm.YBegan approx 2/9/2009
30-45 minutes
2/9/2009 after vaccine--to
ethargy after Hepatitis B vaccination that was administered at approximately 24 hours after deliveryU of child. When
### performing ### metabolic te
08, @ 8-9AM, mom observed infantYto start to choke and exhibited redness all over his faceYand swelling observed ### by mom ###on tongue and
ven 02/09/09. on 02/10/09 mother reported
Y swelling and redness at injection site, RN advised Y mom to alternate
2/9/2009 cool2/10/2009
and warm compresses
9, two days after vaccine administration, the patient developed a rash on her left lower extremity N and was 1/14/2009
diagnosed 1/16/2009
with shingles.
re 102 deg. - hives - severe pain at site and lymph nodes under arm - fatigue Y 2/3/2009 2/3/2009
rned to clinic 2/9/09 stating she noted
Y small lump left tricep region appr. 10 days prior. reports U area getting1/20/2009
progressively
1/31/2009
larger. area appr.
hird dose my daughter got very pale, Y sweaty, aand dizzy. The nurse and I layed her back onUthe exam table. 7/15/2008
She became
7/15/2008 unresponsive fo
es approximately ten days after receiving Zostavax vaccine, she had severe muscle crampsN5 to 10 times a day ###in the
1/8/2009
following areas of he
nt developed diarrhea (10 watery stoolsY per day, 2 days after to Rotavirus vaccine. He also developed
Y diarrhea
2/4/2009 after 2/6/2009
the rotavirus vaccine g
5mm area of "bruising", erythema right upper outer arm (area of injection site). No systemic Y symptoms. 6/2/2008 6/4/2008
ATES "HAD FULL BODY RASH, NO FEVER." Y
ash onset 5 days after vaccines ?rotavirus
Y vac. Y 2/4/2009 2/8/2009
iven 2/20/08. On about 2/26 pt went into CHF, symptomatic. She recovered spontaneously Y by about 3/12/08.
2/20/2008Background:
2/26/2008Severe mital r
CALLED AND REPORTED HIVES STARTING 30 MINUTES AFTER DTAP WAS ADMINISTERED.BENADRYL Y 2/10/2009 WAS 2/10/2009
GIVEN. CONTINUE
the TDAP vaccine on the morning of Y Jan. 26. That night, I was unable to sleep, felt very dry,Uand consumed 1/26/2009
a large1/27/2009
amount of water. The n
ection sight up into shoulder, erythema, entire arm itching, face flushed. Y 12/2/2008 12/2/2008
, pain at injection sight up to shoulder and down arm, entire arm itching, flushing in face, vomitting,
Y and fever.
2/11/2009
itching,2/11/2009
pain, flushing started
m area of erythema, induration, hot to the touch, and sharply demarcated. Patient complained U of pain... tender
2/9/2009to touch.Patient
2/10/2009 had a low g
7:00 p.m. To E.R. by ambulance for Y sudden onset altered loss of consciousness. ObtainedUlabs, CT, lumbar 1/21/2009
puncture.
2/6/2009
Had been c/o inso
es long by three inches wide swelling of injection site - 24-48 hours from injection. Red & hotUto the touch. 2/10/2009
Tylenol for 2/11/2009
discomfort.
ed from a health care professional via the MedicalY Communication the 0 following information N on 30 JAN 2009:
1/27/2009
A 52-year-old
1/28/2009 male patient wa
mom took patient to ER for Y nausea and
Y vomiting. Y 12/19/08 mom took 230 Y
patient to ER for shortness
Y of breath. Diagnosed
### with###
acute myeloid le
nted within 2 minutes of vaccine administration. Patient obs x 45 minutes. BP checked after Y10min. BS checked-88.
2/12/2009 2/12/2009
Drank water. Walked o
both sites - Erythema no fluctuance. (R) arm ~2-5cm; (L) arm ~8cm. TX - BENADRYL + TYLENOL. U 2/9/2009 2/10/2009
and neck turned red with a rash and itch - symptoms ongoing 1/26/2009 1/27/2009
vere bronchospasm and shortness of Y breath 40 minutes after vaccine. No EPi needed; Stable Y Bp and O22/11/2009
SAT, 911 2/11/2009
to ER -discharged hom
arted temp 1:30 am 2/12/09. Mom gave MOTRIN temp was 100.8 at highest, no sore at injection Y site. 2/11/2009 2/12/2009
eft deltoid swollen and tender. 1st GARDASIL
Y injection given 8/16/08 and no reaction. 2nd GARDASIL injection2/4/2009given 2/5/2009
2/4/09 and above re
ely after administering, Pt developed hives - no other s/s. Doctor ordered BENADRYL and save Y Rx for BENADRYL
2/10/2009 2/10/2009
other reports fever 102 degrees -onset evening after immunizations. 3" redness at site of PENTACEL (L) upper 2/3/2009thigh-2/3/2009
warm to touch.
1/2 dollar sized red rash. Not hot to touch. Child fussy-more than with other shots. Giving TYLENOL
Y and 2/5/2009
MOTRIN. 2/6/2009
d, warm to touch. Local reaction at site of injection. Y 2/10/2009 2/10/2009
ingles) developed # days after vaccine
Y administration. Y 1/29/2009 2/1/2009
red FLUMIST with expiration date 2/3/09 on 2/12/09. No apparent adverse event. U 2/12/2009
red FLUMIST with expiration date of 2/3/09 on 2/12/09. No apparent adverse event. 2/12/2009
Y 8/21/2007
hest, back, face, scalp, arms - few on legs U 1/12/1998 2/10/2009
ported within 7 minutes of receiving VARIVAX vaccine patient c/o hurting in chest and throatYarea and felt2/4/2009 sick to his stomach.
2/4/2009 No shortness
B #2 administered at 11 am on 2/9/09 at noon cheeks became red and flushed then pale, severe Y headache..2/9/2009Premedicated
2/9/2009at 7am with TY
sis and upset stomach with 15m of VARIVAX, resolved within, 5-10m in office developed hives Y after vaccine2/10/2009 2/10/2009
ports she got shingles from the vaccination
Y (L) upper thigh near groin area. She saw her MDUwho confirmed it ### and treated
1/8/2009 her. Hives exten
veloped rash on neck, face on 2/9. Y Also had some shortness of breath and "watery eyes" onY2/8. Rash on2/6/2009 inner arms, 2/7/2009
back, chest, per nur
n has been received from a physician concerning a 24 year old patient with a history of papanicolaou N smear
4/20/2007
abnormal 8/1/2008
who on 20-FEB-200
was considered medically important. Information regarding PREVNAR was received from a U healthcare professional
11/6/2007 regarding a 24-month-
received vaccines (Dtap, Fluzone).YNo allegeries Y or cold systems noted
1 or reported. 1/15/09Y- mother states 1/14/2009
noted 1/15/2009
"bumps" under patient's
as vaccinated on 1/30/09 after fallingY on the ice. After the vaccine she called complaining of rednessY and1/30/2009
pain at the injection
2/6/2009site (rt arm). S
RT RED, BURNING ABDOMINAL/CHEST RASH. TODAY PT OBSERVED TO HAVE SMALL N RED RASHES 2/3/2009
TO LEFT 2/5/2009
UPPER ABDOMEN
en Varicella/DTaP 1530: call from parent that pt Y awoke from nap congested
1 & wheezing-advised
Y to give2/10/2009
albuterol nebulizer
2/10/2009 per Dr. and if n
the Gardasil vaccine and walked out of the room. As I exited I lost vision and hearing and collapsed,
Y still2/11/2009
conscious2/11/2009
and very nauseated. D
fever, chills, loss of appetite for 6 days Y 2/4/2009 2/5/2009
shrill cry for 45 minutes (non-stop crying) Y 12/2/2008 12/3/2008
male received 2nd doe of VZV on 02/10/09 at around 0830. Starting at 2100 on the same day U the child 2/10/2009
exhibited erythema,
2/10/2009edema in the l
ction site reaction to the R upper extremity. Pt received pneumovax on day one and erythema, U edema started2/11/2009 on day2/12/2009
two and persisted thr
hours of Jeff's first DPT Yshot, he hadY a grand malY seizure. We continued
2 to give Yhim the series
N of shots and at age 5/18/198425, he continues to hav
S HUSBAND PRESENTED TO PHARMACY ON 2/13/09 STATING THAT HIS WIFE HAD AYRED STREAK 2/5/2009
APPROX. 2/6/2009
4 INCHES LONG AN
m pain upper arm, can't lift arm withoutY significant pain. TD vaccine given 1/21/2009 10:30 AM. N Saw doctor 1/21/2009
following1/21/2009
week 1/28/2009. Pain
-Back of L arm--upper area--above elbow and below arm pit swollen. Approx 70 mm long--warm Y to touch.2/4/2009
Redness 2/5/2009
noted at two injection s
ates he started a fever@ 1PM Fri. 1/30/09&
Y by 8PM it was 104 degrees. Dr's office suggested Y alternating1/29/2009
Motrin&Tylenol-it
1/30/2009 would go down
received his second immunization with DTAP/HIB/IPB on February 9 at about 10 AM. He didYwell after the2/9/2009 vaccine unto 2/9/2009
about about 1:45 P
sil vaccination on 2/19/08. Second YGardasil vaccination April 2008. 3 weeks later, on May 9, N she came4/15/2008
home from school5/9/2008 complaining of s
fter injection, child woke up with nausea and stomache ache. Arm very sore for 4 days, including Y his armpit.
12/2/2008
Complained
12/3/2008that it hurt if he m
patient was administered Rotatec. After immunization, patient had 10 days of watery diarrhea Y and vomiting.2/11/2009 02/11/09
2/12/2009
- patient was admin
ternoon began chest pain. By Thurs. Y AM pain unbearable so went to ER. EKG normal & sent Y home. Fri.1/13/2009
AM pain severe 1/14/2009
so went to ER. EK
tate Epidemiologist stating that he hadY received a call from local provider stating possible measlesY case.1/12/2009
He spoke1/24/2009
with child's PCP and w
ter shot - mild malaise developing, 7 hours after shot- fever and severe chills (chills and shaking Y was worse than ###the worst### malaria attack I
ythematous papular eruption, itchy, Y on fore/arms/trunk/thighs. 2/5/2009 2/8/2009
swelling and erythema Y 2/10/2009 2/11/2009
fter vaccine admin., pt. walked backYinto the waiting room complaining of dizziness. AssistedY into a chair2/13/2009 with mother 2/13/2009
at side. Several attem
ly pruritic chicken pox U 2/19/2002 2/11/2009
exam 11-25-08. GARDASIL #1, MENACTRA & ADACEL given to update imms- Pt has since learned that she ###was pregnant at time of va
urs stated arm was the size of a football.
Y Had pain, redness, warmth. Had no fever. Felt weak. < 24 hours 2/12/2009
after shot2/12/2009
the arm was still 4.5
lled and notified that the day after injection
Y her arm was twice the size an extremely painful."YBENEDRYL 1/28/2009
DM and started
1/29/2009to feel better. Re
nute seizure - tonic clonic associated Y with fever. No treatment except TYLENOL, MOTRIN for Y fever 1/29/2009 2/7/2009
m unsure of onset, but pt. had been seen in local ER 2/6/09 with no mention of rash she wasUtreated for croup 2/3/20092/6/092/7/2009
with decodnon to EPI
ed to office at 4:00 pm- with red spotty rash on facial area. No c/o itching voiced. No rash noted Y on trunk 2/5/2009
at time of visit.
2/5/2009
VS obtained, norm
Rec'd vaccines in AM and was fine Yall day. She went to a martial arts class in the pm and after Y class became 9/3/2008faint and
9/3/2008
had seizure. She w
ears 1 hour post injection - Return of Bells palsy, also " set off arthritis & joint pain". Has had Y flu shot every year ###with 0 reaction
### did not see
swelling to site, itching. (Varicella). Y 2/4/2009 2/5/2009
ight of injection L arm became sore.Y 2/6/09 Severe pain to L arm. 2/7/09 increase temp, feltNbad. 2/8-9/09 2/5/2009
redness noted
2/5/2009 to L arm below s
noticed next day- became worse over next 24 hrs then started to decrease on day 3 -> resolved. Y 2/2/2009 2/3/2009
a redness noted same evening. There was no sleep disturbance. Next day, hard & red thighYSeen 27 hr after 2/5/2009
the shot:
2/5/2009
large red area creat
after shot began headache- for next 36-40 hours extreme nausea & headache (sinus & jaw) Y Routine chiropractic
2/8/2009 app't2/9/2009
& therapy helped & m
raised papulovasicular lesions arms, wrist and back U 8/3/2007 2/13/2009
ter vaccination, at 7 pm developed fever (101.5F). Given MOTRIN by mother. Fever was 103F Y at 1 am,2/12/2009
102F at 5 2/12/2009
am, and 100 at 9
eoccurrence of Reitens Disease after Y 3rd TYPHOID pill - c/o S-1 pain resolved post backs requiredY steroid
1/9/2008
use Last1/13/2008
episode of Reitens dis
eizure 24 hours post vaccines 101 degreeY F otitis diagnosis at 24 hours as well Y 2/4/2009 2/5/2009
eeks after vaccines given developed fever and rash (which resolved in short period of time),Ubut rash faded 8/5/2008
and actually persisted until see
11/4/2008 N ### ###
ven 1st dose of Gardasil Lot # 14484 Y on 2/4/08. Patient became ill with Severe Adominal
Y Pain
N and Nausea.8/18/2008
Patient 9/3/2008
given 2nd dose of Gar
avax injection, patient's arm from shoulder
Y to injection site started aching (within 15 minutes).
Y By the next 2/5/2009
day, the injection
2/5/2009 site was surroun
op a fever, irrability, decrease in appetitie
Y and diarrhea that I could not control at home which U resulted in an
2/9/2009
ER visit.2/14/2009
after receiving D/T immunization my arm at sight of injection starting hurting. I couldn't lift myYarm up above 2/12/2009
shoulder2/13/2009
level without alot of so
arre requiring hospitalization,
Y IV gammaglobulin
Y Y and acute rehab. Symptoms
7 started 1 weekYafter vaccination
8/19/2008 2/23/09
8/28/2008
Received hospital m
minutes after the shot I walked out of the doctors office and into the lobby, and all of a sudden I lost all energy in my body. Literally, I felt as t
us case was received from a consumer Y on 06 February 2009. A female patient reported thatUshe received an injection of Tetanus/Diphteria
er flu injection 9/29/08, pt became feverish, aching all over, nauseated for a few days, also states U he developed
9/29/2008 a huge
9/30/2008
cold sore on his nos
h VARICELLA on 9-4-08 vesicles on face & trunk. fever of 103 degrees X 6 days Y 2/14/2000 9/4/2008
les over trunk x 4 days. Y Y ### ###
CELLA - few vesicles on trunk fever Y 101 degrees -> HA -> X 5 days fatigue
Y -> 8/16/2007 9/18/2008
les on trunk X 3 days Dx : VARICELLA Y Meds: ZOVIRAX Y ### 12/8/2008
PM feet starting itching. 2/03 2:00 AM Awoke & whole body itched "terrible"- Took < chewable Y BENADRYL 2/2/2009
(Total 25mg).
2/2/2009 2/03 6:00 AM Co
vaccines 2/3/09, 2 days later, developed erythematous papules on face then over next few days, U progressed
2/3/2009
cephaolocauded
2/5/2009 to his whole
ted 02/13/09, highest was 102.8F, parent noted redness, not wanting to use her right leg. Seen Y on 12/14/09,
2/12/2009
afebrile
2/13/2009
after ibuprofen, 1cm X
e onset of erythema, pruritus and edema on right upper arm after receiving MMR vaccine. VSY - B/p-104/64, 2/11/2009
R-20, P-74,
2/11/2009
regular. Patient was
es starting January 3rd. Nausea andYflu-like symptoms Y starting around
5 January 15th. Low back N pain started 1/2/2009
early January.
2/2/2009February 2, patie
d Influenza A U ### 2/15/2009
r vaccine administered patient developed
Y joint pain, insomnia, numbness of certain areas onNright side of body2/3/2009
(cheek,2/3/2009
elbow, thumb, heel),
RECIEVED A SUB-Q DOSE OF ZOSTAVAX IN HER RIGHT ARM ON 2/12/2009. THE PATIENT Y TOLERATED
2/12/2009 THE
2/14/2009
SHOT VERY WELL;
ceived 1st dose of Gardasil vaccineYon 8/8/08 in Dr. office, since having the vaccine she hasNhad recurring8/8/2008 headaches,9/28/2008
severe joint pain, ch
ped burning, itching rash on both upper
Y arms, chest and upper thighs over 3 day period postYvaccination; 1/29/2009
to Er on 1/29/2009
day 3 -received IV solu
ziness & fast heart beat Y 2/13/2009 2/13/2009
ter received Gardisil vaccine today..Number 3, and she fainted about 8 minutes after the shot. Y She was2/16/2009
okay..nurse2/16/2009
kept us a few minutes
periences severe flushing episodes,Ynausea, severe abdominal pain, back pain, difficulty breathing. N Several
12/1/2008
physicians and ###tests find noth
as had chronic constipation with abdominal
Y pain since administered the oral vaccine (Rotateq). He has not 2/16/2009
been able 2/16/2009
to have a bowl movem
adache, nausea, joint pain, unusualYtiredness/weakness, aching muscles, muscle weakness,Nbad stomach2/6/2009 ache. 2/18/09
2/6/2009Received vaccine
n 1/21/09. Came in with swollen R side of face on 2/9/09 Y 1/21/2009 2/9/2009
was reported by a healthcare professional via another manufacturer and described the occurrence U of grand mal seizure in an adult female
Y N 10/8/2008 12/1/2008
myalgia. Episode of tachycardia 24 hours after vaccine, lasted 5-6 minutes. Y 1/29/2009 1/30/2009
dominal pain after first dose. ChestYpain, difficulty breathing, shortness of breath, palpitations Y and cramping
1/29/2009
after second
1/29/2009 dose. No wheez
en outside guidelines. Per MFG. No need to revaccinate. Y 2/15/2009
ls, weakness, RUQ pain and tenderness. 2/24/09 Y Mr received for DOS 7 1/30-2/7/09 with D/CYDX: Hypovolemic1/26/2009 shock
1/30/2009
r/t profuse diarrhea a
le on L Tricep Area with wheal of induration, ? early vesicle formation at center of papule. Scattered
U papules
1/23/2009
on Trunk
2/10/2009
and extremities App
some sinus congestion at the time Yof her vaccinations. Two days later she developed fever Yand cough. She 2/2/2009
was diagnosed
2/4/2009with pneumon
ing dizzy after shot. Pt told to sit- down
Y - given a cold compress. Pt LOL for under 1min with Y some jerking
2/16/2009
movements2/16/2009
ammonia inhalant
as given two tetanus injections (ADACEL) in 1 year. Denies pain. Edema problems after 4 days. Y 2/12/2009
elling pain @ injection site hives present both arms. U 2/11/2009 2/11/2009
ported pain and swelling at injectionYsite. Exam revealed erythema (approx 3 cm in diameter) Y warm to touch
2/15/2009
and tender
2/16/2009
to palpation. No fe
n has been received from a Nurse Practitioner concerning a female who approximately 6 months U ago was8/1/2008
intramuscularly
8/1/2008 vaccinated with t
n has been received from a Registered Y Nurse (R.N.) Y concerning a 172 year old female with noN family history
1/2/2008
of seizures4/1/2008
or drug allergies wh
n has been received from a consumer Y concerning Y her son, a 5 year1old male who allergic toNamoxicillin who was vaccinated with one dose
n has been received from a registered Y nurse concerning
Y a 71 year old
0 male patient with penicillin
N allergy1/22/2009
and SULFONAMIDE
1/22/2009 allergy, who
n has been received from a kindergarten
Y teacher concerning her husband's relative's churchmember's
U daughter's
8/5/2008 friend
9/1/2008
at school, a girl wh
n has been received through the Merck pregnancy registry from a physician concerning a 17Yyear old female who ### on 16-NOV-2007
### was va
n has been received from a Registered Y Nurse concerning her daughter (a 15 year old female) N who in August
4/16/2008
2008 was
10/1/2008
vaccinated with the
n has been received from a physician concerning a female with penicillin and sulfa allergy and U a history of3/1/2008
knee surgery and tube placed in
n has been received from Y a kindergarten teacherY concerning her husband's
0 relative'S
Y churchmember's
N daughter, a 14 year ###old girl who on
ceived the three doses of ROTATEQ - #1 doseYon 06/18/08, #2 dose 1 on 08/22/08, # 3 dose Y on 10/24/08. Diagnosed ### 1/27/2009
on 01/27/09 with rotav
e, emesis. 2 ED visits. Y Y 1/27/2009 2/4/2009
and "pinging" when I tap thumb & pinkie Y + ring finger together ; (L) forearm feels irritated & achy
N when resting it### on any sfc,### Face of shoulde
U 2/9/2009
L injection given in left deltoid at 4:15 pm, client stated she was dizzy and felt hot at that time.
Y Client lost consciousness
2/6/2009 2/6/2009 at 4:16 pm, was as
5X 8cm erythematous, indurated area Y 1/28/2009 1/29/2009
as seen at the Emergency Room because Y she was having seizures Y 2/10/2009 2/10/2009
fter had HEP A shot had bilat hand swelling and palms looked red, had been fussy during night. Y swelling1/27/2009
was gone 1/28/2009
by end of day, feet were
ES GENERALIZED RASH AND ITCHING OF SKIN SINCE DAY AFTER hEP b VACCINE WAS U ADMINISTERED.
1/26/2009 pT. 1/27/2009
HAD RECEIVED tW
weeks after getting 1st set Y of Gardasil,
Y patient complained
Y that she79
was
Y weak and Y was having N a hard time 11/3/2008
speaking. On 11/29/08
### patient ha
d during pregnancy. Pregnancy resulted in Voluntary Interruption of Pregnancy at ~ 11+2 weeks 9/17/2008 10/6/2008
lled stated that child began with fever about 12 midnight Friday night (Feb. 13. She stated child Y convulsed 2/13/2009
3 times and 2/13/2009
threw up. When ask
atigue, difficulty concentrating & sleeping following vaccinations N 9/5/2007 10/7/2007
ted shingles 8 months s/p vaccination Y U 6/4/2008 2/8/2009
es that 4 hours after immunization that Hannah complained of "butt & thighs are numb & chest Y feels jittery".
2/10/2009
Did not call
2/10/2009
physician and symp
### Y N ### ###
en Left arm. Patient came back to clinic 1 day after receiving injection. Patient treated with N Prednisone 2/16/2009
taper, benadryl2/17/2009
OTC, and intermitte
injection given on 2/10/2009 in the right
Y arm subcutaneous. On 2/17/2009 patient presentedUwith extensive 2/10/2009
erythematous
2/12/2009 rash extending fr
large reddened area approximately 2.5x3 inches in circumference 3 days after vaccination. Y Area was swollen
2/12/2009and hot
2/14/2009
to touch. Patient rep
U 2/6/2009 2/15/2009
veloped vesicular rash in dermatomal distribution over thoracic area, c/o pain over this area.Y
mother called 2/17/09 reporting, about Y 2 hours after receiving MENATRA injection c/o shooting N down left2/16/2009
arm and leg 2/16/2009
2/16/09. Today 2/17/0
on shoulders, back, (R) side family Dr. Y order BENADRYL. U 2/17/2009 2/17/2009
pain left index finger mcp onset 2/13/09 U 2/11/2009 2/13/2009
ious, spontaneous report of administered expired FLUMIST in a 30 month-old female patientYwas received 1/23/2009
from a nurse
1/23/2009
practitioner in the U
ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/6/2009a 38-month-old
1/6/2009 female who
ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/5/2009a four-year-old
1/5/2009 male who rec
ious spontaneous report of administration of expired product was received from a registeredYnurse concerning 1/5/2009a four-year-old
1/5/2009 female subse
ious spontaneous report of hives has been received from a physician concerning a 32-month-old U female, subsequently
### to ###
FLUMIST. This c
ious spontaneous report of administered of expired FLUMIST was received from a physicianY concerning 1/6/2009 a 58-month-old 1/6/2009
male. who receiv
1/12/2009 female subs
1/5/2009 female who
ious spontaneous report of administration of expired product was received from a registeredYnurse concerning ### a 38-month-old### male who re
ious spontaneous report of administration of expired product was received from a registeredYnurse concerning ### a four-year-old
### male who rec
ious, spontaneous report of administration of expired product was received from a nurse concerning Y a 24-month-old### female ### patient subsequ
ious, spontaneous report of administration of expired product was received from a nurse concerning Y a 28-month-old### male ### patient subseque
ious report of "six patients received expired FLUMIST" was received from a nurse concerning Y a 24-month-old
1/1/2009
patient1/1/2009
(gender unknown). Th
ious, spontaneous report of administration of expired product, vomiting and diarrhea was received Y from a nurse### in concerning
### a 33-month-o
ious, spontaneous report of administration of expired product, dehydrated, elevated white blood Y cell, vomiting, ### diarrhea and ### lethargic was re
ious report of "six patients received expired FLUMIST "was received from a nurse concerning Y a four-year-old
1/1/2009
(unknown 1/1/2009
gender). The patien
eous non-serious report of administration of expired product was received from a certified medicalY assistant
1/7/2009
in a physician's
1/7/2009concerning a c
ious spontaneous report of administration of expired product was received from a certified medical Y assistant
1/7/2009
in a physician's
1/7/2009office concerni
neous non-serious report of administration of expired product was received from a certified medical Y assistant
1/7/2009
in a physician's
1/7/2009office concern
accine used Expired drug administered) A non-serious spontaneous report of administration Y of expired product### s received ###from a registered
ious spontaneous report of administration of expired product was received from a registeredYnurses concerning### a 24-month-old
### female who
ious report of "gave patient expired FLUMIST" was received from a nurse concerning a four Y year old male patient. ### On 30-Dec-2008,
### the pa
nt to make f/u apt child not respondingY to parent Y when she call child's
1 name, PCR to parent Y to shake baby's7/7/2008
arm and7/7/2008
PCR called nurse. Ba
hat started several hours after receiving her booster flu shot. U 1/13/2009 1/13/2009
U ### ###
oy passed out suddenly after receiving vaccines on 1/17/09 @ around 6 pm. I turned aroundYto dispose 1/17/2009 of the needle, 1/17/2009
when he suddenly w
ours after receiving the vaccine had chills, fever, Y myalgias, vomiting 1and headache. Sxs were severe enough 5/18/2005
that she5/18/2005
was admitted to the h
ne-type disorder. Fever,Yjoint pain, diffuse swelling. 4/6/09 Received chiropractor medical records U of 11/14/2008.
6/1/2008FINAL DX: ###sciatica, DJD,
tions given on 1/12/09 at approx. 4:00 PM. Mom Y called at 10:40 AM31/13/09 stating 2-3 inchYdiameter swollen 1/12/2009red area
1/13/2009
on (L) arm. Appt wa
s seen 11/12/08 for pulling ears x 1 week. He had no URI Sx or fever but mom reported oneYslightly loose stool### that am, sl.###decreased appe
er shots had episode of vomiting and developedY seizure. Hospitalized 1 and started on Phenobarb.Y 3/9/091/12/2009
Received hospital
1/13/2009 medical records
ns, Shaking, High Fever. Y N 7/11/2006 7/18/2006
iving the third series of Anthrax
Y Vax.YBecame insulin
Y dependent, shortly after. 2/23/09
Y OfficeYnote received
9/24/2003
for 1/23/08 for### Diabetes Mellitus
eption - open reduction after failed enema
Y reduction.
Y Presenting sx: 1listlessness, decreased Y feedings (fluid1/6/2009
intake) increased
1/9/2009sleep. 3/3/09
nset arthralgias 12/29/08. Pain, swelling elbows, wrists, hands, fingers,knees, ankles low grade N temp initially. ### Seen by PCP ###& Rheumatolo
elling to the right deltoid area. ###
r Tdap I started having numbness
Y inYfeet and (R)
Y leg. This went on25 forYa month and Y 1/2 and I never put it together ###at that point.
### 12/12/08 Ha
s, nausea, tiredness, confusion, off balance
Y AM & PM, racing thoughts and actions in the AM. N 2/25/09 MR1/5/2009
received. 1/7/2009
HPV vax 12/2/08 and
d Guillain Barre Syndrome after multiple vaccines Y in basic training. Service
7 member had pneumonia
U prior 9/3/2008
to hospitalization
9/6/2008 for GBS, but num
n began 4 days after primary smallpox Y vaccine. Service Member meets criteria for "Suspect"Ypericarditis according ### to CDC ###guidelines. Def
GARDASIL vaccine about 15 minutes later. Pt had light headiness and dizzy, pale and nausea. Y 1/15/2009 1/15/2009
ng in lower part of body. Y Y 6 Y ### ###
d to office about 1 hour post vaccination with c/o rash. Very faint bumpy rash starting on arms, Y progressed through ### day to### include trunk + l
iously well except notedYto have poor Y weight gain.
Y Appeared well at2visit. Vaccines administered Y approx1/19/2009
10:30 am. Noted
1/19/2009at daycare to be
e- intense Flu-like symptoms w/ fever- Y coughing- nasal congestion- ending in a visit to ER. Lung, N blood and 1/9/2009
urine samples
1/9/2009seemed o.k. Cam
ery severe local Rxn at site of pneumococcal vaccine. Two days laterYsuffered urinary retention Y and ARF. Vaccine ### was listed### as one of ma
d petechiae 1/30/09. Diagnosed withY I.T.P. 2/1/09 Y (Platelets 5,000). 2Responded to I.V.I.G. - Platelets
Y 95,000,
1/8/2009
on 2/2.1/30/2009
Platelets 205,000 on 2
e call from parent - reports child c/o pain left arm + shoulder since vaccine on 1/13/2009 to day Y of call 1/16/09
1/16/2009
- Parent
1/16/2009
reports relief with Ty
accine administered. 1/19/09
Y - Developed
Y severe
Y viral symptoms. 1/25/09
1 - Dx with DVT andUhospitalized; 1/16/2009
put on Heparin.
1/25/2009 1/27/09 - D/C on
ived the Tdap shot in my left arm 12-15-08
Y at family practice which my arm became very sore N 12-16-08 & has ### been sore every since 1-15-0
episode following injection, approx 30 Y seconds Y following vaccination.1 Member not caught before Y hitting floor.
2/9/2009
Patient sat
2/9/2009
up at 2-3 mins later
### N 4/28/2008 ###
1/18/2009 N 1/14/2009 1/18/2009
e week after shot. Fever 101 degrees Y F 104 degrees F. Unknown rash (was told Y chickenpoxU& given Prednisone).
5/23/2006 Developed
5/30/2006 food aversion
ation for numbness, pain, in hands and Y feet. IVIG,
Y Narotin. 2/20/09-records
5 received
Y for DOSN11/28/08-presented ###to ED with ###C/O hands an
ER twice for abdominal pain, fever,Yvomiting. Diagnosed
Y with intussusception.
5 Tried to reduce
Y with barium 7/8/2008
enema several
9/25/2008 times but was no
eption. Required partial colectomy. 2/24/09-records Y received for DOS 5 1/8-1/13/09-DC DX: Intussusception.
Y 1/5/2009
Presented 1/8/2009
with 2 day history of
M 1/15/09 - Right upper arm redness, Y pain and swelling to hand, red raised area noted surroundingU injection
1/14/2009
site, seen
1/15/2009
by attending, given
cant 15 minutes after the shot. After 15 minutes when she get up + walk she fell little bit dizzy Y + palpitation
1/12/2009
few minutes.
1/12/2009
Notified provider
a enduration, erythema & swelling extending
Y area 10cm diameter. No treatment rendered. Y 12/8/2008 ###
08 pt. presented to office c/o pain LYdeltoid w/ radiation of pain to elbow. Area of erythema measured
Y 1.5x2 cm. ###Normal remainder
### of exam
sions (>250) on extremities, torso, face and bucal mucosa 8 days after receiving first varicella Y vaccine. Tx: Acyclovir
### 1/7/2009
800 mg every 6 hours
0min after injection while sitting in waiting area, c/o dizziness, lightheadedness. Attempted toYmove patient1/8/2009 to exam room1/8/2009
but began to faint
oximately 8 minutes after receiving 6 vaccinations, pt. c/o feeling faint. Pt. became unresponsive Y and began
1/12/2009
jerking1/12/2009
movement of her head
hours after vaccine pt reports swellingY and tenderness in left axilla. Also had tenderness at injection site.1/12/2009
Swelling progressively worsened
ls, Diarrhea, Malaise following day hives day 4 U 1/8/2009 1/9/2009
2 degrees F), severe left arm pain at site of administration. Y 1/8/2009 1/10/2009
NTACEL, PCV7 and Rotavirus 1/12/2009 Y - developed fever to 106 1/11 per mom, Occ crying. Y Temp on and1/12/2009
off throughout
1/13/2009day 101-102 per
hing & macular rash on thorax. Y 1/14/2009 1/14/2009
tions given on 1/8/09 at app. 4:30 pm Y - Call from mom on 1/9/09 @ 3:30 noting redness, soreness, Y & swelling
1/8/2009
of L thigh
1/9/2009
- PA notified mom
office and c/o L upper arm still being sore 2 weeks after injection. Received GARDASIL 12/30/08- Called office### 1/14/09. ###
STAVAX Received 12/25 itching rash started at site of injection Spread all over his body down Y legs and back ### Took BENADRYL ### R on 12/2
e very irritable Abd pain. Y ### ###
n has been received from a 39 yearYold male patient
Y who was in the0hospital for a hip replacement.
U He had 3/1/2007
a chest x-ray
3/1/2007
and then received
iting and diarrhea within 48 days afterY admin. of 2nd ROTAVIRUS vaccine at 4 mos well check Y on 11/07/08.
11/7/2008Was 11/9/2008
tx at hospital ER, with IV
mplaints of wheezing at night and fells pressure on the chest and coughing starts about 2 weeks U after vaccination
10/8/2008 but reported ### to me on 1/
d crying - went to clinic. Sent home -Ydid well. Y 1/13/2009 1/13/2009
n has been received from a physician Y concerning a 22 year old female who was vaccinated U with the second
12/1/2008
0.5 ml 2/12/2009
dose of GARDASIL (lot
TDAP vaccine 12/29/08 - felt overlyYfatigued on 12/30 & early. 12/31. Late morning 12/31 IYdeveloped abdominal ### cramping ###- severe- unab
n has been received from a male concerning his 4 year old son who in January 2007, was vaccinatedU with1/1/2007
PROQUAD. 1/1/2007
His son was diagno
ven Influenza virus vaccine instead of Hepatitis B on 12-30-08. She was then given HepatitisYB on 01-2-09. ###
n has been received regarding a case in litigation from a consumer, concerning her son whoNon an unspecified date was vaccinated with a
ed my cell phone and left message stating she had symptoms of rapid heart rate & dizzinessYafter receiving 2/6/2009
vaccine Friday
2/6/2009afternoon. I spo
n has been received from a 74 year old female with arteriosclerosis, and diabetes and a history N of left eye 7/11/2008
twitching7/19/2008
before vaccination who
ff and could not move right arm for Y 3 days. Then the soreness moved down arm and wake up N in middle of night. ###Went to### orthopedic speci
me very swollen and red, itched, area about 2 1/2 X 2 1/2 inches. Lasted for 6 days. Then just Y swollen and 1/23/2009
started 1/24/2009
to go away. Had bump
U 2/11/2003 2/7/2009
red HEP A into R deltoid. Then administered GARDASIL into R deltoid. 10-15 seconds later, Y patient lost2/9/2009
consciousness2/9/2009
+ fell backwards f
ought back in office by guardian 2/2/09 with a c/o (R) BELLS Palsy noted after one day vaccines U for 5 y.o. 1/30/2009
given KINRIX,
1/31/2009
MMR, Varicella, In
as given inj f/m PNEUMOVAX last Friday. Pt came in today with c/o high fever (103.8) severe Y pain in rt arm
1/30/2009
& nausea 1/30/2009
30Jan09
accines - on 1/16/09, low grade temp. Y suddenly became limp & unresponsive. Vomited & then Y responsive. 1/15/2009
911 brought
1/16/2009
to ER then he beca
enza vaccine given approx. 3pm 1/21/09. Caregiver noted "hives" around injection site and torso Y approx.1/21/2009
6pm. No other1/21/2009
sx other than hives
macular rash extending medial upper arm down to antecubital fossa N ### ###
RA was administered to 56 y.o. pt. - only licensed for up to 55 years of age. No adverse reactionsY were reported.
1/13/2009
der discomfort reported 11/13/08 Flu vax given 10/30/08 shoulder X-ray 11/24/08; MRI shoulder 12/4/08 Tx: Physical ### therapy
###
ling in fingers, unable to lift arm over head. 3/18/2008 3/20/2008
local redness/swelling with some itching. U 1/29/2009 1/31/2009
.4 and red rash all over arms, trunk, legs, feet 24 hrs after administration. BENADRYL and tepid U bath administered.
1/14/2009 1/15/2009
1/16/09-Rash on face &
arrhea after 1st ROTATEQ lasted x 3 months. Eventually resolved, used NUTRAMIGEN. Y 9/9/2008
ash c/w RUBELLA. Irritability, fever, poor po intake. U ### ###
d PREVNAR vaccine 1-14-04. Pt had fever of 102 degrees rectally. Y 1/14/2008 1/15/2009
Y 1/2/2009 1/12/2009
104 X 3 days post vaccine Y 1/13/2009 1/13/2009
minutes of receiving GARDASIL, patient Y passed out, regained consciousness. Since that timeU - 2 episodes5/16/2008
of similar
5/16/2008
symptoms with loss o
me into the clinic complaining about rash all over body. The Pt. stated that he had been abroad U the weekend 2/5/2009
prior. 2/12/2009
From what the note from
0 minutes after injections began ruritic
Y episode with erythematous rash on inner arms, One area Y on chest1/12/2009
with slight1/12/2009
edema of eyes. Sent to
eks of peripheral neuropathy - pain and sensitivity to left triceps and left pectoralis area/chestYwall. no weakness.
10/6/2008 saw10/8/2008
a neurologist.
to patient he was suffering from fever, headache, joint pains, nausea, rashes, and diarrhea Y on the 15 Feb2/6/2009
2009. Seen2/15/2009
by Medical Provider
en warm touch left arm 2/17/09 0600 treatment was given on 2/18/09 at 01000 Benadryl 12.5mg/5ml Y and
2/16/2009
Cleocin 75mg/5ml
2/17/2009
HPV Vaccine dose #3. Did fine in office. Fifteen minutes after leaving (while still in car) patient
Y noticed that her hand was quite swollen an
9, patient called the health department to state that very soon after he had received the Zostavax
U vaccine, he began
### noticing ###that he was b
n was given an Adacell vaccine rather than the ordered hep B No adverse reaction Y ###
symmetrical eruption of dull erythematous irregular patches to face upper/lower extremities U and anterior posterior
2/4/2009 trunk2/6/2009
s taking oral Typhoid Fever vaccine for a trip. She took them correctly, one piull every other day.
Y The first2/12/2009
day, no problem,
2/15/2009 2nd day, she fe
en burned and very hard with itchy Y red bumps. Very large knot in arm. Treated by Hospital forY Allergic reaction.
2/7/2009 2/8/2009
GIVEN AT 0915 LD IM WAITED 20YMIN IN THE LOBBY WITHOUT REACTIONS. LEFT AND Y WENT BACK 2/18/2009TO SCHOOL
2/18/2009 AT 1120 SHE C
08 Mom called provider office an spoke Y with nurseY complaining of left3 leg swelling. 4/6/09-records
Y received
12/1/2008
for DOS 12/6/2008
12/18-12/21/08-DC DX
vaccine, developed fever in night, byY next day fever raised to 106 - went to emergency roomYfor tests, antibiotics ###in case it###
was an infection
shot was given I had mild tenderness Y in the shot area for a few days. It seemed to be gettingUbetter but then
2/12/2009
on the sixth
2/17/2009
day it began to get
n right thigh, Hib given left thigh 8 days
Y ago. Swelling and lump on right thigh about 3 cm with Y less swelling
2/10/2009
and lump
2/11/2009
on left thigh (1.5 cm
pot about the size of a quarter that was tender and warm on friday 2/13/09 U 2/11/2009 2/13/2009
series of Guardasil on 7/24/2008.
Y On
Y 9/10/2008, patient went to emergency room in ambulance U due to 7/24/2008
rash and difficulty
9/10/2008breathing, assum
en 11/16/09 & given VARIVAX #1, PREVNARY #4 & HEP A #1. 1/17/2009 Developed a rashYon legs, face 1/16/2009
& arms. 1/17/2009
@ 8 pm 1/17/09 develo
Tdap, influenza and PNEUMOVAX vaccines 01/06/09. Pt called clinic 01/13/09 to report thatYon 01/07/09,1/6/2009 she had experienced
1/7/2009 onset "sev
veloped severe diarrhea after 1st ROTATEQ >10 stools per day x2 weeks. Resolved - needed Y Pregestemol.2/29/2008
ed Varicella vaccine 1/12/09. RTC today Y 20 to reddened area 11X10 CM @ site of vaccine. U 1/12/2009
as vaccinated on 1/22/09 (fluid was Y noted in both ears at the time). His ears became inflamed Y and he was 1/22/2009
given amoxicillin
2/3/2009(has previously
16 scattered red pin point papules w/ pin point scab Y 1/20/2009 1/20/2009
MMR#2 2/2/09 woke 2/3/09 with L shoulder, neck, upper arm pain/swelling ? and headache.Y Self treated2/2/2009 with IBUPROFEN2/3/2009800 mg and TY
ter having 3 vaccines (VARIVAX, MMR Y & PREVNAR), had hives on face - no other exposures U in interim Given
2/9/2009(4mg)2/9/2009
1cc decadron Benadr
and called for help Pt found sitting pale
Y semi responsive. Very pale wiffed ammonia inhalate Y help arrive. Pt taken ### to urgent###care for observa
m around 4:30PM. Went home, seemed X 2hrs. Around 8pm became very fussy temp 100.6.Y Didn't sleep 1/30/2009
well that 1/30/2009
nite. Next day was som
Y 1/29/2009 1/31/2009
Y Y 1/9/2009 1/9/2009
Y Y 1/16/2009 1/25/2009
ed swollen - Hot to touch Y Y 1/6/2009 1/7/2009
04 and higher for seven days straight.
Y Within 48 hours after vaccine U ### ###
ort received on 02 June 2008 from aYhealth care professional. A 28-year-old patient, had received U a 0.5 mL 6/6/2008
intramuscular right deltoid inject
d pain at injection general malaise, fatigue "out of it" Pt observed with no subsequent sx's. Y 1/6/2009 1/7/2009
10 min after receiving YF-VAX + ENGERIX-B.
Y Pt had reaction of SOB and urticaria app. 15minY after he left2/18/2009
FLAS. Pt 2/18/2009
was treated with 50m
-VAX given 2/10/09 (1cc given rightYdeltoid subQ) @ 1300-1400. On 2/13/09, while at daycare, Y the patient 2/10/2009
had hallucinations
2/13/2009 (tactile of bug
GARDASIL 1/7/09 at routine health assessment Patient seen in the office on 2/5/09. Developed N lump in her 1/7/2009
neck on 2/2/2009
2/2/09. Diagnosed wit
Flu and MENACTRA 10/31/07. By Thanksgiving Y he had foot droop of 3 left foot. Seen
Y by primary in Feb. '08 for ankle
### pain. ### Referred to Ortho
ost administration infant very fussy and immunization site with erythema & mild edema, tender Y at 7-8cm. 12/8/2008 12/8/2008
grandmother described staring spells which lasted 2 weeks after visit. She states they were Y "just like patient's mother's
### absence
### seizures c
iven 1/2/09 symptoms began 01/03/09 included: dizziness, lasted 2 hrs. rash lasted 2 days nYwith vomiting 1/2/2009
1 X. Per 1/3/2009
the patient mother BEN
an staring & jerking involuntarily. (Woke
Y up crying at 12:15) We took her to the ER and by 1:30 Y a.m.. she was ### fine.) No other
### reactions. (N
ng after receiving the vaccine, c/o fever 102 degrees F, vomiting x1 and muscle aches, joint Ypain- 2/10/2009 2/10/2009
swollen upper thigh to medial thigh. Y 1/9/2009 1/12/2009
ceived vaccines on 01/23/09; developed low grade fever + x 3 days 01/28 - 01/30; given Amoxil Y for purvulent1/23/2009
rhinitis.
1/28/2009
Rash noted on 01/30/
l received from family member reporting that vaccine recipient has rash & severe nausea. No U mention of1/13/2009
fever. Vaccine
1/14/2009
was given 1-13-09
1/5/9 no problems. 1/6/9 - Circular welts
Y with blisters- itching back, legs, arms, buttocks - worse
Y on 1/7/9. 1/5/2009
Went to ER1/6/2009
1/7/9 - placed on BEN
ceived PENTACEL injection by itself (IM) in right lateral thigh. 5 hours later mom called stating U his right leg1/14/2009
was swollen and warm to touch
n R upper arm - minutes later 5 cm diameter welt with raised erythematous center painful. Used U ice, TYLENOL,
1/14/2009educated
1/14/2009 pt's mom on brin
ceived HEP B3 vaccine on 7/20/06. A few days later she had a severe nose bleed, blood pouring Y out of 7/20/2006
nose and mass 7/25/2006
coughing up blood
ceived HEP B vaccine on 4/28/06 A few days later she had a severe nose bleed, blood pouring Y out of nose 4/28/2006
and mouth. 5/2/2006
Coughing up blood
ithin 24 hrs. Started on legs-became Y generalized in 48 hrs. 2) Low temperature elevation (38-38.4)
U > 481/2/2009
hrs. 3) Periods
1/2/2009
of extreme irritab
ed lesions head to toe-not palms or Ysoles. On dorsum of hands and feet though. Y 1/12/2009 1/17/2009
and redness over (L) leg (thigh) 30 x 30. Y 1/19/2009 1/20/2009
nd swelling of right upper arm x 2d, treated w/KEFLEX Y 1/12/2009 1/13/2009
EL given right thigh in am 1/15/07 - Parents
Y came back in due to pt crying non-stop 11:30 2:00, U vomiting 1/15/2009
X 2, not nursing
1/15/2009
pt calm at times, re
nted after receiving vaccines- Menactra, Tdap, Hep A#2 Y 2/13/2009 2/13/2009
as given vaccine. Approximately 5-7Yminutes after patient's eyes rolled back. Upper body began Y to jerk. Called
2/13/2009
911. 2/13/2009
ght deltoid pain and swelling with vomiting x 1 and low grade fever. After 48 hours patient feltYmuch better. 2/12/2009 2/13/2009
nt fever and maculopapular rash of trunk. Y 2/4/2009 2/10/2009
d a PNEUMOVAX on 2/17/09 and noted Y a reaction on 2/18/09 arm swollen (raised) 7x7 red area with a 2/17/2009
small fine rash,
2/18/2009
Hot to touch and pa
lling, itching, rash, warmth at site. Y 1/6/2009 1/6/2009
vaccine breakthrough. Diagnosed with varicella on 1-19-09. U 7/7/2005 1/15/2009
rs had 3" diameter cellulitis. Patient has a history of IgG2 deficiency. Treated with KEFLEX BACTROBAN.
U 2/16/2009
Cellulitis 2/18/2009
at site of DPAT.
started within 10-15 min after MMR and VARIVAX injection. Slight puffy lips and stable visual Y signs. POS 1/13/2009
decreased 1/13/2009
95% - CTA afterward
ght by Mom, had vaccination on 1/20/09. Mom noticed swelling right thigh yesterday. No fever. U Groin - right1/20/2009
thigh - mild swelling and erythe
lymph swelling/tenderness with palpation
Y (Jan 15 2009). Hives and itching on neck and extremities
Y 12 Jan1/9/2009
2009. Seen1/12/2009
and treated with PR
m lesion R thigh around shot sight. Red,
Y hot, indurated, tender. Began around 1 day after shot. N 1/21/09 decreased
1/14/2009 to1/15/2009
2 1/2 x 2 1/2 cm.
me size swelling and tenderness at DTaPY site. Y 1/21/2009 1/22/2009
njection site, gave BENADRYL advised mom to give in 6 hours if hives came back or go to ER, Y call 911 if1/23/2009
any trouble 1/23/2009
breathing.
ck like sensations in his (L) UE that radiate to his hand. At the time of onset, approximately 2Yweeks after the injection,
### the###
pt said he did no
ness area (4 1/2 inches x 4 inches) on left arm with swelling and soreness. N 1/27/2009 1/28/2009
hs old patient received vaccines (routine) PEDIARIX, Hib, PREVNAR, Rotavirus - 4/21/08. On N 4/22/08 mom 4/21/2008
noted bloody
4/22/2008
stools and cramp
ory of rash prior to presentation. On exam, 12cm x 15 cm around erythematous rash lat/post.Y(L) arm warm to touch, ### multiple ###bullae laterally
nization at 12:15 pm on Thurs 10-9-08 Y c/o headache starting at 11 pm that night; woke up w/headache
Y -10/9/2008
severe at 4:3010/9/2008
- headache describ
-fell to the ground stomach upset on Dec 6, 2008 and on Dec 7, 2008 Y 12/6/2008 12/7/2008
diameter, slightly elevated, red, irregular skin area where injection given. Denies itching or pain. U Instructed1/12/2009
to notify1/14/2009
primary physician.
ame limp and unresponsive x 5 minutes. Y Y 1/26/2009 1/27/2009
d Ulcerative Colitis after ANTHRAX Y 1-4, sxs started 2 years after #4, diagnosis made 1 year N after # 4. Diagnosed
1/4/2000with narcolepsy in 2008, b
s she was well at the time and took Y no medications. Approx 24 hours later SM reports she awakenedY with papular
### pruritic###rash on bilateral
ration, pain on LT arm cold compress, Y OTC Benadryl U 1/21/2009
dministered on 1/23/09 - On 1/23/09 leg was hot, red, swollen, from hip to knee, painful to touch, Y fever and1/23/2009
hives on1/23/2009
neck-chest - Pt instruc
iven 1-12-09. Pt complained of severe pain at injection site on 01-16-09. It was not relievedYby ice or EXCEDRIN. 1/12/2009 1/16/2009
ADVIL provided minima
R) deltoid, fever, swelling at injectionY site, body aches, chest tightness, headache. Pt seen by Y PA at Medical1/20/2009
Clinic on1/20/2009
1/22/09. Recommend
bump on L legs. Shot 2 days ago. Y ### ###
ash - generalized RX - BENADRYLY& PREDNISONE Y 1/19/2009 1/20/2009
hours after injection, pt c/o extreme Ymuscle pain in legs arms, back and abdomen. -No local Y reaction noted 1/15/2009
@ injection1/15/2009
site. Pt also c/o H/A
to pt several hrs after injection, the site became red, raised and warm to touch. Area was the N size of a 50c piece. ###Ice applied### to area since
g redness, itching + swelling at shot Ysite L upper arm starting approximately 24 hours after shot has 8x5cm 1/19/2009
are erythema
1/21/2009
+ swelling + tende
ccine given to a patient under 1 year of life by mistake. HEP B ordered and HEP A given. Discovered after 1/7/2009
injection.
became very painful, unable to lift. Y 1/8/2009 1/8/2009
ouch of flu- woke up with headache took ALEVE. Feels extra tired. This happens some years Y when gets1/22/2009
flu vaccine1/22/2009
also. Arm is sore. Inje
er receiving tetanus shot- Had severe pain & aching (deep) in right upper arm - It has been 4 months & although 9/4/2008 the9/12/2008
pain is less, is still very
h that spread over body and face swelling 1 d after vaccines, followed by rhinorrhea and cough. Y On 1/12/09 1/9/2009
child was 1/10/2009
wheezing. Also taking
redness and swelling. It ran base of neck on right down to right elbow. TYLENOL/BENADRYL U 1/20/2009 1/21/2009
1/7/2009
d Rheumatoid Arthritis-- Pain beganYwithin 5 days of last dose of GARDASIL vaccination. Severe N joint pain--unable
### to 1/2/2008
walk. 2/26/09 Recei
ted approximately 5 min after vaccinations
Y given. She reported feeling fine just after vaccines.
U During check 2/6/2009
out she fainted.
2/6/2009Blood pressure
with a full body rash and fever - pt taken
Y to hosp. for urticaria. Also has with peanut butter. Y 10/6/2008 10/8/2008
ot 1/12/09. Also, exposed to many children with URI symptoms 1/12. On 1/13/09, had syncope related to1/12/2009 quick changed1/13/2009
in position. Also n
e fever, symmetric erythema, induration, Y slight increased warmth right upper thigh beginning about 20-241/21/2009
hours after1/22/2009
injection 10 1/2 cm dia
eadache (Migraine) N 11/3/2008
oke in AM with redness size of baseball Y then increased to size of softball per dad. 1/23/09 seen
Y in office 1/20/2009
induration centrally
1/21/2009 with 16x11 ery
administered 1/21/2009 Rt arm. Redness Y and swelling next morning 1/22/09. School nurse Y measured redness
1/21/2009 - 9 cm.
1/22/2009
redness, inability to perform R.O.M. with affected arm. Diagnosis Brachial Neuritis post TD U for adults 2 days.
1/24/2009
Treatment
1/25/2009
per pcp Ibuprofen
on STRATTERA. Mother reports changes on behavior. Child more opositional and inattentive Y after receiving
1/23/2009
vaccine 1/23/2009
e call from Pt's mother stating Pt has little red bumps/rash on chest and both arms. Instructed U mother to take
1/20/2009
her to 1/30/2009
MD for diagnosis. Mothe
y 4/08 and 12/08 (Not certain vaccine related - Pt concerned and asked for it to be reported Y 1/15/2008 4/1/2008
d hives (urticaria) in underarms, waist Y and legs. Prescribed MEDROL DOSEPAK 4 mg and ZYRTEC. Y 11/1/2008 11/2/2008
ere bilateral knee pain, spreading toY proximal lower leg and distal anterior thighs. No benefitYfrom TORADOL 1/17/2009
30 mg1/24/2009
IM. Excellent relief with
h 3 weeks after injection. Y ### 1/13/2009
lient called to report 1/15 am experienced
Y tingling sensation R side rib cage area into back. ByU 1/15/09 afternoon
1/13/2009pain 1/15/2009
R mid rib cage into b
se reaction known Y ###
ness, swelling, discomfort @ injection Y site within hours of administration. Symptoms persisted Y despite patient
1/30/2009
treating1/30/2009
with TYLENOL ES, M
after receiving injection patient had localized pain at site, aches, drowsy, muscle soreness especially
U in back
1/20/2009
down to1/20/2009
middle lower back. C/
n usual, cold or pains after vaccine, got sick with Flu and other symptoms, such as weakness, Y fatigue, continual ###coughing,### mucus constant
ng of the vaccines child started limping.
Y Right leg from groin to knee swollen with redness and Y warmth present.
1/28/2009 Right1/28/2009
thigh left above knee
swelling and redness to injection site that occurred within minutes to hours of administrationUper mother.1/13/2009 On exam 2 days later, site w/swe
veloped redness & swelling at injectionY site- 6.5 X 10 cm. Y 1/15/2009 1/21/2009
& swelling @ injection site in the evening post receiving imms. It now extends to entire upper Y arm- Instruction
1/20/2009on cool
1/20/2009
compress, BENADR
3/3/09-records received-brief syncopal episode after immunizations, resolved without treatment. Y Seen on1/16/2009
1/19/09 for1/16/2009
PPD reading.
Y 1/21/2009 1/21/2009
veloped itchy rash minutes after imms Y have given (DTaP + IPV) Y 1/9/2009 1/9/2009
screamed. 5 1/2 hrs. after vaccines Y cried hard, turned head & started jerking his head 5 seconds Y - foggy look
2/9/2009
on face2/9/2009
- no further episodes
mial shingles left side T 3-6. Tx - Zovirax
Y 200 mg/5 mL 3/4 tsp three times a day x 1 week. U 9/11/2007 1/18/2008
atigue chills fever - flu- like symptoms Y
x 3 nights (night only) (highest 104.5) slight rash all over body, not much appetite, no breathing Y difficulty1/26/2009 2/2/2009
high fever, irritable beginning 2nd day Y after vaccine Temp up to 104 at home per mom. 102.1Yat office 1/10, 1/6/2009
102.3 1/12 1/8/2009
at office use of TYLE
fter the immunization was administered, the patient developed a 7.5 cm x 5 cm area of cellulitis. U He was started
2/5/2009 on antibiotics
2/6/2009 (KEFLEX) af
as diagnosed with rotavirus after receiving
Y vaccination series. Y 9/8/2008 ###
ours after immunization, had leg swelling and hives at (R) thigh at site of Hib vaccine associated Y with prolonged
1/9/2009 crying.
1/9/2009
Y U 2/5/2009 2/6/2009
e " temp 2/9/09 in PM. 2/10/09 no temp today but (Rt) leg where PCV given is little swollen. U Red hardened 2/9/2009
area size 2/9/2009
of dime. No excess cr
comfort in (L) arm - 2/6/09 redness and swelling (L) arm N 1/30/2009 2/4/2009
lled 24 hours after immunization, stating injection site the size of a dime & was red & raised.UI told patient 2/7/2009
to take 2 BENADRYL
2/8/2009 & I would c
tchy leaky rash on left side chest and shoulder. Soreness and shooting "pings" of pain. AchyNshoulder and 8/28/2008
neck. Hydrocodone
1/17/2009 for pain.
nd influenza vaccine on 2/9/08-started with vomiting, high fever approx. 2 hours after vaccineY 2/9/2009 2/9/2009
redness and itching around the injection site after DTAP given symptoms began 24 hours after U vaccine given.
2/4/2009No medications
2/5/2009 or treatment
dache, fatigue, general full body aches and joint pain + felt "warm" with 24 hr of vax. Improvement Y within2/5/2009
48 hr but @ 2/6/2009
72 hr - all sx returned
mperature of 100.0 degrees blurred vision lasting three days. Only lights out lying in bed gaveYme relief. 2/4/2009 2/5/2009
arms, legs, hands, &* feet. Looks likeY little blisters. Symptomatically treated with ANTHRAX, CLARITIN,Y & 1/4/2009
MOTRIN Vesiculopapular
1/20/2009 lesions
s stated within 24 hrs. of the injection. Symptoms include fatigue, weakness in right arm, mildYfever, swollen 2/3/2009
lymph nodes2/4/2009
involving the right
asal congestion & pressure, headaches, muscle & joint aches, dizziness, nausea & light headedness Y for 10 days.###Took TYLENOL### & SUDA
U 2/6/2008
shortly after the injection (about 0 minute) my head started to whirl - got lightheaded - felt like Y I was going2/3/2009
to pass out. 2/3/2009
Also it increased the
njection site, raised, red, hot, multiple. ORAPRED given and BENADRYL cream. U 2/11/2009 2/11/2009
area, slightly raised, firm, not, itchy. Center of area appears to have vesicles 2/9/2009
n radiating to the neck. Pt. can barely Y lift arm. U 2/9/2009 2/9/2009
er vaccination c/o being light headed, dizzy, feeling like she was going to pass out. Slept 2-3 Y hours, R arm
8/14/2008
hurt, did8/14/2008
not seek medical atten
problems -mucus spitting day nightY- choke on it about to lose breath mucus worse, eye dry Nskin keep peeling 5/11/2007off. Weezing, arm hurt come
, increased blood pressure-racing pulse,Y nauseous, bronchial spasms, difficulty breathing and Y speaking- Taken### to ER given ###BENADRYL an
INRIX + TDAP given 9:35 - passedYout in lobby - unconscious 10 min sustained 1-1 1/2 inchY laceration to 2/10/2009
back of head2/10/2009
in fall
pt rec'd HPV-4. On 1/12/09 when nurse in contact with pt again. Pt reports injection site tingling N for 2 weeks 8/5/2008
then site8/19/2008
went numb approx 2"
umbness going down L arm with injection Y (in left arm). Numbness, tingling severe within 15 Y min-Startes within
2/4/20093 hours2/4/2009
numbness @ L foot
ately 24 hours after vaccines had episode Y of eye rolling, shaking and possible apnea lasting Y 2-3 min. No fevers.### Evaluated### in ER. Of interes
ped symptoms of chickenpox after having received 2 doses of VARIVAX Y 10/4/2007 1/26/2009
she felt faint, nauseated, sweaty at work.Y Felt "throat tightening, difficulty breathing & only able
Y to speak 12/5/2009
or 2 words2/5/2009
at a time". She said
eloped varicella on 2/4/2009 - had Rec'd 2 doses of VARIVAX on 2/9/99 and 2/12/08 U 2/12/2008 2/4/2009
R 1/28 - Next AM, thigh visibly raised, pink, well defined, non, tender 21/2 X 3 cm area. No fever. Y 2/2/09 Swelling
1/28/2009gone, looks like a bruise.
er DTaP and VARIVAX in R shoulder, 7x7 cm bright red area, with heat, 2x2 induration where Y DTaP given; 2/2/2009
No fever.2/4/2009
4 days later, less red
ated she has had pain in her left shoulder and in her left lower arm since receiving the flu vaccine U 2/5/09. No
2/5/2009
redness,2/6/2009
swelling or induration
swelled within hrs of receiving MMRY(SQ) and DTaP (IM) on 09Feb09. No erythema. Swelling U approx 1 in 2/9/2009
greater than 2/9/2009
R leg. Non-painful b
d blurry vision within 24 hrs of above vaccinations seen by optho- optic neuritis, MRI was negative for mass, 1/21/2009
treated1/22/2009
with oral steroids. Was
n itching in area of vaccine admin. right after injection. Later that day swelling began. On 01-30-09- Y day after
1/29/2009
injection,
1/29/2009
outside of arm is red
munization 2-3-09 and was fine withYinjection. On 2-4-09 mom states Pt had 101 degrees temp Y and pt leg2/3/2009
had swollen 2/4/2009
up the size of baseb
rs of receiving MMR/VZV/ Hep A vaccine fever to 103 degrees persisting x 5 days. No local Y reaction. 1/26/2009 1/26/2009
DTaP at 2:30 pm. Per call to On callY doctor at 10:30 pm - vomited several times since 12 with Y possible mild
1/21/2009
temp. Asked
1/21/2009
to eat but not kee
generally hot feeling well last night. Erythema 50cm sized. Afebrile. Took BENADRYL + IBUPROFEN. U 1/28/2009 1/29/2009
RIVAX immunization on 6-23-99 now Y has chickenpox Y 6/23/1999 1/19/2009
cal reaction with 15 cm area, painful swelling. Treated with antibiotics for possible Cellulitis. No Y fever. Improved rapidly. Also had superficial
child had redness and area felt hot to the touch (around injection site/shoulder area) Advised Y to use cool1/27/2009
compresse 1/29/2009
- give TYLENOL for c
st thigh with mild erythema, taut with some mild dimpling swelling (med). 3 puncture sites visible Y in 3-4 cm 1/13/2009
diameter area.
1/14/2009
atous rash cheek & peri orbital tissue, pruritic both wrists Y 1/23/2009 1/28/2009
m nap this p.m. screaming for 2 hours was noted to have erythema and swelling of left leg. Erythema Y & swelling
2/6/2009 has 2/6/2009
subsided at office visit
at site, size of apple swelling at site fever at site Ice applied to site, APAP administered PO
oped varicella rash on trunk and extremeties 13 days post varicella vaccination. N 1/19/2009 2/4/2009
arter size area left ECU tender areaYwith left wrist deviation & painful motion. Occurred nightUafter taking1/26/2009
2nd dose of 1/26/2009
oral TYPHOID. Had r
tion was received at 10:45 AM. When Y pt. arrived home 11:30-11:45 AM she felt a little strange
Y but thought 2/9/2009
it was due2/9/2009
to not eating. Then a
er vaccine developed fever & rash on Y back. 2/3/2009 2/5/2009
/swollen Rt injection site slightly redY U 2/9/2009 2/9/2009
came nauseous, lightheaded, and had momentary syncopal episode. Pt. was hypotensive @ Y 80/40 but2/11/2009
BP rebounded 2/11/2009
after pt. was laid on
hrs had pain, swelling, low grade feverY (99 degrees) and rash. Rash was 8X12 cm U 1/27/2009 1/28/2009
body aches, headache, fever, chills Y x 7d. Sl. ST decreased appetite positive weight loss 9 pounds
Y in 8 days.
2/3/2009 2/4/2009
little light headed and sick to her stomach. Did not vomit. Recovered quickly. Y 1/9/2009 1/9/2009
IVAX. That night after shower, she had a generalized blotchy rash all over body not hives. 1/27 Y rash gone, 1/26/2009
developed 1/26/2009
swollen tender ill defi
/o reaction to Varicella vaccine. Rash Y on Left arm and Back c/o itching. (1/19/09) Pt. given Rx
Y for Prednisone1/5/2009
50 mg1/19/2009
x 1 for 7 days.
bq VARIVAX given Rt lower thigh. Parents notified stuff about 5 minutes after with large reddenedY area to 2/2/2009
Rt thigh Dr2/2/2009
notified and seen pati
e fever - 2 hrs after shots given- no longer running one Rt. leg- swollen & red 1/27/2009 1/27/2009
Y 1/22/2009
0:00 AM - Fri morning - Had severalYblisters @ site of Vaccine on Lt arm - Midday Fri - Lt armYbecame tight 1/29/2009
and swollen
1/30/2009
by 7:30 pm Lips and
ed his vaccines and when he woke up Y noticed a lump on his (R) thigh. When seen in office, the
Y lump appeared
1/13/2009red, 1/14/2009
itchy, and slightly larger
ation site with vesicular lesions and circular erythematous tender and generalized erythematous N papular 1/26/2009
trunk, extremities.
1/26/2009
n has been received from a registered Y nurse, concerning a 9 weeks old male patient, with a U history of gastroesophageal
### reflux
### disease and
n has been received from a Nurse Practitioner concerning an "about 2 month old" patient who Y in December 12/1/2008
2008, was
12/1/2008
vaccinated with the
n has been received from a registered nurse (R.N.) concerning a patient who was vaccinated U with a first and second dose of ROTATEQ (lo
n has been received from a nurse concerning a 23 month old female patient who was vaccinated U orally with the three series of ROTATEQ
n has been received from a registered Y nurse concerning her 17 week old grandson with no pertinent
Y medical history
### who on ###07-OCT-2008
n has been received from a physician concerning a 2 year old patient who on 08-JAN-2009 U was vaccinated 1/8/2009
oral with1/8/2009
his first dose of ROTA
n has been received from a registered Y nurse concerning her granddaughter who on 29-DEC-2008 Y was vaccinated### orally
1/2/2009
with 2 ml of the fir
n has been received from a physician concerning a patient who was vaccinated with a dose Uof ROTATEQ. The physician stated that she h
n has been received from a registered nurse concerning a female patient with gastrooesophageal Y reflux1/19/2009
who on 19-JAN-2009
1/19/2009 was vaccina
n has been received form a registered nurse concerning an approximately 16 week (4 month) Y male with 1/19/2009
a history of1/19/2009
gastroesophageal reflu
n has been received from a physician concerning a 16 week old patient who on 09-JAN-2009 U was vaccinated1/9/2009
with the 1/9/2009
first dose of ROTAT
n has been received from a physician concerning a patient who was vaccinated with a dose Uof ROTATEQ. The physician stated that she h
n has been received from a registered Y nurse concerning a 62 day old female patient with noUpertinent medical
1/26/2009history
1/26/2009
and no known drug a
n has been received from a community pediatrician concerning a 32 weeks patient who wasUvaccinated with ROTATEQ (lot # not reported)
n has been received from a physician concerning a patient who on 28-JAN-2009 was vaccinated U orally with
1/28/2009
a dose 1/28/2009
of ROTATEQ (lot numb
n has been received from a physician Y concerning a teenager patient who was vaccinated with U three doses of GARDASIL on unspecified da
n has been received from a nurse practitioner concerning 2 patients at the practice who were U vaccinated with a dose of GARDASIL on uns
n has been received from a physician Y concerning a teenager patient who was vaccinated with U three doses of GARDASIL on unspecified da
n hs been received from a registered nurse concerning a female with sulfanomide allergy who U was vaccinated with a dose of GARDASIL o
n has been received from a receptionist in a physician's office concerning her daughter whoUon 28-JAN-2009 1/28/2009
was vaccinated
1/28/2009 with the fourt
n has been received from a nurse practitioner and the mother concerning a 16 year old female Y with no medical
1/28/2009 history
1/28/2009
and drug allergies w
n has been received from an office Y staff member concerning a female patient who in approximately
U January
1/1/2009
2009 was 1/1/2009
vaccinated with the
n has been received from a physician Y concerning an 11 year old female patient who in July 2008
U "6 months 7/1/2008
ago" was7/1/2008
vaccinated with the f
n has been received from a physician concerning an 11 year old female patient with asthmaNwho on 25-NOV-2008 ### was vaccinated
### intramu
n has been received from a medical assistant concerning 3 female patients who fainted afterYreceiving the first dose of GARDASIL. Medica
Y concerning a female patient who on an unspecified
N date received
9/1/2008 the11/1/2008
first dose of GARDASI
n has been received from a physician concerning a female who on an unspecified date was U vaccinated with a dose of GARDASIL and her
n has been received from a physician concerning a patient who was vaccinated with a dose Uof GARDASIL (Lot # not reported). After patie
n has been received from a registered nurse concerning a 26 year old female with polycysticNovarian syndrome, 1/27/2009 a history
1/27/2009 of thoracic sympa
n has been received from a physician concerning a 15 year old patient who on 13-MAY-2008 Y was vaccinated
7/14/2008
with first
7/14/2008
dose of GARDASIL
n has been received from a physician concerning an 18 year old female with no medical history Y who on 30-DEC-2008 ### 1/4/2009was vaccinated with
n has been received from a physician concerning an unknown number of patients who wereUvaccinated with a dose of GARDASIL and exp
n has been received from a Certified Y Medical Assistant concerning a 21 year old female withYa history of dysmenorrhea
2/8/2008 and pelvic pain as
n has been received from a physician concerning an approximately 14 year old female who Y was vaccinated 1/1/2009
with the 1/1/2009
first 0.5 ml dose of GA
n has been received from a physician concerning a female who on an unspecified date was U vaccinated with a dose of GARDASIL (lot num
Y concerning a 15 year old female patient who inN November5/24/2007
2006, was10/1/2008
vaccinated with GARD
n has been received from Merck Pregnancy
Y Registry for GARDASIL vaccine from a Nurse practitioner
U concerning
12/8/2008 an 12/8/2008
18 year old female wi
Y concerning a 16 year old female patient who on 25-MAR-2008
Y was5/27/2008
with first dose of GAR
n has been received from a physician concerning a 22 year old female who on 23-Jan-2009Uwas vaccinated 1/23/2009
in arm 1/24/2009
with the second dose o
n has been received from a 22 yearYold female patient with yeast hypersensitivity, no drug/reactions
N allergies
1/23/2009
who on 1/23/2008
23-JAN-2009 was va
n has been received from a physician concerning a 17 year old female with drug hypersensitivity
N and allergic reaction to AMOXICILLIN and
Y concerning a 23 year old female patient with no
N pertinent medical ###
history and no known drug
Y nurse concerning a 28 year old female patient with asthma,
N allergies an allergies to penicillin, CECL
n has been received from a RN concerning a 16 year old female who was vaccinated with her U first dose of GARDASIL on an unspecified d
Y nurse concerning an 18 year old female student with N a slight temperature
1/9/2009 at the
1/9/2009
time of vaccination (
n has been received from a respiratory
Y therapist concerning a 11 year old female patient with U no pertinent1/26/2009
medical history
1/26/2009 and no known dr
Y concerning a 48 year old female licensed nurse practitioner
N with sulfanomide 1/26/2009
allergy who was admin
n has been received from a nurse concerning a 26 year old female who was vaccinated withUa first dose of GARDASIL, lot number not repo
Y assistant concerning a female patient who "experienced Y a severe headache after her first dose of GA
Y concerning a 14 year old female patient with attentionNdeficit disorder
10/1/2008
and depression
10/1/2008 who on 24-JUN
Y nurse concerning an 18 year old female patient who on Y 05-APR-2007 9/4/2008
was vaccinated
Y nurse concerning a 15 year old female patient with noYpertinent medical
6/25/2008 history
6/26/2008
and no known drug a
n has been received from nurse practitioner
Y concerning a "high school age" female patient who
Y on unspecified date was vaccinated with tw
n has been received from a consumer concerning her daughter who on 18-Apr-2008 was vaccinatedN with
4/18/2008
the first 0.5ml
7/16/2008dose of GARDASIL
n has been received from a nurse practitioner concerning an 18 year old female patient whoNon 26-NOV-2008 ### was vaccinated ### intramuscula
n has been received from a consumer concerning her 14 year old female daughter who on 16-OCT-2008
N was ###vaccinated ### with the first dose
Y concerning a 16 year old female patient who on unspecified
Y dates was vaccinated with the first dose
n has been received from a physician.
Y The physician reported that "she heard from a friendUthat the female patient, who was not the physi
n has been received from a Registered
Y Nurse concerning a 14 year old female patient with Flu N vaccine allergy
1/23/2009 and 1/23/2009
gastroesophageal reflux
n has been received from a clerk inYa physician's office concerning her 19 year old daughterYwho in approximately
6/1/2008 June 6/1/2008
2008 "Summer 200
Y a 23 year old female patient who on unspecified
U dates was 1/22/2009
with the first and the s
Y concerning a female patient who on unspecified date Y was vaccinated with her second dose of GARD
n has been received from a office manager
Y concerning a 19 year old female patient with no Yknown drug 1/16/2008
allergies/drug 6/2/2008
reactions who on 16
Y nurse concerning her 18 year old daughter who on 27-OCT-2006
Y was vaccinated
### with the first dose
Y concerning a 13 year old female patient with a historyYof passing out 1/23/2009
every time1/23/2009
she received an injec
n has been received from a nurse at physician's office concerning a female patient who on 31-DEC-2008,
U was###vaccinated
1/14/2009 with the third dos
n has been received from a physician who on 01-DEC-2008 was vaccinated with a dose of GARDASIL
U vaccine.
12/1/2008 The patient had an abnorm
Y concerning his 12 year old daughter with no known medical
N history1/22/2009
and drug 1/22/2009
allergies, who on 22-JA
Y a 13 year old female with no drug reactions orYallergies who7/23/2008
on 23-JUL-2008
n has been received from a consumer concerning his 15 year old daughter with acne, no known N allergies 1/20/2009
and no pertinent
1/21/2009 medical history,
Y an 18 year old female patient who on 16-JAN-2009
Y was vaccinated
1/16/2009 intramuscularly
1/16/2009 with the f
n has been received from a consumerY concerning her 14 year old female daughter with no pertinent
N medical history, 7/1/2008
no drug reactions/alle
Y concerning a female patient who on 15-AUG-2008 was Y vaccinated8/15/2008
with the first
8/15/2008
0.5 mL dose of GAR
n has been received from a physician concerning a 16 year old female patient who was vaccinated
Y IM with the first dose of GARDASIL (lot
n has been received from a nurse practitioner concerning a 20 year old female with no known Y drug reaction/allergies
1/12/2009 1/12/2009
and a history of exerc
n has been received from a physician concerning a patient who on 20-JAN-2009 was vaccinated U with third
1/20/2009
dose of GARDASIL
1/20/2009 (Lot # not re
Y a 18 year old female patient who was vaccinated
U with first dose of GARDASIL (Lot # not repo
U with two doses GARDASIL. Subsequen
n has been received from a Nurse Practitioner
Y concerning a female who was vaccinated withU a first dose of GARDASIL vaccine, and devel
Y concerning a 17 year old female patient who on 27-JUN-2008
N was vaccinated
### with first dose of GAR
n has been received from a practiceYmanager concerning a 21 year old female with no pertinentN medical1/20/2009
history, drug 1/20/2009
reactions or allergies
n has been received from an office Y
manager (also reported as an emergency medical technician N concerning a ### 23 year old### female patient w
Y nurse concerning a 12 year old female patient who onU11-OCT-2008 1/19/2009
was vaccinated
1/19/2009 with the first do
Y concerning a 14 year old female who "sometime Y this month" 1/1/2009
was vaccinated
n has been received from a physician concerning several females who on unknown date were U vaccinated with GARDASIL vaccine. On uns
n has been received from physician concerning a 14 year old female who was vaccinated the U first dose of with GARDASIL on an unspecifie
n has been received from a nurse practitioner concerning a 22 year old female who on 03-DEC-2008
U was12/3/2008
n has been received from a registered nurse concerning a 19 year old female who on 12-MAY-2008
Y was vaccinated
### intramuscularly
### in the
n has been received from a pharmacist
Y concerning her 9 year old daughter who in August 2008, N was vaccinated
10/1/2008with 10/1/2008
a first dose of GARDA
n has been received from a nurse concerning a 25 year old female with no drug allergy whoYon 09-JAN-2009 1/9/2009
was vaccinated
1/9/2009 with the first d
n has been received from a nurse practitioner concerning a female who was vaccinated withNthe first dose of GARDASIL. 1/1/2008"Few months ago
n has been received from a physician concerning a female who on was vaccinated in the deltoidY with the1/19/2009
first and second
1/19/2009dose of GARDAS
n has been received from a healthcare worker concerning a 14 year old female with penicillin Y allergy and1/16/2009
drug hypersensitivity
1/16/2009 of DARVOC
n has been received from a physician concerning a female with eczema who about 1 year ago, N was vaccinated1/1/2008with the
1/1/2008
first dose of GARD
n has been received from a registered pharmacist concerning three female patients who on Y unknown dates were vaccinated with GARDAS
n has been received from a consumerY concerning her 18 year old daughter with asthma whoNin the summer 4/15/2008
of 2008,9/1/2008
was vaccinated with t
n has been received from a consumerY concerning her approximately 20 year old daughter with N no pertinent11/1/2008
medical11/1/2008
history, who in Novem
n has been received from a consumer for the pregnancy registry of GARDASIL vaccine concerningU his fiancee
6/1/2008who has has two doses of G
n has been received from a medical assistant and a registered nurse concerning a 15 monthYold patient who vaccinated with a dose of GAR
n has been received from a medicalYassistant concerning a female patient who on 14-JAN-2009 N was vaccinated
1/14/2009 subcutaneously
1/24/2009 with the th
n has been received from a patient's mother concerning her 12 year old daughter with no pertinent
N medical1/3/2009
history and1/3/2009
no known drug aller
Y concerning a 13 year old female patient who onY 15-JAN-2009 1/15/2009
was vaccinated
1/15/2009intramuscularl
Y concerning a 20 year old female patient with AZITHROMYCIN
N allergy
### and a history of seizur
n has been received from a Nurse Practitioner concerning a female patient who completed GARDASIL
U vaccine (lot # not provided) series.
n has been received from a doctor of pharmacy who spoke with a nurse in her facility and stated
U that on an unspecified date another patien
n has bee received from a 19 year old female patient for GARDASIL, concerning herself withNno pertinent 10/1/2008
medical history ### and no known dr
n has been received from physician concerning a female patient who was vaccinated with a Y0.5 ml dose of GARDASIL vaccine. The patien
n has been received from a physician concerning a 16 year old female who on 15-JAN-2009Nwas vaccinated 1/15/2009
with a1/15/2009
0.5 ml dose of GARDA
n has been received from a 19 year old female with no drug allergy who in January 2008 was N vaccinated 1/1/2008
with the first
1/15/2009
dose of GARDASIL.
n has been received from a physician concerning a female who was vaccinated with a third U dose of GARDASIL vaccine and experienced p
n has been received from a registered nurse concerning a 20 year old female who on 09-OCT-2008
U was10/9/2008
vaccinated with the ###first 0.5 ml do
n has been received from a nurse concerning a 19 year old female patient for the pregnancyUregistry for GARDASIL.
2/3/2008 6/27/2008
With allergy to BENAD
n has been received from a doctor of pharmacy concerning her daughter who in October 2007 N was vaccinated
10/1/2007 with10/1/2007
the first dose of GARDA
Y and her assistant concerning 23 year old female whoYon an unknown date was vaccinated ### with a firs
Y concerning a 22 year old female virgin patient with no pertinent ###medical
12/1/2008
history no drug reac
n has been received from a registered nurse concerning a female, who was vaccinated withUthe second dose of GARDASIL, IM in upper de
Y concerning a 16 year old female patient with penicillin
Y allergy,
1/14/2009
who on1/15/2009
14-JAN-2009 was vac
n has been received from a consumer concerning her 15 year old female daughter with no pertinent
Y medical
8/26/2008
history8/26/2008
and no drug reactions/
n has been received from a nurse concerning "almost every single patient" (approximately 237)U who was vaccinated with GARDASIL. Sub
n has been received from a medical assistant concerning a 17 year old female with no pertinent
N medical history
1/8/2009 who1/12/2009
on 30-OCT-2008 was
n has been received from a nurse practitioner concerning a female who was vaccinated withUa dose of GARDASIL (lot # not reported). Sub
n has been received from a Certified Medical Assistant concerning an approximately 14-year-old
Y female12/1/2008
with no known 12/1/2008
drug allergies who
n has been received from a nurse practitioner concerning her daughter who in October 2008, was vaccinated 10/1/2008
the first
10/1/2008
dose of GARDASIL.
n has been received from a physician concerning a 15 year old female who was vaccinated U with a 0.5ml dose of GARDASIL (lot number no
Y nurse concerning her 26 year old daughter who on 13-JAN-2000
Y 1/13/2009
was vaccinated1/13/2009
with a second dose
n has been received from a nurse concerning a 14 year old female student patient who on 12-JAN-2009
U 1/12/2009
with the third dose
Y nurse concerning a 17 year old female patient with CODEINE
Y allergy
8/26/2008
who on8/26/2008
19-JUN-2008 was vac
Y concerning a female patient who was vaccinated with Ya dose of GARDASIL 1/5/2009 (Lot1/14/2009
# was not available)
n has been received from a nurse concerning a 25 year old female patient with no known drug Y reactions/allergies
1/7/2009and 1/7/2009
medical history who
n has been received from a female patient, with no known drug reactions/allergies and no pertinent
U medical history, who was vaccinated w
n has been received from a licensedY practical nurse concerning a 19 year old female patientUwith no known 8/20/2008
medical history; who on 20-AU
n has been received from a nurse practitioner concerning a 19 year old female who on 08-Jan-2009
N was 1/8/2009
vaccinated 1/8/2009
Y concerning a female patient who on vaccinated with the U three doses of GARDASIL. Shortly after the
n has been received from a physician concerning a female patient who was vaccinated with Ua dose of GARDASIL
10/1/2008 last fall and said the vac
n has been received from a licensedY practical nurse concerning an 18 year old female patientN with no known
9/15/2008
medical 9/15/2008
history and drugs alle
n has been received from a nurse Concerning a female who was vaccinated with the third dose U of GARDASIL vaccine. The nurse reported
n has been received from a physician concerning a female patient with unspecified psychiatric
U problems12/1/2007
and restless1/1/2009
legs syndrome who in
Y concerning a 25 year year old female patient with
N no pertinent medical history, ###not known dru
n has been received from a physician assistant concerning a 15 or 16 year old female patientU who on unknown dates was vaccinated with
n has been received from a registered nurse concerning her daughter who was vaccinated with U the third dose of GARDASIL. Four days af
n has been received from a physician concerning a female who on unspecified date was vaccinated
U with a first dose of GARDASIL and had
n has been received from a physician concerning a 13 year old female patient, who on unspecified
Y dates, was vaccinated
11/1/2008 with the second
n has been received from a nurse concerning a female who was vaccinated with a first doseUof GARDASIL. The patient called the nurse 4
n has been received from a Nurse concerning
Y a 20 year old female patient with no pertinentYmedical history
1/8/2009
and no drug
1/8/2009reactions or allerg
Y nurse concerning a 23 year old female patient with noYpertinent medical### history and### no known drug a
n has been received from a nurse in the physician's office concerning a 43 year old female who
U was vaccinated with three doses of GARDA
n has been received from a physician's assistant concerning a 15 year old white female, 75.9Y kg and 157cm 1/8/2009
in height,
1/8/2009
who on unspecified
n has been received from a consumer concerning her daughter who was vaccinated with theUthird dose of GARDASIL. 1/1/2009
In January 2009 ("a
n has been received from a physician concerning a 14 year old female who on 01-MAY-2008 N was vaccinated
5/1/2008
with the
5/22/2008
third dose of GARDA
n has been received from a physician's assistant concerning a 13-15 year old female who onY 08-JAN-2009 1/8/2009
was vaccinated
1/8/2009 with the third do
n has been received from a 21 year old female with attention deficit disorder and no medicalUhistory who was vaccinated with ### three doses o
n has been received from a consumer concerning her 17 year old daughter with a history of N drug hypersensitivity
1/5/2009to MYNOCYCLINE
1/7/2009 who o
n has been received from a physician concerning a female who was vaccinated with a first dose
N of GARDASIL 1/8/2009
without any reactions and o
n has been received from a registered nurse concerning a 21 year old patient who on 10-NOV-2008
N was vaccinated
### with a first dose of GA
n has been received from a 19 year old female with no known drug allergies who on 05-JAN-2009
N was vaccinated
1/5/2009 with1/8/2009
the third dose of GA
n has been received from a nurse concerning a 16 year old female with no medical history ofY drug allergy 7/11/2008
who on 11-JUL-2008
7/11/2008 was vaccin
n has been received from a nurse practitioner, for GARDASIL, a Pregnancy Registry product, U concerning7/3/2008
a 17 year12/1/2008
old female who on 03-J
n has been received from a medical assistant concerning her daughter who was vaccinated Uwith the first dose of GARDASIL on an unspec
n has been received from a physician concerning a female patient who was vaccinated with Uthree doses of GARDASIL vaccine (no lot num
n has been received from a nurse practitioner concerning a 15 year female who in May 2008, Y was vaccinated
5/28/2008
with the
6/1/2008
first 0.5ml dose of G
n has been received from a consumer concerning her 15 year old daughter with no medical N history and drug
7/1/2008
allergies,
12/1/2008
who in July 2008 wa
Y concerning an 18 year old female who was vaccinated
Y with9/3/2008
the second9/4/2008
dose of GARDASIL in
n has been received from a nurse practitioner concerning a 17 year old female who on 06-MAY-2008
N was5/6/2008
vaccinated with GARDASIL intra
n has been received from a 45 year old female patient who was vaccinated with two doses of U GARDASIL vaccine (no lot number was prov
n has been received from a registered nurse concerning a 22 year old female who on unspecified
Y dates was vaccinated
### with
###the first and th
n has been received from a medicalYassistant concerning a 13 year old female patient with noY pertinent medical
7/16/2008history
7/16/2008
and with allergic rea
n has been received from a doctor of
Y pharmacist concerning a 17 year old female patient with N no pertinent10/1/2008
medical history and no known d
n has been received from a registered nurse concerning a 10 year old female patient who onY 15-MAY-2008 was ###vaccinated ###with the first do
Y concerning a 14 year old female who on 20-MAY-2008 Y was vaccinated
5/20/2008
with the
5/25/2008
first dose of GARDA
n has been received from a consumer concerning her 19 year old daughter who on 09-APR-2007 U was vaccinated### with
3/12/2008
the first dose of GAR
n has been received from a 24 year old female patient, for GARDASIL vaccine, a PregnancyNRegistry product 9/1/2008
concerning
12/6/2008 herself with no p
Y concerning a 16 year old female with no medical history Y or drug allergy
1/5/2009
who on1/5/2009
05-JAN-2009 was va
n has been received from 2 nurses concerning a 17 year old female with a history of faintingYwho on 30-DEC-2008 ### was vaccinated
### with the
n has been received from a physician assistant concerning an 18 year old female with reactions
Y to vaccines who was vaccinated ### with a dos
n has been received from a 24 year old female medical assistant who in December 2008, was U vaccinated 12/1/2008
with a second dose of GARDASI
n has been received from a physician concerning an 17 year old female who on 02-JAN-2009 Y was vaccinated
1/2/2009
with the
1/2/2009
first dose of GARDA
Y nurse, for the Pregnancy Registry for GARDASIL, concerning
U an 7/16/2007
18 year old female ###
with urinary freq
n has been received from a physician concerning an 11 year old female who in August 2007, Y was vaccinated
8/1/2007
with the8/1/2007
first dose of GARDA
Y nurse, concerning a female patient, who on an unspecified
U date was vaccinated with GARDASIL. Th
Y nurse, concerning a female patient, who on an unspecified
U date was vaccinated with GARDASIL ,0.
n has been received from an educator concerning a 7th to 9th grade female student, who "within
Y the last 1/1/2008
12 months"1/1/2008
was vaccinated intram
Y the last 1/1/2008
12 months"1/1/2008
Y the last 12 months" was vaccinated intram
n has been received from a physician concerning a female with allergy to latex who was vaccinated
U with GARDASIL. Concomitant therapy
n has been received from a 27 year old female patient who on 08-OCT-2008 was vaccinatedY with a first 10/8/2008
dose of GARDASIL, when she was
n has been received from a consumer
Y concerning her 12 year old daughter with no known medical
N history
6/10/2008
and allergies,
6/10/2008who on 10-JUN-20
n has been received from a physician Y concerning a 12 year old female patient who on an unknownY date was vaccinated with the first dose
n has been received from a Registered Nurse concerning a 17 year old female patient with no Y pertinent 8/31/2008
medical history 9/2/2008
and no drug reactio
n has been received from a consumer Y concerning her 21 year old daughter with no previousYmedical history reported ### who###on 06-APR-2007
n has been received from a licensed Y practical nurse for the Pregnancy Registry for GARDASIL, U concerning 10/8/2008
a 26 year old female
### patient wit
n has been received from a consumer Y concerning her 16 year old daughter with no drug reactions
Y or allergies
12/9/2008who on 09-Dec-2008
### was va
n has been received from a registered Y nurse concerning a 16 year old female with no medical U history and allergies### and 0 previous
### pregnan
n has been received from a certified nurse midwife for the Pregnancy Registry for GARDASIL U vaccine, concerning
8/15/2008 a8/15/2008
19 year old female wh
n has been received from a Registered Nurse regarding the Pregnancy registry for HPV concerning Y a 2411/4/2008
year-old female with penicillin and
n has been received from a Registered Nurse, for the Pregnancy Registry for GARDASIL vaccine U concerning a### 24 year
2/26/2008
female with of asth
Y for the pregnancy registry for GARDASIL vaccine
Y concerning 1/28/2008
a 27 year2/11/2008
old female with a his
follow up information has been received from a nurse, for the pregnancy for GARDASIL, concerning Y a black female with one previous preg
n has been received through the Merck Y pregnancy registry from a female consumer, nurse practitioner
Y and
2/22/2008
physician 2/22/2008
concerning female wi
n has been received from Pregnancy Registry for GARDASIL vaccine from a Registered Nurse Y (R.N.) concerning
10/9/2007a10/9/2007
female patient who was
n has been received through the Merck Y pregnancy registry from a physician concerning a 25Yyear old female with ###a history### of tonsillectomy
fter vaccinations, he developed a rash all over body (mostly on face & neck). It was a red, blotchyY rash with
1/26/2009
tiny raised2/4/2009
bumps. Rash laste
rtness of breath. Rx- BENADRYL 25mg Y IV, SOLUMEDROL 125mg IV; MEDROL DOSC Pack, Y BENADRYL PO- ###Symptoms ###resolved.
ceived vaccine 01/19/09 (Monday) and Y report ear ache and cold sores on 01/23/09. Patient treated
Y as such
1/19/2009
but returned
1/23/2009
to MD office and d
ported - symptoms of Brachial neuritis Y - R arm deep ache, weakness, numbness. N 1/20/2009 1/26/2009
e fever, chills, body ache, dizziness lasted 36-48 hours Y 1/29/2009 1/30/2009
was given 1/30/09-same day Patient developed repetitive Head nodding 3-4 episodes per hour N per parents.1/30/2009
Observed 1/30/2009
1 episode in clinic
cm erythematous plaque, hot raised, at injection site, mild pruritis. Pt noted began after injection,
U enlarging
1/22/2009
qd 1/22/2009
zed swelling @ injection site (upper quadrant of left thigh) 14 days post vaccination pain to the U touch, cranky1/8/2009
child. Redness
1/22/2009present 4d. Po
anus shot in my right arm. About 4Ydays later I noticed a lump on my right shoulder. I had an ultrasound + that### showed1/4/2009
3 lumps. I had an
0 min of giving immunizations infant became limp 1 eyes appearing "vacant." No jerking motions/cyanosis
Y 1/21/2009
- 1 Hr 150-O2
1/21/2009100% monitored f
d coldness, stiffness, chills, spasticity occurred 4 hrs after vaccine (flu). Episode lasted 5 minutes.
Y 10/8/2008 10/8/2008
d hives approximately 12hr after PEDIARIX, Hib, PCV7, ROTATEQ. Y 1/13/2009
m fever, hot to touch, pain at injection Y site, shortness of breath, redness and swelling at injection
U site. 1/21/2009 1/21/2009
AP instead of DTAP Y
zure like activity Y Y 1/28/2009 1/29/2009
cines, pt. was nervous, I left the room so pt. could get dressed. MOP said pt. got up to change Y and pt. fell1/28/2009
back. Pt.1/28/2009
was pale. We laid her
ceived vaccines on 1-16-09- Hepatitis Y A, PREVNAR, influenza, and MMR. On 1-24-09 patient started with 1/16/2009
symptoms 1/24/2009
of rash, fever-rash sta
m with erythema, length of deltoid positive
Y warmth, positive swelling given 10 days KEFLEX 250 Y mg every 11/6/2008
12. 11/8/2008
103.5 degree F X 48 degree + MOTRIN/TYLENOL
Y 1/26/2009 1/26/2009
mmatory reaction to right upper arm 2/10/2009 2/12/2009
onset of facial rash & rash @ sites Y of vaccines within minutes post VARIVAX @ 1205- refractionsY was noticed.
1/8/2009 1/10001/8/2009
EPI 0.1 ml given in
ith fever - suspicious CT Y Y 1/20/2009 1/21/2009
rash on (R) side of face and on arm. Last for 3 days. Y 9/4/2008 9/5/2008
TX: BENADRYL TYLENOL Topical treatment of lesions N 12/5/2007 1/19/2009
red vaccine to patient. Patient older than eligible age. Product guidelines say age less than 65 Y yrs old is eligible.
1/9/2009 Client is 65 yrs old.
ort received on 16 January 2009 from a health professional. A 58 year old female, with a history N of hypertension, ###Hypercholesterolemia
### and
s in right thumb that rapidly spread to Y both hands and then into feet. Sense of tongue burning N followed by a sense ### of numbness### about the f
ef near syncopal episode when she got up from exam table, less than 2 minutes after injection. Y Completely 1/27/2009
resolved1/27/2009
in 10 minutes. Did not
2 since midnight. Fever to 102.2 with Y blurred vision short term. Headache. SOB from a few U hours after shot
1/29/2009
until midnight.
1/29/2009 (L) arm sorenes
vaccine given to child less than 6 months of age. Y 1/30/2009
tous, tender to palpitation. Anterior aspect
Y of left arm. Plaque about 4cm in diameter. U 1/28/2009 1/29/2009
ls, nausea, sore at inj site H/A, achy feeling. Y 1/26/2009 1/26/2009
ocal cellulitis (L) deltoid treated with antibiotics. Y 1/7/2009 1/14/2009
ZOSTAVAX 1/27/09. 1/30/09 presented Y to our office arm pain from elbow to arm pit, "feels on
U fire" swollen,
1/27/2009
hard and 1/28/2009
red. Treated with OTC
tenderness, and warmth @ site of injection possible infection --> pt. referred to PCP. U 1/30/2009 1/4/2009
munization red, swollen, tender with patient c/o arm, shoulder and neck pain - 1st local reaction U I've seen1/22/2009
with. 1/22/2009
eiving Tdap pt. had fever, vomiting and body aches for 3 days. Y 1/31/2009 1/31/2009
edema, itchiness @ site of injection, c/o general malaise. 1/28/2009 1/30/2009
- warm area 2 days and gradually subsiding. Y 1/1/2009 1/1/2009
izzy while walking , fainted. Y 1/29/2009 1/29/2009
ded, heart racing, palpitations. Y Y 1/15/2009 1/15/2009
ates the child had diarrhea x 7 days. Y 12/1/2008 12/1/2008
from client states "upper right arm has been hurting since she received the hepatitis A-B vaccine U on 1/12/09".
1/12/2009She 1/12/2009
has applied cold and he
th swelling, induration, warmth and ,mild erythema of left thigh. U 1/27/2009 1/28/2009
ncope within 3 min, fell to floor, hit head.
Y Unresponsive for several minutes. VS were stable.Y Went to ER1/8/2009for eval. Recovered,
1/8/2009 sent home.
n has been received from a consumer concerning his child who on an unspecified date was U vaccinated with a dose of PROQUAD (lot num
n has been received from a physician concerning a patient who on third week of December U 2008 was vaccinated ###with the### first dose of ROT
PM Tongue "thick and hard". Y Difficulty breathing and swallowing. 2/3/09 12 Noon (L) arm sore. Y (L) hand/fingers
2/2/2009 tingling.
2/2/2009
2/3/09 Family calle
ZOSTAVAX - on 9/17/08 in left upper Y deltoid. On 12/19/08, pain in left arm, left neck, left cheek
Y occurred. 9/17/2008
Herpes lesions ### occurred - left no
t on 12/3/08, Flu vaccine 11/17. 3/19/09Y MR received from PCP which include neuro consults. N Pt seen 11/17/08 ###for12/3/2008
URI sx. Flu vax given.
veloped sore right arm the day she received the vaccine. Bothers her most at night rolling over U in bed. Difficult
2/9/2009to put2/9/2009
deodorant on. No feve
ed ZOSTAVAX on 01/06/2009. She developed an itchy painful rash on her neck and on itchyUsensitive area 1/6/2009
right scapula
2/1/2009
and under her righ
ped urticaria (Hives) within 24 hoursYof receiving vaccine (HEP B) U 2/12/2009 2/13/2009
@ approx 2 pm, slept for 6 hours (unusual) waking once to nurse and cry @ 6 pm and then back Y to sleep until
2/5/2009
8 pm. Upon
2/5/2009
waking went very
as given Hepatitis A and VARIVAX; Y within minutes was syncopal and had tonic-clonic seizureY while still in2/16/2009
exam room. 2/16/2009
Pulse 70, B/P 104/62
ng 4 y/o shots, 1 day post getting them Y arm (right arm) blister, red, sore. Fussy all day 2 days U post shots2/11/2009
with red lacy2/12/2009
rash, clammy, pale,
area of vaccine MIN local reaction of Y about 1 inch around VACC site-has pooling reaction area Y under the2/10/2009
vaccine site 2/17/2009
of redness about 6 in
ed Vaccinia characterized by headache nausea and generalized erythematous papules sparing face and 2/8/2009 neck 2/19/2009
s been running a fever up to 104, dizziness,
Y shakes, muscle ache, headache, weakness, coughing,
N flush
2/16/2009
and loss of 2/17/2009
energy. These sympto
headaches, frequent illness Y includingY viral spinalY menengitis, numbness
9 and tingling in different
U areas of the body. ###First
1/15/2009
shot 10/31/08, seco
veloped temperature of 102F and headache on 2-18-2009 around 1:45pm. Parent reported U symptoms to2/17/2009
clinic at approximately
2/18/2009 4:30pm an
17 started to get a papular rash on both feet hands and arms with itching. Took over the counter Y Benadryl 2/11/2009
1 tablet February
2/17/2009 18 2009. The r
om pt: sx's began 2-17-09 PM - painYL side only (arm, shoulder, breast). She went to work 2-18 Y and left early
2/17/2009
d/t sx's.
2/17/2009
Co-workers commente
02.5 one hour after the DTaP1/Hib/IVP Y shot administered. Also signs of severe distress, screaming
U and5/9/2001
crying. He5/9/2001
continually grasped m
( 2/12/09) he was shivering, temp taken, was 94 degrees. At 2 am,his temp was 103. He had Y an uneasy2/12/2009
stomach for 2/12/2009
a few days. Nausea b
s before Thanksgiving, mother
Y saysYpatient had Y cold symptoms, coughing
4 and nasal congestion.
N The week of ### Thanksgiving, ###Nov. 24, 2008
headache, right earache, left arm pain (same side as vaccination), vomiting x 1. Y 2/10/2009 2/11/2009
st his hair- all of it over the course of 3 months and became completly bald. He has not had any N new growth.3/30/2007 4/30/2007
ain - stiff after receiving vaccination that has continued to be bothersome U 8/25/2008 8/26/2008
-Pt received Fluzone MDV 0.5ml, and should have received Fluzone 0.25ml. 1/29/2009
- Pt received Tdap instead of Dtap 1/30/2009
- Pt received Fluzone MDV 0.5ml instead of 0.25ml. 1/29/2009
lled and questioned soreness of vaccinated arm. Patient stated that it was warm to the touch U and approximately
2/16/20092" in diameter. It was also
swollen and tender and hard after recieving DTaP but should of recieved dT booster insteadY 2/17/2009 2/18/2009
ticed onset of partial seizure like activity the night after vaccines were administered. Episodes U of shaking2/16/2009
the head and 2/16/2009
shaking one arm wi
ay after receiving vaccines, lethargic, eyes droopy, woke up 2x only to feed for 8-10 min each U time 2/18/2009 2/18/2009
ed the following information from a nurse via the Y agency on 05 FEB 132009: A 68-year-old woman,
Y born on 26 APR ### 1940, was ###vaccinated wi
was reported by a lawyer and described the occurrenceY of arm pain0in a female subject of unspecified
N age5/8/2000
U of vaccine
4/10/2008exposure
4/10/2008
during pregnancy
U of pregnancy
4/10/2008in4/10/2008
abdomen and spread to back with itching, Y stinging and pain. Pain constant treated with VALTREX
U 1g tid 10/9/2008
x 7 days and2/2/2009
NEUROTIN 500mg b
2/12/2009
and swelling at site, Dorsal portion of Left arm in subcutaneous area. 4 cm round. Y 2/17/2009 2/18/2009
r all over body 10 days after immunization pt examined 2/9/09 rash resolved Y 1/26/2009 2/4/2009
ve like. Swollen Rt leg - redness. Y Y 2/17/2009 2/18/2009
chicken pox disease on 2-19-09 9/22/2003 2/19/2009
veloped #3 1-2 mm papules red on right thigh 1 week after shots Y 1/29/2009 2/5/2009
ed. 7/7/09 Medical records received Y DOS 12/26/07 to 6/23/09. Assessment: Rash Patient presented
Y with1/8/2009
erythematous
1/14/2009
maculopapular ras
9 donor reported a rash she developed following a Hep B injection she received on 2-17-09.YRash on 2-18-09 2/17/2009
stretched
2/17/2009
across abdomen a
r reported by parent to be 105.6 degrees Y F. Office temperature within normal limits 97.2 degrees
Y F without 2/11/2009
other symptoms.
2/11/2009 Lab work comp
rythematous vesiculopapular eruptions Y over arms, hands, legs, heels, chest, upper back, upper trunk, onset 1/15/2009
17 days 2/1/2009
following receipt of SP
ve 1 dose of MENACTRA that had expired 2 days before no problems. U 2/4/2009
t 2008 his mother brought him to immunizationsYto receive his 6 month 10 old shots and Synagis. Y Mom reported the ###child was### cranky having a
d bilateral red eyes, itching, pain similar
Y to 4/29/05 eye infection 2 hours after receiving both IM Y influenza10/1/2005
10/2005 and 10/1/2005
FLUMIST 10/2006. P
3 AVA vaccinations in 2007 and continuedY to experience cough, fatigue, myalgia, arthralgia, dizziness,and
2/28/2007
short term memory problems.
n has been received from a physician Y concerningY a 32 year old male 0 patient with Wilson's disease
U and decreased immunoglobulin levels w
n has been received from a female who on an unspecified date was vaccinated with the firstYdose of MMR II and "had a reaction like stop b
n has been received from a physician Y concerning a female who on an unspecified date was Yintramuscularly vaccinated with the second dos
2/19/2009 N 2/18/2009 2/19/2009
- entire body - breathing on her own,Y difficulty swallowing,
Y weakness3arm
Y and legs at 2200 thenU progressed 2/5/2009
this AM. 2/5/2009
2/27/09-records receiv
o hospital 2/6/9 for intussusception. 3/9/09 Received
Y hospital medical
2 records of 2/6-2/7/2009.
Y FINAL DX: Ileocecal
### 2/6/2009
intussusception Recor
Feb. 5, 2009 fever 102- C was the highestY the fever and slight rash on face, no energy, red eyes
Y not eating.
1/27/2009
Fr. Feb 6,
2/5/2009
2009 fever and rash
ic rash encircling entire base of neck developed 48 hours after ZOSTAVAX administered without Y rash at injection site of R deltoid. Develop
lls, muscle aches. Y Y 2/19/2009 2/19/2009
& warmth of left thigh where KINRIXYwas administered on 2/17/09 U 2/17/2009 2/18/2009
nner thighs and lower back positive pruritis. U 2/17/2009 2/19/2009
tight chest, hives, and difficulty breathing that lasted for three hours. Y 9/20/2008 9/20/2008
d, extremely cold chills, dizziness (these conditions lasted four days). Y
in today for yellow fever and Hep AYvaccine for travel to Peru. Vaccine was given (yellow fever) Y SQ in left2/16/2009
arm and Hep2/16/2009
A IM in R deltoid at
d FLUMIST on 10-8-08, but still tested Y positive for influenza B on 2-4-09. Y 10/8/2008 2/4/2009
d FLUMIST on 10-9-08, but still tested Y positive for influenza A on 1-31-09. Y 10/9/2008 1/31/2009
d FLUMIST on 10-8-08, but still tested Y positive for influenza A on 2-2-09. Y 10/8/2008 2/2/2009
ceived FLUMIST on 10-9-08, but still Y tested positive for A and B influenza on 12-7-08. Y 10/9/2008 12/7/2008
ot in Oct - (first shot ever for flu). By next am lips were swollen and remained for the day. ByYevening lips started ###getting dry ###and chapped a
nconsolable crying, poor feeding Y 2/3/2009 2/3/2009
oid has 2cm annular red induration - Pt c/o nausea, vomiting, & fever of 101.4 F 2 days afterYinjection was2/5/2009 given. States
2/7/2009
she has never had
cry after PENTACEL vaccine Y 2/13/2009 2/13/2009
after Vaccine given patient called with Y an intense PRURITIC Response - patient returned toYoffice for DEPO 2/9/2009
MEDROC 2/9/2009
Injection.
n MMR & DTAP into left deltoid & VARICELLA & IPV in right PT got 10 X 10 area of erythema N on left deltoid
2/11/2009
& a headache
2/12/2009
lled the pharmacy with concern about Y red area excessive swelling and redness at the injection Y site (size2/11/2009
of a grapefruit).
2/12/2009Patient was conce
the shingles vaccine 7-07 and developed shingles exactly at the injection site and then spread N down my arm 7/1/2007
numerous
1/26/2009
lesions and tremen
U 1/27/2009 2/9/2009
ot on Jan 7-09- my arm ached- the place were the shot was given it got red and swelled up bigger then a 1/7/2009 50 cent piece. The worst is my n
ports child with facial swelling and vomiting
Y started 2/6/09. Seen ER at medical center 2/6/09. N Mom reports 2/5/2009
"Dr said she
2/6/2009
had allergic reactio
edness/warmth of (R) arm. Area of induration
Y 7 cm x 8 cm. Treated with 3 d of Prednisone. U 2/6/2009 2/7/2009
15 min. Wait after Hep B injection, pt Y stated she felt tired. Helped to exam table where she started
U having
2/19/2009
seizure like
2/19/2009
movements of arms.
m area longer than palm size, tender notes to L auxilla, low grade temp + malaise 2/16/2009 2/16/2009
mplained of severe body ache's, fatigue, night sweats, + fever. Y 2/6/2009 2/6/2009
r injection, itching L deltoid at 48 hrs, 8 x 8 cm red indurated area 2/12/2009 2/13/2009
d raised, red area at injection site used ice with relief this am. C/O sever pain to right arm - no U pain medication
2/12/2009taken2/12/2009
by RN advised to take
r (103.6), sweats, chills, malaise. No treatment. Y 2/18/2009 2/18/2009
accine was administered at 11:30am Y on Wednesday, 2/18/2009. On the way home from herNCF appointment, 2/18/2009
I stopped
2/18/2009
at our Chiropracto
ter the vaccine was given the patient Y noticed, redness, swelling, itching and pain of her rightUarm. Dizziness
2/16/2009
and sleepiness
2/17/2009notices as wel
headache and achy, a few hours after receiving vaccines. Y 2/11/2009 2/11/2009
ates she had itchy, red spots all over arms, legs, trunk and scalp a few hours after receiving the Y vaccine (2/19)
2/19/2009
that lasted
2/19/2009until 3am this mor
as given 4 vaccines on 2/17/09 afternoon (menactra, varivax, gardasil, adacel). Late that evening note redness 2/17/2009 and2/17/2009
soreness to the back o
observing redness and swelling at injection site the morning after the Tdap was administered. U Swelling and
2/17/2009
pain has2/18/2009
increased today (day t
O of headache, swelling resulting inYleft arm numbness, swollen tongue and slurred speech.YPatient seen 2/19/2009
in ER and 2/19/2009
treated with Prednison
D RASH ON UPPER TRUNK AND BOTH ARMS, TOOK BENEDRYL AT 6PM 2/19/09 AND 8AM N 2/20/09.2/18/2009 2/19/2009
her called and spoke with RN in clinic on 2/18/09 informing her patient had seizure on morning Y of 2/18/09, 2/17/2009
and wanted 2/18/2009
Dr Gold informed. P
lling and erythema 2 days after injection with Tdap (ADACEL) and HPV4 at same site. Y 2/17/2009 2/19/2009
ately 10 minutes after immunizations, parent reported
Y stiffening and 4eyes rolled. Patient wasUnot in office2/20/2009
at this time/was
2/20/2009
with parents. Bab
ite swollen, red, itchy and painful for over 1 week. No treatment. Y 2/8/2009 2/9/2009
ceived Yellow Fever and Hepatitis BYVaccination and waited 10 minutes in the Aid Station before Y departing.
2/18/2009
15 minutes
2/18/2009
after departed he re
alance, double vision, dizziness, nausea,
Y abnormally high blood platelet count. 3/12/09 ReceivedU ER medical records
### of 11/28/2008.
### FINAL
d entire body rash with lesions, itching, elevated temp. lasted for 8 days. Parent states "looked Y like regular 1/8/2009
case of 1/19/2009
Chicken Pox". Child ad
dministered 2/6/2009 on february 19, 2009 rash covering trunk and face no fever otherwise normal Y . rash 2/6/2009
pruritic blanching
2/19/2009 raised papule o
ately 5 min after giving immunizations,Y pt became Y combative, c/o severe
1 abd pain, throat pain.Y Patient was 2/19/2009
sweating2/19/2009
and scratching skin. M
PER ARM PAIN, SWELLING, AND WARM TO THE TOUCH MEASURING 5X5 CM. SYMPTOMS U STARTED 2/18/2009
ON 2/19/09
2/19/2009
AM. PT SEEN BY
ack to clinic today to report a reaction to receiving the Pneumovax vaccine in our clinic two days Y prior. Pt 2/18/2009
states receiving
2/18/2009the vaccine in th
2/20/2009
s post Varivax immunization ( 1st dose) Employee developed itching rash on arms & legs , tiny, Y raised " pimple### like"1/18/2009
,fluid filled rash Emplo
headache. Facial swelling w/rash. Lymphandopathy.
Y Prednisone at tapering dose. Doxycycline. Y ### ###
ssed out about 10 minutes after receiving 5 vaccinations at her 4 year old well check up. While Y under observation,
2/10/2005 she 2/20/2009
passed out in her m
g Varicella vaccine, Tdap, then HPV, child's eyes rolled back, body slumped to right side, b/lYarms and legs 2/19/2008
waved/flapped
2/19/2008 side to side. No
warmth, pain/soreness and itchiness since vaccine was administered at left upper arm Y 2/16/2009 2/16/2009
g Fever and stomach ache during the night. To 101.2 degrees Farenheit by 8am 02/19/2009.U Patient complained 2/18/2009 of2/19/2009
headache and nausea
08 pt received anthrax and typhoid vaccines. The following day pt c/o generalized tingling throughout
U her body.### Nov. 17, seen### by Dr. Cash a
1/24/2009 N 1/8/2009 1/24/2009
3/21/2009 Y Y 35 Y U 1/23/2009 2/13/2009
oth legs and arms with weakness. Muscle
Y weakness
Y (not working right
48 Y in func). Speech impairment.
N 4/20/09 Received
### hospital
### & rehab me
DTAP, IPR, MMR & VARIVAX IZ onY2-19-09. Came in 2-21-09 to clinic to have PPD read. U Left upper arm 2/19/2009
red, swollen,
2/20/2009
tender & hot to tou
ower back bilateral 2 days after vaccine administration. Y 1/29/2009
iredness from 14:00pm - 14:30pm. 2/17/2009 headache @ 15:00pm, took two TYLENOL gel Y capsules @ 2/12/2009
15:00 pm,2/12/2009
Sx resolved by 15:15
e given 2-09-09 (Monday). Mom called Thursday 2-12-09, she reported following: Pt had slight Y fever and2/9/2009
didn't feel2/10/2009
great and some itching
redden, hot to touch at injection siteYwith swelling, no fever, no rash, no difficulty breathing, reported
Y 2/2/09
2/18/2009
TX. Benadryl
2/20/2009
ETix 120 mg 2.3
that she had a flu shot here in our clinic
Y in early December 2007. Although there is no record Y of it being12/1/2007
administered here. Dime-sized ar
l seizure. PMH negative. Y Y
o developed pinpoint red rash (dots) on torso, legs and arms - U 2/6/2009 2/6/2009
lling & itching. U 2/18/2009 2/20/2009
ents with pain in upper right arm. Outer
Y aspect of upper arm is noted to be red, raised, increased
U temp hard
2/11/2009
& 35 mm 2/12/2009
x 25 mm blistered w
tching pain began 1 day post-vaccine Y 2/18/2009 2/19/2009
at vaccine site with 3X4 cm mild redness on LDT. Y 2/11/2009 2/11/2009
ce today 2/20/09 vaccine Tdap has reaction swollen and redness, - as per phone call with mom. U 2/19/2009 2/20/2009
0/09 mom saw arm swollen & red on area of DTAP vaccine area. Mom will apply ice on edutal U arm as per 2/19/2009
phone call 2/20/2009
with mom on 2/20/09
after vaccine administered pt developed a festering lesion about 1 in x 1/2 in under arm (R) that U did not itch 2/13/2009
or hurt. Also
2/16/2009
had numbness in u
eddened thigh with 1 1/2 2-d of decreased interaction (per mom; "out of it" X 1-2 d) (did not bring Y in to this8/7/2008
MD for eval8/7/2008
subsequently fine)
redness @ injection site- esp with VARICELLA. 0 Rx except for observation for 30 mins Pt.Yadvised to give 2/20/2009
BENADRYL 2/20/2009
@ home no sob, w
ness @ injection site - (immediate) --> Hives developed after 5 mins. on chest - observed pt.Yfor 30 mins. 2/20/2009
Advised BENADRYL
2/20/2009 PO @ home
ed of itching all over. Rash noted arms, face, inner legs and buttocks. BENADRYL 25mg given N PO. DECADRON 2/20/20094mg 2/20/2009
with Depomedral 40m
approximately 5 minutes after receiving vaccinations. Y 2/20/2009 2/20/2009
month shots, my son developed some shrill, high-pitched screaming and alternated between Y screaming8/15/2008
and passing 8/15/2008
out for about 12 hour
00, chills, redness behow injection area,
Y swollen around injection area, hot to the touch, hard, N very very painful,
2/17/2009sweats,
2/17/2009
dizzy
ediately developed fever, rash and Y discomfort. Within 2 weeks behavior changedYdramatically, N language4/18/2007
skills regressed,
4/18/2007
frequent fevers, s
argic, not eating well, not as many wet diapers U 2/19/2009 2/20/2009
NCED ITCHING ,SHORTNESS OFYBREATH, HEAVINESS IN CHEST DIFFICULTY BREATHING, Y RASH 1/29/2009
,REDDNESS 1/29/2009
SWELLING ALSO
occurred at site of administration within hours, spreading over the next day to a total size of approximately
Y 1/29/2009
3" by 5", 1/29/2009
accompanied by itching
eving the vaccines at his 4 month appointment, my son demonstrated some jerking/shaking of Y his head while
10/7/2008
sleeping.
10/7/2008
This lasted for abou
day as receiving the combo booster Y shot, his arm around the site got very warm, Hard to the U touch and 2/10/2009
he aid it hurt.
2/10/2009
It was a large red ra
ontinuous non stop, nausea vomiting Y 1 today, 2 times yesterday, normal breathing, c/o warming, U no report 2/21/2009
of rash 140/92,
2/21/200974, 22R, No whe
on 5 hours post vaccination. 24 hours post vaccination: 1.5" hard, raised, hot, red area around Y injection sites
2/18/2009
on thighs.
2/19/2009
36 hours post vacc
ely after the proquad and hep A vaccines,
Y his appetite severley decreased. Less than a weekNlater, he had a fever ### of 102 to ###
105 for three da
anfer from sharing towels/clothing with roomate vaccinated 27 Jan 2009. Developed lesions along jawline 17Feb 2009. 2/17/2009
ure of 102.6. Headache. Sore arm. Strange fluttery sensation in chest. Treatment: Bedrest. Y Aspirin. 2/20/2009
Fluids. 2/21/2009
uscle control in both arms, restless, high
Y fever - 103.4 - 105.8 at one point, lethargic, lifeless, Ylimp, blue around
1/20/2009
mouth,
1/20/2009
fingernails and feet, l
ch of shingles in C5 distribution 9 days
Y after administration of Zostavax Y 1/23/2009 2/1/2009
n has been received from a registered nurse, for the Pregnancy Registry for GARDASIL, concerning Y a 17
5/12/2008
year old female
5/12/2008 patient with atten
n was viewed on the Internet concerning
Y a 19 year
Y old patient who in 0 approximately April 2008
N (10 months 4/1/2008
ago), was vaccinated with the fi
Y concerningY a 20 year old female 0 with respiratory allergies
N who on 9/16/2008
21-FEB-2008, 11/4/2008
24-APR-2008 and 1
n has been received from a physician Y concerning a female patient who was vaccinated with Uon unspecified date with a dose of GARDASIL
n has been received from a consumer Y via the Internet
Y concerning her0 daughter who in AugustU 2007, was 8/1/2007
vaccinated with GARDASIL. Sub
n has been received from a healthcare Y worker concerning a 58 year old female with Y allergy to
Y VICODIN 1/21/2009
and MINOCIN 1/21/2009
who on 21-JAN-200
n has been received from a healthcare Y worker concerning a 49 year old female with Y hypertension
Y who on 28-OCT-2008
### was
###vaccinated IM
n has been received from a healthcare worker concerning a 38 year old female with Y no medical
U history or 2/16/2009
drug reactions/allergies
2/16/2009 who on 1
n has been received from a physician Y concerning a 60 year old male patient with diabetes, hypertension
U 12/1/2008
and dyslipidaemia
12/3/2008 who on the mor
ter started to get restless in the legs and had many
Y headaches. She was twitching and couldn'tN stop from jerking movements
1/25/2009in head and le
ceived her 1st GARDASIL shot on 1-16-09.
Y She received no other shots and wasYon no medication.
Y On 1/16/2009
1-20-09, patient
1/22/2009
woke up with flu-lik
n the GARDASIL shot. A week after being injected I had a serious allergic reaction and broke out in a very itchy rash 1/27/2009
all over my fingers an
ter had the vaccine GARDASIL andYnow her arm is bruising up looks really nasty and she saying U she's got
11/6/2008
numbness of the ###arm and Dr. do
ped trunkle red micropapule rash 2 wks post MMR Y 2/6/2009 2/16/2009
ziness". Slumped in chair post immz given pupil dilated. Assisted to cot when appropriate. YApplied cool 2/7/2009
rag. Given2/7/2009
snack & juice when re
e nonspecific rash. Described as hives by parents. Y 9/22/2008 9/23/2008
e non-specific rash described as hives by parents. Y 3/20/2007 5/1/2008
ing non stop x 1-2 hr. 2/18/09 - temp Y 101 this mother has cystic fibrosis - not breastfeeding. Y 2/17/2009 2/17/2009
to have stiff neck on (L) shoulder - progressed to stiffness bilaterally in her trapezius muscleYand base of 2/2/2009
skull. Feb. 102/4/2009
- symptoms intensif
er receiving shots RT leg, sore, red,Ywarm and swollen about the size of mom's palm of hand. N Went to see2/7/2009
Dr on 2/10. 2/9/2009
Told was an allergic
er shot injection site itched, became red and raised. Eventually the itching moved down arm Nand red rash8/3/2007went away.8/5/2007
On 11/2007 she wen
e and client dizzy evening after shot.Y Next morning left arm swollen and client began to shiver Y and low grade
1/27/2009
fever 100
1/27/2009
degrees F. Very re
et of excruciating right shoulder andYupper arm pain following flu virus immunization. Pain intensity
N very 10/1/2008
high (9+/10)10/2/2008
and maximal at onset.
after imm Fever 101.1 Y 1/15/2009 1/15/2009
lled Health Dept @ 3:45pm reporting Y that child's lips were turning blue and swelling, she also
Y reported child
2/17/2009
to E.R. 2/17/2009
because they were still
as given vaccines on 2/13/2009. Patient came into office on 2/17/09 c/o nausea, diarrhea, wtYloss, fever, 2/13/2009
chills, stomach
2/14/2009
bloating and stoma
ted 2 days after flu vaccine ? allergyY to eggs. Y 2/11/2009 2/14/2009
d varicella vaccine RA SQ on 2-4-09 Y and returned to office 2-16-09 with red/swollen (15 mm)Y in area around 2/4/2009
injection2/5/2009
site and reported are
d she was pregnant 2 months after receiving GARDASIL vaccine. Pt miscarried at 2 1/2- 3 mos Y pregnant. ###
ceived Tdap instead of DTap. No adverse reaction. Y ###
mmunizations, about 3-4 min later fell to the right off chair, hit head on floor. I helped her up. YShe was twitching.
2/16/2009 Felt
2/16/2009
dizzy, blacked out. La
w grade) starting five days after administration, following by rash to face/neck/torso on ninth dayU after shots. 2/2/2009 2/6/2009
es erythema in shot area started dayYof injection, worsened through weekend. Presented to Clinic U 2/16 with
2/13/2009
large (about
2/13/2009
10 x 11 cm) erythe
stered 2nd dose of ROTATEQ. Rec'd this dose prior to administration of IM vaccines due today. Pt had projectile2/11/2009 vomiting
2/11/2009 immediately after
stered 1st dose ROTATEQ, had projectile vomiting with copious emesis from mouth +nostrils. Y No other vaccine### had been given.
### Pt observe
e - post immunization evening - continuing at time/date of call on 02/12/09. Given MOTRIN by U mother - Mother
2/11/2009
related
2/11/2009
- Some relief - but on
ction - mild redness, soreness Y 2/9/2009 2/10/2009
r receiving the tetanus, influenza and meningococcal vaccines and having blood drawn, service Y member2/21/2009
complains 2/21/2009
of ringing in his ears, lig
y gave DTAP #4 to 8 month old. Received DTAP #3 on 1/21/2009. Mistakenly gave ROTATEQ Y #4 same time. ROTATEQ #3 on 1/21/09
eport on 2/21/09 at 1 pm pt fever 102 degrees axillary. Gave acetaminophen and "fever wentYdown". Crying 2/13/2009
most of2/21/2009
the time. Temp did not
tial syncope, nausea, lasting several minutes post injection. Was monitored for 20 min and was Y normal. 12/11/2009
week later2/11/2009
developed chest pain,
GSK labels their pre-filled syringes of Hepatitis B Vaccine - ENGERIX-B for adults and children U with a yellow and olive band, respectively, to
degrees within hours of injection. C/O severe pain to right leg, nearly intractable pain. Unable
N to bear weight
2/16/2009
on leg2/16/2009
x 36 hrs. Post injection
DTD on 2/7/09. Mom up pts feet dizzy after leaving clinic & laid down rest of day. Arm was Ysore that even. 2/7/2009
& by next2/7/2009
day was red & swolle
urned 7 days after immunization withYlarge bruise on right upper arm, extending from deltoid (bottom
Y edge)1/7/2009
to elbow,1/10/2009
approx 5" in width. Sta
Hepatitis A inoculation on 2/10/09 at approximately 11 am. At 10:30 pm experienced symptoms Y similar to 2/10/2009
attack of food
2/10/2009
poisoning. Vomited
eadache day of vaccine, through evening. Recurring headaches, constant fatigue, joint pain prominent U in left
2/7/2009
arm where 2/7/2009
administered. Decr
Y 3/1/2003
rted with rash, fever and HA. Seen Y on 2/11/09 counted 44 lesions (papules). Seen 2/12/09 vesicular
N fluid1/21/2009
sample collected.
2/9/2009Feels worse.
t started around 2pm. Slight swelling. Hurts to move arm. Ibuprofen and ice the shoulder/arm. Y 2/13/09 doing2/10/2009
much better.
2/10/2009
n has been received from a certifiedYnurse midwife concerning a 24 year old female patient with Y asthma, epilepsy ###and migraine
### headaches
FAINTED IMMEDIATELY AFTER INJECTION OF GARDASIL. 5 SEC. OF COMPLETE UNCONSCIOUSNESS Y 2/20/2009 FOLLOWED
2/20/2009BY CONFUSI
nausa, shakiness increasing since 4th dose of Imovax received 2/17/09. Recommended use U of aspirin 2/17/2009
on regular basis.
2/19/2009
iving 2 IM injections in left deltoid (Hep A #2, Menactra) while seated, patient stood up and had Y a syncopal 2/23/2009
event. No 2/23/2009
LOC, recovered within
SECONDS AFTER VACCINE ADMINISTRATION Y THE GIRL COLLAPSED. SHE APPEARED Y PALE, FLACID ### AND COLD### TO THE TOUCH
ite became red, swollen, sore, hot and itchy. Welt and itchiness lasted from 2/17 to 2/22. Only Y treatment 2/16/2009
was cortisone
2/17/2009
cream to ease itch
REFERS THE CHILD SUFFERED Y A RASH ALL OVER THE BODY WITH RED BLISTERS.YSHE TOOK12/8/2008 HER TO THE 12/8/2008
DOCTOR'S OFFICE
& swelling at injection sites.Low grade temp - 99.0. Fussy and irritable U 2/19/2009 2/20/2009
of child= developed high fever (statesY 104 degrees)the
Y evening of 2/19/09
1 and had a seizureU and was taken2/19/2009
to the 2/19/2009
hospital- time unknown
vaccine child had generalized scarletina body rash with confluent 2 cm area left lower thigh and U 1 cm confluent
2/20/2009right2/20/2009
thigh rash that started
D SWELLING AT INJECTION SITE, NOT ABLE TO MOVE ARM, FEVER Y 2/16/2009 2/17/2009
vaccine administered in a local health Y department clinic on 2/18/09 in the morning to this adolescent
U female.
2/18/2009
Patient2/22/2009
had history of undocum
ness, rash (2"x1"), itching at injection site U 2/19/2009 2/21/2009
ness, rash (1"x1"), itching at injection site U 2/19/2009 2/21/2009
oke up the morning of 2/19/09 to find she had alot of itching on her left hip and discovered 5 N raised spots.2/12/2009
This was the2/19/2009
same side she had S
today to our Health Center with complaints of vomiting and fevers of 103.Today at 103.3R. Dr U Anees requesting
2/20/2009reporting
2/20/2009
for possible adve
ame pale and complained of being nauseated and light-headed. RN assisted client in putting Y her in a supine
2/2/2009
position2/2/2009
with legs elevated. T
soreness, and swelling at injection site, with mild, red, raised rash on stomach and back (some U itching). Swollen
2/9/2009 glands
2/23/2009
behind the ear/nec
gan 4 days after receiving vaccines accompanied by fever for 2 days. Y 2/12/2009 2/16/2009
as running a fever on and off for twoYdays prior and on 2/15/09 around 8:30 pm she had a seizure Y that lasted
2/6/2009
almost2/15/2009
25 minutes and had to
ates, awakened with fever 102.8 theYfollowing morning after receiving vaccine. Myalgia, arthralgia Y and continued
2/19/2009 episodes
2/20/2009
of fever over 72
ADACEL @ 10:30 am - within 10 hours Y child c/o severe H/A, dizziness and nausea, and chills. Y BP - orthostatic
2/20/2009hypotension
2/20/2009- unable to sta
@ 10:20 AM stating she had an upset Y stomach, nausea and shortness of breath this was herU3rd GARDASIL 2/23/2009
injections.
2/23/2009
2/26/09 Received
since the vaccines pt. has had fevers, headaches Y & generalized weakness.
11 Just prior to admit. noted visual
1/13/2009
problems1/14/2009
and gait problems.
n on 2/18. C/o sitting soreness, muscle ache on 2/19. On afternoon of 2/19 & 2/20 had fever Y 38-38.9 degrees
2/18/2009C, generalized
2/19/2009 body ache, i
1hr post immunization and had syncopal episode Y - No seizure activity.
1 3/11/09-records received Y for DOS2/17/2009
2/17/09-presented
2/17/2009with vomiting p
was reported by a physician via a salesY representative
Y and described1 the occurrence of itchingU in a 4-year-old
2/19/2009
male2/19/2009
U age
3/20/2000
d GARDASIL injection 1/21/09. Pt reported being pregnant 1/20/09. U 1/21/2009 1/30/2009
ash that resolved with oral diphenhydramine x 1. Y 2/20/2009 2/20/2009
patient and she states that she is feeling better. She is still weak, a little sleepy, not pain. No headache or 1/5/2009
sinus pain at this moment. No
Y aY60 day old female 10
who on 05-DEC-2008 was N vaccinated12/5/2008
with one dose12/8/2008
of ROTATEQ (lot n
n has been received from a licensed Y practical nurse
Y concerning a 790 year old female who onU10-FEB-2009 2/10/2009
was vaccinated
2/12/2009 SQ with a 0.65
n has been received from a physician Y concerning a patient who was vaccinated with a dose Nof ZOSTAVAX (Merck). After receiving ZOSTA
n has been received from a consumer concerning his now 22 month old son who at 14-15 months U of age,6/1/2008
was vaccinated with PROQUAD
follow-up information has been received through the Merck pregnancy registry through Y a 23Yyear old female consumer 10/2/2007
who was vaccinated
n has been received from a Registered Nurse (R.N.) concerning a patient who was vaccinated U with the second dose of GARDASIL. The pa
n has been received from a physician Y concerning a 19 year old female who in early Y September N 2008, was9/1/2008
vaccinated9/1/2008
n was viewed on the internet
Y concerning
Y a 14-year-old
Y female patient,
0 who on anYunspecified N date was vaccinated with a dose (s) of GARD
rmation received on 21 January 2009 Y from a health care professional. Upon receipt of follow-up information on 17 February ###2009, it was de
eakness in extremities, numbness,
Y difficulty
Y walking
Y and climbing stairs.
9 Diagnosed Y with GBS, N later changed5/28/2008
to CIPD6/10/2008
due to recurring symp
was swollen from shoulder down to elbow, golf ball sized, red, hard knot at injection site + itching. Y 2/9/2009 2/9/2009
Y Y 1/8/2009 1/14/2009
mmediately following rotovirus 'drink'. On 2/12/09, pt. had fever (101.5) rectally, vomited for 3Yhrs. Was very, 2/11/2009
abnormally
2/11/2009
fussy and agitated
me day, then stomach upset, dizziness, right sided "numbness". No muscle weakness on testing Y at visit on2/4/2009
2/17/09. All2/4/2009
symptoms resolved i
ADACEL, in Left delt and PNEUMOVAX in Right delt on 2/17/09- Called office 2/19/09 c/o swelling U &pain 2/17/2009
came in for 2/19/2009
eval 2/19/09- Right u
to patient he was seen by an ER Physician
Y at hospital on 02/23/09. Diagnosed with Bell's Palsy.
U Prescribed
1/23/2009
Prednisone
2/3/2009
and Acyclovir. Pt
eared 2 days after shot lightly. Strong heavy rash at 10 days after shot continuing 5 more days. Y Fever 104.5 ### degrees X 72 ###hrs starting 9 d
ed ZOSTAVAX 12/18/09; Saw Derm. on 1/7/09 for rash. Returned to medical center 1/10/09 Y + Dx'd zoster rash ###R thigh. Tx'd NEUROTIN
facial paralysis began day after vaccinations
Y were given. Went to ER on 2/1/09 where Bells NPalsy was diagnosed.
1/28/2009 Is 1/29/2009
improving but not yet
er up to 103.3 degrees F, congestion, cough soreness in throat; U ### 2/18/2009
r of vaccines being given pt becameY irritable, facial flushing, hives diffusely esp on trunk/back Y but also on 2/17/2009
extremities.2/17/2009
Mild swelling of eyel
ble crying, pallor, & loss of consciousness,
Y 8 hrs after being given immunization for the first time.
Y 2/17/2009 2/17/2009
ace, stomach, back, legs started onY2-8-09. Pt. temp 98.5 degrees (2-9-09). 103 degrees Feb N 5 + 6, 2009 1/27/2009
cough, rhinorrhea
2/8/2009 started Feb 2
t vaccine admin. Pt c/o lightheaded,Yloss of appetite, nausea, cold chills, unable to move feet. U C/o vision2/18/2009
change. 12/18/2009
hour later pt c/o heada
t one hour after recurring second shot of GARDASIL. Pt self report "3 white spots, on my face" U noticed after
2/17/2009
she left2/17/2009
the clinic. "a little itchy
lands, (femoral), redness and swollen site, no fever, Hurt - make her cry. Rest made it betterY- iced +heat 2/6/2009 2/7/2009
Presented with 3 weeks nonproductiveY cough, treated with AZITHROMYCIN. Patient still with symptoms 1/10/2008
as of 02/15/2009. ###
flu shot 2-16-09 came to office 2-18-09 left upper arm red & swollen & hard 5 cm no rash Y 2/16/2009 2/16/2009
er receiving MENACTRA developedYflushed face, clammy & weak legs, "feels well''. Y 2/17/2009 2/17/2009
g hot, HA, eyes burning then blacked out. Woke up on floor. Also w/ rash on abdomen and thigh. Y 2/17/2009 2/18/2009
warmth and firmness felt at injection site on upper left arm. 2 1/2 cm at area of induration felt there, no erythema
9/22/2008 9/23/2008
umps on stomach, legs & back. Sm Qtip size red raised bump on VARICELLA site right leg and Y PREVNAR 2/17/2009
site is a2/19/2009
bruise. Pt feels well. Pt
V combo administered 2-10-09. Within 24 hrs developed swollen, red, painful arm at site - 2-11-09 U broke 2/10/2009
out in oral blisters
2/13/2009 on tongue, ante
d Bells Palsy 8/12/08 received. N 5/16/2008 8/12/2008
HEP A (VAQTA) on 2/11/08 & 8/1/08 Today, mom reporting no local reaction. Y 2/16/2009
(L) arm 8X8 in redden- warm to touch - (R) arm 2X1 in redden - warmth to touch c/o pain. BENADRYL Y 2 tsp
2/5/2009
BID - Cool2/6/2009
compresses
r antibiotics + MMR. Face-trunk some spots on extremities. Y 2/6/2009 2/11/2009
& a lot of pain after receiving TD still having pain, arm weakness & numbness N ### ###
er receiving the shingles vaccine in Y his R arm, patient developed a characteristic rash in the Yright C8 T1 1/21/2009
nerve root. 1/25/2009
He also had a neuralgia
mentation on (L) arm (Linear appearance), non-raised, even distribution, cramping in hands (B) U on occasions2/16/2009
injection site urthen 1 hr. Progressed to diffuse edema & erythema from elbow to distal deltoid. Y Some mild 2/16/2009
tenderness.
2/16/2009Hard slightly numb
muscle pain, edema to 3x regular size, Y rash, fever and general malaise. Y 2/13/2009 2/13/2009
munization given 2/15/09 (Booster). States no pain on 2/15/09. States in afternoon on 2/16/09 Y had dull headache
2/15/2009which2/16/2009
lasted one hour. O
ent for Hep-B vaccine. Prior to giving Y shot, assessed allergies to PCN, Sulfa, naproxen, zithromax
Y and pineapple.
2/18/2009Denied
2/18/2009wheat/yeast allerg
Rxn. Redness, Swelling & injection site 9X8 cm. Systemic Rxn vertigo, mild headache, nausea. Chills, 2/17/2009 Bodyache. 2/17/2009
of her face red and swollen. Right eye
Y swollen completely shut, trouble breathing, trouble sleeping,
U fidgety,
1/16/2009
non responsive,
1/17/2009irritable, fever,
N 2/19/2009 2/19/2009
perature 105 core. Y 2/12/2009 2/13/2009
lesions around left flank 2/5/2009 2/10/2009
gas, distended stomach. pain. Started within 4 hours of dose and continued for 8 hours (tookY sleeping pill) 2/23/2009 2/23/2009
a dull frontal headache since waking on 2/20/2009 after 1 day of Tdap and still present on 2/24/2009U 2/19/2009 2/20/2009
after Tdap given had 101.7 temp. Y Y 2/19/2009 2/19/2009
ven two injections in the left arm on 2/23/09. She called the clinic on 2/24/09 and advised us Y that she woke 2/23/2009
at 0300 with
2/24/2009
pain in her left axilla
after she received 2nd vaccine of gardasil she continues with a rash on her body.Saw PCP doctor N was then
6/16/2008
referred to dermatologist were
o anterior and posterior trunk beginning
Y approximately 2/21/09 progressing in intensity. No respiratory
Y distress
2/19/2009noted.
2/21/2009
Patient evaluated by
ministered to Left deltoid and a large welt formed at injection site over next 24 hours. Site was Y hot to touch2/5/2009
and tissue2/5/2009
was hard underneath
urting when given and never stopped Moved arm around during the rest of the day About 7 hours Y later when
2/17/2009
she went2/18/2009
to bed, the pain got m
ent started having feversYon the dayYof DTaP vaccination
Y (2/19/09) up
1 to hospital admission Y(2/20/09). Mother
2/19/2009
reported
2/20/2009
temp of 101.9 on 2/
1/12/2009 N 1/12/2009 1/12/2009
PED SIGNIFICANT ERYTHEMA IN Y THE SHOT SITE ON HER RIGHT THIGH APPROZ 4 TOY 5 CM IN DIAMETER 2/12/2009 2/13/2009
became erythematous, warm, slight induration. Temp 98.9 Keflex 250/5ml 1tsp TID X 10 days Y Compresses 2/9/2009
Benadryl 2/10/2009
12.5/5ml 1tsp q 6 hrs.
d hives all over body few hours after immunizations we're given. Y 2/6/2009 2/6/2009
ter vaccination patient experienced palpitations, and lightheadedness for 45 minutes, A bruise Y 1 inch long 2/17/2009
and 1/2 inch
2/17/2009
wide appeared, a r
swelling L arm Y 2/9/2009 2/10/2009
occal vaccination given on 2/22/09 @ 1000. The patient did not experience any symptoms until Y 2/23 when 2/22/2009
she noticed
2/23/2009
her Left Deltoid was
d seizures and had to be rushed to Ythe Hospital Y where he stayed for one week. Patient
Y has N curious mental 6/1/2006
delays; he 6/1/2006
cannot walk, talk, or
arent of error.Will call in Am to check on patient reaction.Will give HepB at 2 mo check. Y 2/24/2009
of face around eyes; no swelling. Per parents, occurred immediately after vaccine; did not call Y MD until several
2/23/2009 hours2/23/2009
after immunized. Tre
from mother: Pt was admitted to hospital 2-18-09 Y due to fever 104.6.3 Stated blood culture done Y in ER was 2/18/2009
(+) for bacterial
2/18/2009 infection. Repea
Y U 2/23/2009 2/23/2009
post immunization with 2 skin lesions. 1) - follicular on neck, throat, (R) arm. - itchy. Pictures Usent to Dr., 2/12/2009
felt to be post-vaccinal
2/24/2009 non-viral pu
Y 2/19/2009 2/20/2009
ed, swollen, warm to touch, thigh area, 4 cm in size, raised Y 1/8/2009 1/10/2009
shot given right arm 2/15. 2/17, soreness
Y at site, lump at site of injection, warm to touch, swollen.
Y Temp 99'.
2/15/2009 2/17/2009
given 2/14 2/17 - arm puffy, warm to touch, redness around site and trailed down arm Y 2/14/2009 2/17/2009
lls VHC x 3 in past week. "Just don't Y feel like myself; very tired, achy, constant HA, nodes on Y side of neck 2/11/2009
and under 2/13/2009
chin are enlarged." R
was on 02/19. On 02/22 injection site became red, 2" circle. On 2/24 it is still a 2" around circle. U No heat or 2/19/2009
pain. Arm2/22/2009
is a little sore. Told her
lled 6 days following vaccination forYa tip to Brazil. He reports facial swelling with sx. StartingUon Sunday2/17/2009 2/22/09 a 1300,
2/22/2009 which was 5 days
ined to dentist about sores in her mouth. Dentist prescribed VALTREX and patient is concerned Y the ZOSTAVAX 1/27/2009caused 2/6/2009
the sores and the
Local Reaction with continued erythema & induration at site. 2 Pruritic rash with small dark lesions on thighs 2/19/2009
on 2/21/09
2/19/2009
MMR & VARICELLA given. 2-11-09 PC from mom. States child "broke out" in rash at babysitters. U RN advised 2/10/2009
parent 2/11/2009
to take child to Dr. advi
TAVAX injection 2-12-09. That evening arm was very tender. His wife is a nurse, redness noted Y from elbow 2/12/2009
to shoulder.
2/12/2009
States arm felt num
tous nodule app 0.5 cm in diam bothY thighs. 2/23/2009 2/24/2009
MMR and VARIVAX on 1/30/09. Fever Y that night for 2 days. Atend of fever had prominent myoclonic Y jerks
1/30/2009
with sleep
1/30/2009
for one day then rec
ld female who came for a routine physical exam and vaccines and developed a rash over the Y next 24 hours.
2/12/2009
The rash
2/13/2009
was of rapid progres
of GARDASIL administered on 2/24/09. Pt experienced syncope, pt recovered well. WaitedY15 mins. Stated 2/24/2009
she felt
2/24/2009
better exited office.
d fever < 12 alter shot swollen tonsil or lymph nodes & L facial swelling injection given SQ on left arm. No 2/21/2009
pain or swelling
2/21/2009 around injection
e morning following the vaccinationYmy right shoulder was in severe immobilizing pain. I could U not move1/17/2009
it due to the 1/18/2009
pain. I attempted to t
serious event was reported by a health Y care professional on 13 January 2009. Based upon additional Y information ###received on 13 February 2
n has been received from a registered nurse concerning a 71 year old female who was vaccinated U with a 0.65ml dose of ZOSTAVAX (Merc
n has been received from a registered pharmacist concerning an adult male who, "many years U ago", was vaccinated with a "complete dose
l pain, diahrrea, general ill feeling 12/07.
Y Again 8/08 - Diagnosed Crohn's disease 10/08. 3/9/09 U Received 8/16/2007
PCP vaccine12/1/2007
records & medical
a BOOSTRIX vaccine (R) arm 10/30/08. Seen on 11/2/08 area red swollen, hot to touch ### 11/1/2008
hours, urticarial rash on chest, shortness of breath, and nausea Y ### ###
ately 12 hrs after reaction, patient experienced
Y localized bright red egg sized swollen area atYinjection site, 2/19/2009
itchy, soreness,
2/20/2009 and firm swollen
t, Kitra Woodall, child had routine immunizations on 02/11/09. Infant jerked right leg slightly U at the time of2/11/2009
getting the 2/21/2009
shot, and small bruise
Y Y 2/24/2009 2/24/2009
ction and cellulitis at injection
Y area.. Y
.went to urgent
Y treatment care and 4 was put on Keflex and U Prednisone...went
2/4/2009 to Emergency
2/5/2009 Room a we
ollowing the vaccine, pt began
Y to have
Y pain andYprogressive weakness 5 of her left arm and leftY leg. SHe was 1/12/2009
evaluated1/22/2009
at joe DImaggio Chil
pisode which lasted for approximately 10 seconds after administering menactra vaccine.childYclaimed she2/25/2009 felt dizzy after
2/25/2009
the last injection. w
ea immediately following Gardasil #1 injection. Sxs resolved spontaneously over course of next Y 30 minutes 2/25/2009
while being
2/25/2009
seen in clinic.
hortly after administration of Gardisil. Out for 3-4 seconds. Observed for 45 minutes before going Y home. 2/25/2009
At home and 2/25/2009
still reports nausea a
ng office c/o site where varicella given had a hard knot, warm to touch, whole back of arm swollen, painful to the point that it kept patient up
hours of receiving vaccine - developed severe lower back pain, diffuse H/A, Shoulder joint pain Y and upon 2/14/2009
rising from2/15/2009
suppine position I wou
wver, Polio and oraL 7/14/08 tYPOID Y ORAL -7/17/08eYHE AND LEG RASH AFTER TRAVEL N 5 WEEKS7/18/2008
LATER AND 7/18/2008
SWELLING OF THE
09 patient was taken to hospital for Yseizure activity.
Y At hospital she was
3 intubated for respiratory Y failure. Mother### reported low ###grade fevers a
lgia. pt received rabies vaccine ist dose on 01/27/09 and second dose on 02/03/09, and wasYscheduled for 2/3/2009
third dose2/24/2009
02/23/09. When pt pr
h fever, chills, severe myaligias and GI upset within 24 hours. Y 2/19/2009 2/20/2009
y patient reported pain on entire arm lasting for more than 3 weeks ###
nd tenderness where shot given (pneumococcal conjugate); fever of 100.4 (pneumococcal conjugate); Y drowsy
2/23/2009and 2/23/2009
loss of appetite (pneum
as administered the Merck HPV vaccine - third dose, patient reported left hand tingling. Physician Y evaluated
2/25/2009
- patient2/25/2009
returned home. Physi
9 Pt presented with a temperature of Y 104.2(f) with no other signs. Drew blood cultures positive Y for Invasive 10/9/2008
Streptococcus Pneumoniae. Tr
lled office today and reported patient had experienced redness and itching after YF immunization. Y Patient2/17/2009
showed her 2/23/2009
the site on Monday m
became red and indurated. Patents' mother describes purulent blisters approx. 1wk after administration Y 2/2/2009 2/9/2009
IVED ZOSTAVAX ON 2/23/09. ONY2/24/09, PT REPORTED NUMBNESS AND "A WEIRD FEELING" Y ON2/23/2009
THE LEFT 2/24/2009
SIDE OF HIS FACE
n has been received from a physician Y concerning an 18 or 19 year old female with a history Y of seizure "in the past during an IV administrati
after the shot was administered, patient
Y showed Y limpness in his left17arm, lasting a little less than
Y a minute. About ###2hours later ### more limpnes
k after 1st GARDASIL, my daughterYbegan having headaches, nausea and began passing out. N Began having 8/3/2007
trouble8/10/2007
breathing. Pediatricia
episode of syncope, sweating and clammy Y 2/24/2009 2/24/2009
t 9am Donor started having; headache (pounding), fever, chills, fatigue. Swollen lymphnodes Y under L arm.2/23/2009
The L arm 2/24/2009
deltoid area where i
Y 2/23/2009 2/23/2009
m (3 inch wide) round tender induration at VARIVAX injection site - developed ~ 24 hrs after the injection. 2/17/2009 2/18/2009
thema, hyperemia and pruritus measuring 12x8 cm Y 2/19/2009 2/21/2009
administered 10-17-08, on 10-23-08 pt seen by PA-C for wide spread hives on palms and soles. U Tenderness to area of injection, no swelling
minutes of injection into right arm, pt began to have erythema around both injection sites - going Y up arm to 2/21/2009
neck, chest 2/21/2009
& shoulder. C/o puriti
at injection site (L) thigh, hot, tender, approx 3" in diameter with fever. 2/23/2009 2/24/2009
olled eyes back of head ? seizure. Seen Y in office 2/25/2009 for this. Y 2/9/2009 2/24/2009
n 2/23/09. Complaining of Hx of itchingY started after given her MENACTRA,/Tdap/Varicella vaccine about2/19/2009 315pm 2/19/09 and at home 715p
administered on 2-17-09 - says "3 to 4" days after receiving vaccines, client experienced symptoms Y of fever
2/17/2009
(102-103), 2/20/2009
chills, nausea - clien
minutes patient experienced moderate swelling and mild erythema of left thigh extending to Y superior portion of### knee joint. ###
The joint was not
02 degree at home the night of vaccineY 2/24/09. Today in office 97.6 AX. Slightly swollen at Ysite RVL, warm 2/24/2009
to touch, 2/24/2009
no redness. Hives on
U 1/2/2008 2/23/2008
0 min after while on elevator. Once off elevator still had symp. Dizziness-noted while still. NoYnausea. Comes 2/17/2009
to a point
2/17/2009
when must slow dow
SQ swelling, local reaction with redness. Tender to touch. Treatment: cool compress and MOTRIN Y prn for2/24/2009
soreness. 2/25/2009
n received from patient's mother byYphone. Per mother Pt. began having body pain at 2:00AM N on 10-21-08, unresolved
### by###
TYLENOL. No f
usea, vomiting; patient received shot of KETOROLAC 60 mg/2ml today, 2/25/09. Also, patient U was prescribed
2/24/2009
PHENERGAN
2/25/200925 mg tabs, 1
Hepatitis B & MMR vaccinations. I have latex allergy. Nurse practitioner (2 of them) said disregardY latex 6/1/2007
allergy pamphlet.
6/1/2007 I broke out in b
swelling 5"X51/2" U 2/24/2009 2/26/2009
vaccines on 2-17-09 No bandaids applied & rash developed 3 days after. Mom stated that happened Y with
2/17/2009
2 mo shots 2/20/2009
also.
mother informed clinic on 02/28/09 that daughter had received MCV4 vaccination prior to going U to college 8/4/2008
and has been experiencing swelli
after receiving vaccines, approximately 15" after vaccines. Pt did not hit head; No seizure noted. Y Pt. recovered
2/18/2009with 2/18/2009
fluids (juice + water)
ll from pt that she had acute joint pain during the night Jan 5, 09. Her doctor told her it was due U to the shingles
11/6/2008 shot. 1/5/2009
Was on 1/2 mg PRED
lled 2-13-09 reporting ash of left arm day after HAVRIX injection. By 2-13 rash with itching allY over body. Mother
2/9/2009 did2/10/2009
not get child to ER as r
month after vaccination developed fever to 101 degrees for 1 week. This was followed Y by "black N out spells". Within ###several ### days a facial tic s
ceived a flu vaccine on 10/15/2008. That evening she felt ill and went to sleep. She awoke in the middle of the ### night to drink
### water and fai
, edema around immunization site. Approximately 1 1/2 in. diameter. Y 2/24/2009 2/25/2009
& erythema of left upper arm very painful Y 2/12/2009 2/16/2009
headache for 11-13 days following vaccine - started within 8 hours of receiving vaccine OTC Ymedication ineffective ### - Advil ###Aleve, Aspirins, S
max 104.8 oral per parent; 101 rectalY @ office fussy - resolved decreased appetite but takingUbottles. 2/19/2009 2/19/2009
nny nose, fuzziness and 2 lesions on Y back. 2/6/2009 2/6/2009
ausea and vomiting. Y 7/10/2008 7/10/2008
s: 1. Pain and swelling. U 2/3/2009 2/3/2009
ine given in left arm. On 2/14 arm became
Y getting swollen and red from the arm to the wrist.YOn 2/15/Pt 2/13/2009
went to ER2/14/2009
were was prescribed w
a pneumonia shot on Monday, February 16 around 9:00 a.m. By that evening I had chills and N body aches. 2/16/2009
The entire2/16/2009
upper arm where th
N VARICELLA VACCINE ON 12/31/08 PRESENTED TO OFFICE ON 01/20/09 WITH PAPULAR Y RACH EXTENDED ### 1/16/2009
FROM HEAD TO EXT
ed with c/o pain and swelling at site.YVery limited arm movement. Fever above 102, and chills. Has had some 2/25/2009
tingling2/25/2009
to arm that injection w
and heat at injection site Y 2/23/2009 2/25/2009
vaccine he stated starring and his eyes Y would roll up. Didnt think anything was wrong and then U he started5/24/2006
jerking. Diagnosed
5/26/2006with epilepsy
lling w/ warm to the touch on left arm. Seen by Dr. - given meds for comfort: Ibuprofen 800mg U T1 TID and Ultram 50mg T1 Q4-6hrs.
nstered at work. A weekYafter shot, YI began to have
Y difficulty swallowing.
23 Y The difficulty increased
N and visited doctor
### 12/2/2008
on 12/1. On 12/2 was o
.6 12:20 pm 2/26/09 2/25/2009 2/26/2009
dministered on 1/14/2009 Y and developed
Y neurologic
Y symptoms on14 or Y
about 1/23/2009. He was
U subsequently1/14/2009
diagnosed
1/23/2009
with Guillian Barre
mplained that baby vomiting from 02/24/09
Y to present, and fever fora day.tynelol given for fever ,fluids pedalite
2/23/2009 for vomiting.
2/24/2009
9 at about 9:30PM, his eyes rolled backY and jerked
Y some, call squad2 and taken to Hosp andYthen to Children's,
2/17/2009 temo2/19/2009
102.9. Questioned se
9 at 6pm pt stated had nausea, lightheadedness and a fever up to 103 degrees. 2-26-2009 pt U came to clinic
2/24/2009
left deltoid
2/25/2009
red,itchy,swollen an
er c/o diahrrea, decreased urination Ydespite adequate fluid intake, red buttocks and gluetal fold. U Also, consistant
2/24/2009 fever
2/24/2009
of 101 F . Referred
eumonvax Immunization on 2-25-09. Pt c/o swelling, warm, rash 3 inches in diameter at injection Y site. Felt 2/25/2009
feverish but 2/26/2009
did not take temp. Sa
eving the pentacel in his left arm at the health dept on monday 2/23/2009, he developed left Yarm significant 2/23/2009
swelling,2/26/2009
redness, and pain. Fa
ebilitating headaches, chronic
Y diahrrea,
Y severe back & abdominal pain, tingling inYhands and Nfeet,numbness in ### hands & feet, ###stabbing pain i
after receiving the injection, a bump appeared at the injection site,lasting about a day. It disappearedY and1/15/2009
then retrurned1/16/2009
about 1 week later.
hours after injection Pain at injection side, redness extending 7 inches by 4 inches; fever of 101 Y degrees2/24/2009
orally; chills; 2/25/2009
severe weakness in a
ke activity, Loss of consciousness on 2/25/2009Ysee notes 4/27/09 Received 2 hospital medical Y records of2/23/2009
2/26-2/27/2009.2/25/2009FINAL DX: seizur
ter receiving CODEINE child's tongue Y started swelling, vomited, HR increase, lips edematous, Y SOB, unresponsive
2/24/2008 EPI 2/25/2008
PEN given IM, O2 s
s LUE arm, shoulder pain with rash at Y injection site. Left deltoid has localized cellulitic area 8Ucm L X 5.5 2/24/2009
cm W. temp2/26/2009is 99.5. No other syste
clinic reporting SOB, throat feels funny.Y Instructed to go to ER. At ER, patient did well and left Y with BENADRYL. ###There was ###some confusio
ots - back abd, 12/26/09 started ZOVIRAX 200 mg 3 PO BID X 5 days. U 3/22/2007 2/26/2009
nyl & Pt sister PKU + mom strong on mercury free. Physician ordered wrong in Epic Y 1/5/2009
ed screaming started ~45' with shots, continued X 45' Pt slept X 48' then cycle repeated X 5Ydays 2/24/2009 2/24/2009
ing the clinic per mother, pt fainted, Dr responded, SPO2 100-98%. Pulse low. Oxygen given Y to pt after 10 min.### Pt able to### stand ambulate a
l - Employee stated received an MMR on 1-16-09 and on 1-20-09 started itching in entire body Y and having 1/16/2009
facial swelling.
1/20/2009
ing, took BENADRYL 50mg followed by 25 mg Q6 hour. Y ### ###
ction site with large reddened/warm site- Better today. Y 12/9/2008 ###
ection hot to touch, red and swollen. Y ### ###
MMR, VARIVAX, and PREVNAR onY 2/24. That night had episode where child stopped breathing Y for 15-20
2/24/2009
sec., eye 2/24/2009
rolled back, went limp
is a 14 month old female whose mother called on 2/25 and spoke with RN, Mother advised child Y had "chickenpox"
2/12/2009 after 2/21/2009
vaccinations on 2/1
daches, severe @times (6/10) lasting Y for 10 days post immunization. During 1st 24hrs post Y vaccine, also2/18/2009
c/o lightheadedness
2/19/2009 / dizziness -
24 hours after administration, she cried and screamed for more than 6 hours and continuedUto scream and cry### off and on ###for the next seve
n has been received from a Certified Y Nurse Midwife, for the Pregnancy Registry for GARDASIL, Y concerning 8/1/2008
a 19 year8/1/2008
old female who in Au
n has been received from a physician Y concerning a 23 year old female who was vaccinated Y with a first dose of GARDASIL 0.5ml IM. Subse
n has been received from a physician Y concerning a 15 year old female with no medical Y history
N and drug allergies who, on an unspecified da
n has been received from a nurse concerning her 26 year old daughter who was Yintramuscularly Y vaccinated with the first and second 0.5 m
Y nurse concerning
Y a 15 year old
4 female patient
Y with noNpertinent medical
9/24/2007 history
12/1/2007
and no known drug a
n has been received from a nurse inY a physician's Y office concerning0a female who was vaccinated N with a dose of GARDASIL (lot # not repo
n has been received from a physician Y concerning a 21 year old female who on 05-SEP-2008Uwas vaccinated with ### a first dose of GARDASI
n has been received from a consumer concerning her son who on an unspecified date was vaccinated U with a dose of MMR II. Subsequentl
009 Pt. talked with PHN + and she stated she had a "reaction" to her Flu shot-stated she had Y "a temperature +### chills, stated###she could hard
treme discomfort following inj. LOC after standing up- approx 10-15 min to fully recover- pt symptoms Y Hx2/24/2009
of LOC with 2/24/2009
vaccine, but mother
as administered diluent for ACT HIB vaccine only without reconstitution of HIB vaccine, but telephone Y call2/23/2009
to mother 2/23/2009
to advise of error. Moth
ticed patch of red skin in area where vaccine was administered 7 days after vaccine was given. Y No itchiness, 2/3/2009
pain,2/10/2009
or heat noted at site. N
advertently received Tdap and MENACTRA that was meant for older sibling. Therefore get MENACTRA Y and2/5/2009
Tdap earlier than usual schedu
vaccinations, Pt developed severe swelling,
Y pain, redness and the area became hard. She initiallyY had a2/11/2009
fever, but it2/12/2009
went away. The area(b
s after the shots where administered to the patient, patient's mom notified one of the medicalY assistants2/19/2009 that the patient
2/19/2009
was developing a r
d few itch spots on abd 4 days ago.YSpots increased over next few days. Y 8/24/2007 2/19/2009
ce member contacted the 24 hour vaccine Y call center to report reproducible flu-like symptoms Y of nausea, vomiting, ### low grade ###fever and diar
lled to report pt c/o "loosing vision onY both sides." Parent to take pt to primary care provider U (Dominican 2/17/2009
Health Clinic) 2/18/2009
for eval. Mother calle
-like reaction. Hives - several days 1 Y week apart for 1 day. Y 1/19/2009 1/19/2009
hills, fever X 24 hrs. (X hrs) Y 2/19/2009 2/19/2009
fter shot employee experienced slight nausea & weakness & hand tremors. Symptoms lasted Y 2 days. No 2/20/2009
medical Tx 2/21/2009
sought. Symptoms r
e, Flu- like symptoms, low grade fever sore throat, nasal congestion, SOB fatigue, aches, etc.N 7/5/2008 7/6/2008
oughout, injection site arm & neck, w/o resp. distress OTC BENADRYL Y 2/13/2009
ht - swelling redness- covering entire upper arm. Area marked with pen. If redness spreads start U antibiotic. 2/24/2009 2/25/2009
ess and weakness approx 45 mins Y after receiving vaccine. Lasted 4 1/2 hours. Seen at ER given Y Benadryl.
2/26/2009
No co/ rash,
2/26/2009
SOB. Injection site
rted child got puffy around eyes the day after vaccination 2/19/09. It resolved 2/24/09. The evening Y of 2/23/09
2/19/2009 child 2/23/2009
presented with patch, r
oreness and hand and fingers became Y tingling approx 1-2 hours after vaccine. Then tired and Y vomiting X2 2/26/2009
at about2/26/2009
2-3 hours with headach
ness and vomiting (4-5X) approx 1-2Yhours after vaccination. After going to have lunch. Had slt Y headache2/26/2009
and arm and 2/26/2009
flank soreness. Seen
V 2005 around noon, swollen
Y lips and
Y wheals under eyes. Took Claritin and wheals resolved, Y but lips swollen,
11/1/2005 so instructed
11/8/2005to take Benad
ues following administration of the vaccine the patients left arm, where the vaccine was givenYbegan to turn 2/27/2009
red and 2/27/2009
develop whelps. Dr. Sp
my identical twin sons were given a vaccine (they had the ones for RSV also), they Y got worse N and worse6/4/2003until at 18 months of age, they we
and spoke with RN on 2/19/09 with c/o Y tremors and high BP since vaccination on 11/4/08. She U reported 11/4/2008
that she did11/5/2008
not know side effects o
4/09 at 2pm due to rash over entire body which started 2/23/09. Received vaccines 2/6/09. U 2/6/2009 2/23/2009
n the Gardasil shot in December 2007. Y In January
Y 2008, diagnosed with 1 Supraventricular
Y Tachycardia
N (SVT): Blacked
### 1/14/2008
out/lost consciousne
ed joint/body ache, weakness, feverY(flu-like symptoms). The following day, patient reported Y pain (10/10) in left###shoulder and ###left leg, brough
ection site, diffuse myalgia and 3 x 4 cm supraclavicular swelling adenopathy. U 2/3/2009 2/24/2009
Swollen on L deltoid upper. Mom just noticed today upper to side on L arm. 0 fever, child active. U Mom called 2/26/2009
today in2/27/2009
office to let us know.
ccine on 2/24, called office on 2/25 reporting 'large read area' @ site of injection T99. 2/26 reports still red, 2/24/2009
hot, tender to touch. 2/27 Still r
nced HA which was constant x2 wks after GARDASIL vaccine. Ordered DARVOCET & asked Y pt to be seen
1/20/2009
for evaluation
2/21/2009 and she did not
LUQ pain, fatigue and weight loss Y since administration of first GARDASIL vaccination. Pt and U pt's mom 7/11/2008
did not report7/11/2008
these symptoms. Pt
e fever, dizziness, pain and swelling at site. N 2/24/2009 2/25/2009
uscle pain to the extent of having diffucult time using all muscles in body needed help gettingYout of bed 2/25/2009
or chair because
2/26/2009muscles were we
pain in upper left arm at injection site
Y and tingling in pinky & ring finger of left hand. Dr. suggested
N Rx therapy,### MRI and EMG. ### MRI showed
ceived the MMR vaccine on 2/18/09.Y Patient had Y an atypically febrile1 seizure on 2/25/09. AYhigh fever was 2/18/2009
NOT documented
2/25/2009 at the time o
ainting loss of consciousness for about a minute while on examining table. Y 2/28/2009 2/28/2009
RST GARDASIL VACCINE Y (administered
Y 9/13/06):
Y experienced dizziness,
9Y light-headed,
Y nauseous,
N headaches,
3/13/2007 leg3/13/2007
cramps, and shooting
algias, Arthus reaction Y 2/24/2009 2/24/2009
d Hives over entire body except face. Y Y 2/23/2009 2/24/2009
pneumoccal/flu vaccine 2 days priorYto presentation at ED. within 12 hrs developed painful, erythematous
Y 9/30/2008
swelling at9/30/2008
the pneumocaccal inje
Pt. stated did not feel shot "going in"Ywhen administered; felt a little faint approx 15min after shot,
U but recovered.
1/29/2009 2/2/09--severe
2/2/2009 aching pain
yesight startin at about two weeks after Y immunization.
Y "Optic neuritis"4 Y3/3/09 MR received forUDOS 12/4-8/2008### with12/4/2008
D/C DX: Optic Neuritis
ain swelling and redness at administration site. Malaise, headache, upset stomach, myalgias,Ysweats. 2/27/2009 2/28/2009
ge reddish purple area with rashed rash at injection site, didnt show up until 11 days after injection.
Y 2/16/2008 2/27/2008
STATED VACCINES WERE ADMINISTERED Y ON WED ON SATURDAY MORNING CHILDYAWOKE WITH 2/25/2009
SWELLIN 2/28/2009
OF LEFT ARM AND
s and two days after receiving the Varicella vaccine patient broke out the approximately 20 pox. Y They began
2/11/2009
on her2/27/2009
thigh. Pt ran a fever o
white male presents with c/o having a flu and pneumonia injections 2 weeks ago and now has Y soreness, redness, ### and
11/9/2008
skin peeling. He sta
ction with redness and swelling to Pentacel. Also, about 3 hours of inconsoleable crying. Fussiness Y over next
1/5/2009
three days.
1/5/2009
Site of other vacci
ed** case of progressive vaccinia. smallpox vaccine Y administered127on 23 Jan 09, patient was diagnosed with 1/13/2009
AML/neutropenic
1/25/2009 fevers on 28
ised and hot rash on torso. Raised hard Y bump at site of shot all occurred two weeks after shot. 2/16/2009 3/2/2009
n has been received from a physician Y and medical
Y records concerning 3 an approximately 3 monthY old male with### rash12/1/2007
erythematous, bronch
ort received on 17 February 2009 from another Y manufacturer as part 10of a study for which sanofi
Y pasteur is not a### sponsor. The ###following is ve
ort received on 17 February 2009 from another Y manufacturer as part8of a study for which SanofiU Pasteur 10/3/2008
is not a sponsor. "The ### patient is a 1
n has been received from Y a physician Y via an email
Y from a consumer 10concerning the Y consumer's
Y 16 year5/20/2008
old daughter who on 20-MAY-2008
n has been received from a physician Y via an email
Y concerning a female 0 who was vaccinatedUwith a dose of GARDASIL. The consumer rep
n has been received from a consumer Y concerning
Y a 12 or 13 year old 4 male who was vaccinated N with a dose of MMR II on an unspecified d
01005622-1 described "losing mental capacities" Y in a 43-year-old female
0 who received LYMERIX.
U This report was received from the vaccin
o left thigh where IPV and DTaP given Warm, Red, Induration. TX CEPHALEXIN 250/5ml/5ml U tid (three 2/26/2009
times a day) 2/26/2009
for 10 days 150ml.
HA that started at back of his head then through whole head, got very pale and nauseous and Y then vomited 3/2/2009
x 2. Pt c/o
3/2/2009
not feel god and na
Multiform Minor, etiology unclear but may be related to MMR and VARIVAX 2/10/2009. U 2/10/2009 2/26/2009
gic reaction. Redness some edema approx 4 1/2 cm diameter. Y 2/24/2009 2/27/2009
ndritis R side > 1wk. N 2/24/2009 2/25/2009
2/10/2009 N 1/14/2009 2/10/2009
eadache, chest pain, increased blood Y pressure,Yloss of consciousness.4 Y ### ###
Breakthrough by baby sister after 1st Var. He also had breakthrough disease (both < 50 each) Y after exposed to ###sister, Hx. Related to nurs
und area of injection) swelling, redness, pain, and itching that has been worsening since 2/27/09 U (when 2/27/2009
given). 2/27/2009
iven 930 AM on 3/2/09: with 1 1/2 - 2 hours later cried, high pitch voice; lasted x 4 hours withY15 minutes cat 3/2/2009
naps. Child
3/2/2009
would woke up an
ction to the R forearm. redness, itching swelling - numbness in the R arm. Reacted only to vaccine Y given intra
2/6/2009
dermal.2/7/2009
Vaccine was given IM
2/17/2009 2/26/2009
Y 1/4/2000 3/1/2009
ter office & receiving PNEUMOVAX, pt. noted fever on & off. Took TGC. Cold then woke up Y during night12/2/2008
wet with sweats.
12/2/2008 24 hours after i
en 2/18/09. MOC called 2/20/09. On Left arm at site of KINRIX, arm was red, firm, and tender. Y No drainage 2/18/2009
Blotchy red
2/18/2009
rash extended down
her states rashes appears on child face 6 days after administration of vaccines. Also states U she uses new 1/26/2009
lotion on child's face and is not s
are L upper arm BENADRYL 25mgYq 6 pm. DURIAF 500/s 1 tsp BID X 10days MOTRIN q Y6 hours. 2/20/2009 2/21/2009
mps - deltoid strength decreased 50% with (not inj site) - lower strength fastening clothing inUback; - adjusting seatbelt.### ###
swelling of R upper arm 4 cm in diameter. U 2/25/2009 2/27/2009
er 50 yo. and received the FLUMIST vaccine normally. Clinic notified 9/20/08 and advised toYwatch pt closely 9/20/2008
next 24 hours. On 9/21/08, pt
ea of slight erythema and purple discoloration at site of injections. Not warm to touch. Not raised Y when seen 2/13/2009
in our office.
2/14/2009
e and excessive pain continuing for 3 wks; Followed by prolonged weakness in left arm for past N 4 months. ### ###
2cm area of erythema and firmness. Tender to touch. Treatment, cold compress. Y 2/3/2009 2/4/2009
esented to Employee Health Clinic and Y informed the RN that she had an allergic reaction to Y FLUZONE she 2/6/2009
had administered
2/6/2009through Empl
rm just below axillae has warmth, redness,
Y & edema on side & back of arm. U 2/23/2009 2/24/2009
lling, dizziness, nauseous evening of date shot given. Couldn't lay on right arm to sleep. ByYnext day at 12:00 2/6/2009Noon 2/6/2009
bruised 50mm across
ter received her 3rd injection of GARDASIL vaccine Y on Feb. 9th 2009.0 She had severe headaches ever since. We took 2/9/2009
her to the emerge
ter received GARDASIL vaccine from her doctor on 02/23/2009. Since having the injection she U has had 2/23/2009
a severe headache,
2/23/2009body aches, u
started throwing up, couldn't get her to respond afterwards for about 10 min, just starred intoUspace (wasn't 1/22/2009
her normal
1/23/2009
self for another 3 da
atient started with breathing problems Y - till her body was shaking. She got hives (slight) on the U arm where 2/23/2009
the shot was2/24/2009
given. As of today s
hrs of being given MMR pt developed erythema multiforme requiring treatment with oral. Y 2/20/2009 2/21/2009
lled advising pt's arm where the Dtap Y was given had gotten Red hot swollen and he complained Y of it itching.
2/25/2009
The swelling
2/27/2009went all the way
n has been received from a nurse practitioner,
Y who was told by one of her own patients, concerning
N a 156/30/2008
year old female
7/15/2008
patient who is not
n has been received from a teenage Y female athlete
Y (runner) via a news
0 report who in May 2008,N was vaccinated
5/1/2008with5/1/2008
GARDASIL. In May 2
n has been received from a medicalYassistant concerning a 15 year old female with no previous Y medical history### or drug
1/5/2009
allergies reported w
n has been received from a physician, for the Pregnancy Registry for GARDASIL, concerning Y a 26 year old female ### 1/24/2008
who was vaccinated wit
n has been received from a physician, for the Pregnancy Registry for GARDASIL, concerning Y a 26 year old female ### who6/1/2008
was vaccinated wit
N
rmation received on 20 February 2009 Y from a consumer. A 65 year old male patient who at the Y age of 5 years
2/10/2009suffered severe chest pain an
ort received 19 February 2009 from Y a health care professional. A 14-year-old male patient with U a medical history ###
of environmental
11/6/2008 allergies a
rmation received on 18 February 2009 Y from a health care professional. A 49 year old male patientN received8/1/2008
FLUZONE 8/3/2008
(lot number U2761A
er shot- hives, pain shooting down arm Y and chest, nurse gave me BENADRYL. One Y week later
N I was still having ###hives on ###my chest after ea
m on 7/22/2008, fever started 99 degrees,Y in 1/2Y hour went up to 1017 degrees. Seizure startedY went to ER 7/14/2008
in Ambulance,
7/22/2008
seizure lasted 45
shot @ store. 10/29 flu-like sx: myalgia,Y sore throat Y 11/1 pain, tenderness
20 @ site. ER/admit 11/10
Y - 12/1 abscess ###L deltoid###--> staph aureus
pain in chest approx 3 days after shot. Shortness Y of breath, fatigue,3 fever, night sweats, muscle
Y soreness.
8/25/2008
Hospitalized
8/28/2008
after for 3 days due
Varicella administered while she is pregnant. 16wks. EGA. U 2/19/2009
d itchy: topical skin reaction site of flu shot. Resolved with hypopigmented round area 12 mmUdiameter site 12/8/2008
injection. Not itching.
### Not sore.
oday with sister who are getting vaccines. Client had vaccines administered on 2/18/09 and U started rash2/18/2009
on her chest 2/25/2009
today mom states cli
induration L deltoid 6cm x 6cm. U 2/19/2009 2/20/2009
ter immunization started with lower Y leg itching which then included the abdomen/torso. Rash-full N body after 12/9/2008
@ 2 weeks with ###cont. itching, bu
re today for Right thigh red area after shot on Friday, an on Left has softball size red rash where Y the immunizations
2/20/2009 were. Patient did not ha
arrhea for 7-8 days on day after vaccine given. Y 1/26/2009 1/27/2009
nset of fever 103.9 with cough, headache, & congestion. U 10/7/2008 2/26/2009
al, redness, tender to touch per patient.Y Swelling and soreness. Y 2/23/2009
trial of ZYRTEC, and if worsening then antibiotics. U 2/19/2009 2/24/2009
- ZYRTEC/allergy med, antibiotics. U 2/20/2009
swelling, pain, itching at site of injection. Instructed pt. to use warm compresses, topical BENADRYL or2/24/2009 Calamine lotion, ADVIL or TYLEN
9- Rash all over, fever, cough x 2 days- Dx: Varicella + Bronchitis Treatment: ACYCLOVIR Y 200/5 1/2 tsp7/12/2007
QID x 5 days2/23/2009
& BENADRYL 1/2 t
ated red and swollen right arm aboutY 2/10/09 with fever 104 degrees and several sm "blisters". Y Took child 2/5/2009
to family doctor
2/10/2009who DX "vaccine
ed 7mm took Benadryl none in am, so not seen in office. Y 2/26/2009 2/26/2009
ash on left side of neck arm and side. Nometasone Furoate, Hydroxyzine HCL 25 mg, Prednisone. Y ### 1/3/2009
ely got left sided eye pain and nausea / an hour and a half later got chest tightness and pain,Ywhich lasted 1/13/2009
intermittently
1/13/2009
5 days. No reaction
eived immunizations for travel on 12-17-09 and came into the office on 3-2-09 with rash on his U body. Rash 2/17/2009
appeared 2/27/2009
to be pin point pustule
ustular, follicular eruption on the chest and back Y 2/17/2009 3/2/2009
ccine given outside age range Y 2/26/2009 2/26/2009
9 Right Deltoid Red, Swollen, hard induration,
Y hot to touch, itchy, red streaks and painful to touch.
U Pain with
2/25/2009
Range 2/26/2009
of motion but has full R
wellimg at injection site, with rash. pain down left arm and on left shoulder blade. onset immediatelyN after
2/28/2008
immunization2/28/2008
was administered t
veloped sores on lip approximately 3-4 days after receiving the vaccine. She then developed Y sores on her 2/5/2009
nose as well
2/8/2009
as around here ey
ceived Menactra vaccine on February Y 25th and 24 hours later on February 26th he developed N fever 101.8,2/25/2009
dizziness, 2/26/2009
nausea, headache, a
Y Y 2/26/2009 2/26/2009
Y Y 2/18/2009 2/19/2009
swelling, warm and hard @ site 2.5 x .5 Y 2/27/2009 3/2/2009
d pain and swelling at injection site.YWas seen in the ED 3 days later Y 2/26/2009
ng and redness of the left lower thigh Y 2/25/2009 2/26/2009
ays of injection client passed out at school andYagain at hiome, no other 2 s/s of illness. Admitted
Y to hosp.5/22/2007
for tests, all5/24/2007
neg. Has passed out 9
pisode within 5 minutes of administering #3 Gardasil and Varivax #2 Y 3/3/2009 3/3/2009
e anxiety - moody and irritable following flu vaccine - constant meltdowns. 2) Sensory issuesNregarding things ### touching her ###- sometimes un
ven his 4 year old immunization on Feb 25, 2009. MMR was given on his right leg and mom stated Y pt developed
2/25/2009 rash 2/25/2009
around the site few ho
spontaneous report of seizures and possible transient ischemic attacks has been received from N a parent who is ###also a nurse ###concerning a
d shingles like rash that itched. Saw primary care doctor was treated and doing well. Y 2/11/2009 2/16/2009
ives BENADRYL. Observed 90 minutes, Y hives diminishing. Referred to allergist for testing. Y 3/3/2009 3/3/2009
cal erythema, swelling, stiffness with fever up to 102 degrees F. U 2/27/2009 2/28/2009
nt- She had a rash + fever @ time ofYER visit. On 3/3/09 zero rash zero fever-body-aches. Per Y patient. 2/27/2009 2/28/2009
of leg with a fine urticarial rash around injection site. Y 2/24/2009 2/25/2009
perienced a syncope episode Friday Y 2/27/09. Transported to emergency room via ambulance. Y Labs and 2/26/2009
CT of head 2/27/2009
negative. Most recen
Tdap and meningitis vaccines. Several minutes later became pale, said he didn't feel well. Became Y unresponsive
1/14/2009for 1/14/2009
< 1 minute. Condition
y injection site rash that spread. Became about 2 in x 2 in rash that developed blisters. Very U itchy, red and2/27/2009
inflamed. No 3/1/2009
fever. No swelling o
scle pain @ injection site, progressively getting worse after injection. Pain radiates to shoulder N trapezius muscle
2/9/2009 and neck.
2/9/20093 wks post inject
reaction to vaccines. MOTRIN and apply cold compress. Y 2/25/2009 2/26/2009
nd vaccine became red. Y U 2/27/2009 3/2/2009
02, with R shoulder swelling and pain X 3d. Seen at ER and started on AbX. Currently afebrile U and improving
2/27/2009recovering.
2/28/2009
swelling and warmth at injection siteY noted 2/20/08. Treated with CLARITIN 10 mg, 1xday for Y 2 days and2/18/2008
hydrocortisone 2/20/2008
cream to site for 2
a haircut on 4/15/08. At that time, he noticed a dime-sized area of hair loss on scalp, back ofNhead. 4/9/2008
contacted manufacturer indicating that Y the caller had received notification of an AE possible associated
U with administration
### ###
of BIOTHRAX va
xperienced moderate (7x6cm) local reaction to 2nd BIOTHRAX vaccination on 12/1/08. AreaYwarm to touch. 12/1/2008
Malaise12/1/2008
12/2/08, feeling better
ports that at approximately 5:00 pm on 10-8-08 he experienced general muscle aches, fatigue Y and fever.10/8/2008
He experienced10/8/2008 two episodes of
ports being tired on the first day afterY receiving the ANTHRAX vaccine. At 6:20 AM on the second Y day she
10/8/2008
noted chest 10/9/2008
pain and shortness
d dry rash localized to the injection site (injection site rash). Subject is a military person who Yhad received 7/11/2008
4 previous7/12/2008
doses of Anthrax vacc
at injection site at 24 hours after immunization.
Y Redness, swelling, itching, tenderness and induration
Y at injection
7/15/2008 site7/16/2008
at 48 hours after immu
ports that approx 5 hours after immunization, she experienced malaise and fatigue. Her symptoms Y progressed
7/9/2008 to stomach
7/9/2008 pain and nausea
ports that three days after receivingYthe ANTHRAX vaccine she felt chest pain and fainted for Y approximately 7/1/2008
30 seconds.7/4/2008Subject was take
e-mail: Subject has a latex allergy and received the anthrax vaccine. Subject is requesting informationU regarding whether the vaccine is mad
of muscle, left leg, from mid-calf to behind the knee. Soreness caused limping. Subsequently Y within 3 days,5/6/2008
pain lessened,
5/9/2008 no longer limpin
ection site, itching at injection site, swelling at injection site, redness at injection site, warmthYat injection 4/22/2008
site, 5cm x 4/23/2008
7cm area.
n has been received from a consumer Y concerning her 20 month old son with penicillin allergy N who on approximately ### November ### 2004 was v
n has been received from a physician concerning a female patient who in August 2008, wasUvaccinated with 8/1/2008
a dose of 2/1/2009
GARDASIL (Lot not
n has been received from a consumer Y concerning Y her 14 year old daughter
1 with purple cornflower
N allergy
2/16/2009
and no pertinent
n has been received from a physician Y assistant concerning a female patient who on an unknown N date was11/4/2008
vaccinated with### the second dose
ort received 23 February 2009 from a health care Y professional. A 4-year-old
2 female patient hadY received 12/4/2008
a third dose12/4/2008
intramuscular left delto
ort received 23 February 2009 from Y a health care professional. An eight-year-old male patientY with no past medical ### history,### had received an
ort received on 27 February 2009 from Y a physician. A 4-year-old female patient, whose past medicalY history was not provided, had received
2-08 was in hospital for syncopal episode.
Y SheYhad normal EEG recording.
2 Was referred for Yevaluation of4/4/2008
a 2 months Hx of spells. First in 2
d spots that started on torso and spreading to her legs. 1/22/2002 2/26/2009
A AND VOMITING Y Y 2/25/2009 2/26/2009
n and swelling in L arm the next morning after receiving a Tdap in this arm. States lymph nodes Y swollen 2/20/2009
and just felt2/21/2009
ill with a bad taste in m
pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 5 11/27/2008 for COPD exacerbation.
Y 10/4/2007
Vaccination took ###place on 10/04/
pneumococcal vaccine trial, with severe COPD, Y was hospitalized for1 chest pain-non cardiacYon 02/06/2009. 1/8/2007
Vaccination2/6/2009
took place on 1/08
pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 6 8/13/2008 for right hip Yfracture. Vaccination
11/7/2007took 8/13/2008
place on 11/07/2007
as vaccinated for meningitis, gardasil, Y and tetanus on 2/18/2009. On 2/19/2009 she could hardly N walk her 2/18/2009
legs were2/19/2009
numb and very weak a
pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 1 11/06/2008 for left femYartery reocclusion.
1/9/2008 Vaccination
9/25/2008took place on 1
at-WATERY EYES-RUNNY NOSE-worn ousore right shoulder(shot was in left bicep)-Phlegm-hoarseness- N 2/27/2009 3/1/2009
and edema localized at injection site. slightly raised irregular borders approx. 2-3 in in diameter.
N Symptoms 3/2/2009
appeared3/3/2009
24 hours after immun
ed Gardisil in left arm then MenigitisYvaccine in right arm. Within a mintue of reciveing the secondU shot she3/3/2009
passed out, 3/3/2009
her body became ri
lled and states she has had arm pain Y since receiving infuenza shot 10/16/2008. Has seen MD N X2. Was put on### NSAIDS TID ###X 1 week w/ n
ess Administered Daptacel to adult patient.
Y Patient should ###have received
### Adacel. Dap
e reaction Administered Daptacel to adult patient. Patient should have received Adacel.YDaptacel box 12/4/2008
and vial not marked for pediatric
ed 2 month vaccines in office, returnedY home with mother and then cried continuously for >4Yhours, with 2/27/2009mother unable 2/27/2009
to soothe baby
e event Administered Daptacel to adult patient. Patient should have received Adacel. Daptacel Y box and vial### not marked for pediatric us
t for 24 hours. Administered Daptacel to adult patient. Patient should have received Adacel. Y Daptacel box and ###vial not marked
### for pediat
e events. Administered Daptacel to adult patient. Patient should have received Adacel. Daptacel Y box and1/30/2009
vial not marked for pediatric use
e reaction. Administered Daptacel to adult patient. Patient should have received Adacel. Daptacel Y box1/30/2009
and vial not marked for pediatric u
ately 2 weeks after receiving the meningococcal
Y Y vaccination and tetanus
5 vaccinations, patient
Y developed optic ### neuritis.4/15/09-records
1/3/2009 rece
lf reported sore arm for 3 weeks. Administered Daptacel to adult patient. Patient should have Y received Adacel.
5/16/2008 Daptacel box and vial not m
e reaction. Administered Daptacel to adult patient. Patient should have received Adacel. Daptacel Y box and
5/16/2008
e reaction. Administered Daptacel to adult patient. Patient should have received Adacel. Daptacel Y box and6/5/2008
ely following vaccination go light headed
Y turned blue and fainted out for approximately 60 secondsY immediately
2/1/2009followed
2/16/2009
by a migrain heada
ed of itchy throat, "patient stated throat
Y closing and feeling very itch all body", abdominal pain, Y mouth numbness,facial
1/19/2009 1/19/2009
erythema, positive ra
NJECTION WITH REDNESS,SWELLING,WARM Y TO TOUCH. Y 2/18/2009 2/19/2009
e local reaction. Painful with patient Y
asking to be carried. Swelling of left quadricep with loss ofU knee landmarks,
3/2/2009 erythema
3/4/2009
and warmth at inj
was reported by a physician and described the occurrence of elevated gamma glutamyl transferase N in a 44-year-old
### 1/21/2009
was reported by a lawyer Y and described
Y the occurrence
Y of skin blistering
0 and peeling in a female
N child who
2/21/2007
was vaccinated with HAVRIX (G
was reported by a physician via a sales representative and described the occurrence of cellulitis Y in a child (4 to 6 years of age) male subjec
nced vomiting and 1 bloody stool. He Y was taken Y to ED where they found
1 he had intussusception.
Y He was 12/8/2008
treated w/air 1/2/2009
enema. He was obs
h began to get red and swell with 2 Y papules appearing in central lesion that had fluid but dried Y up. I saw today
2/18/2009
about2/19/2009
2 weeks post vaccines
dness, soreness at injection site - approx
Y 8 hrs later increase HR with some PVC'S, severe HA Y and backache, ### low grade fever
### 99.6 lt heade
of Right thigh and vomiting. Went to Y emergency room on 2/26/09 follow up. In our office on 3/3/09 Y thigh looked
2/24/2009
normal2/26/2009
child is fine.
es X 3 inches round, red, warm to touch
Y region left deltoid. Were HEP A given. Slight red rash Y around injection
3/3/2009 site 3/4/2009
and back. 18 hours po
ped fever 101.7. 15 cm area of redness,Y tenderness, and swelling. Localized just to vaccine location.
Y Treated
3/3/2009
with oral3/4/2009
MOTRIN and BENAD
achy at site of injection, tenderness and achy in back. Ibuprofen given - 2 hrs later: Pt felt better,
Y decrease3/2/2009
fever, back3/3/2009
tenderness gone. Fev
n tongue - Labored breathing - BENADRYLY Y ### ###
ons given - mom calling stating childs (L) leg was swollen from knee to groin and red. - No temp - n pain.3/2/2009 3/3/2009
Y 3/3/2009 3/3/2009
eadache-fever-dizziness. Doctor visit, Y bedrest, Toradol injection for headache-Hydrozodone for Y headache2/23/2009 2/23/2009
lled 2 days after immunizations listed were given. States child has Hx of eczema rash-mild, but Y noted some hive-like### raised ###
areas on skin o
r receiving Tdap at 03/02/2009 . Temperature= 101 (Ty) control by Tylenol. Y 3/2/2009 3/2/2009
t injection site dx by CHOP. Admitted x 48 hours for IV antibiotics, nml, us, neg, cxs. Full recovery
Y of mobility. Had HIB + pneumococcal sa
d flu shot at clinic on 11/3/08. States
Y she started with discomfort to left upper arm from flu shotN area to her 11/3/2008
elbow and 11/6/2008
states "it feels bruised
VAX vaccine administered 2/24/09 Right upper arm. Two days afterward the patient called the N office questioning
2/24/2009if site
2/24/2009
reaction was norma
of immunization, patient returned to the doctors office to report injection site was itchy. Site Uwas seen by 3/3/2009
Dr. Site was also red, slight swolle
as 2.5 X 2.5 cm indurated erythematous area @ VARIVAX site. Y 3/2/2009
ame limp, unable to hold head up, Refused to bear weight on Lower extremities. Awake and Yalert but "out 2/16/2009
of it" according
2/16/2009
to father. This las
ADACEL, MENACTRA, FLUZONE, Hep A, VARIVAX, and GARDASIL - just after receiving YGARDASIL she 3/3/2009
stiffened3/3/2009
up and eyes rolled ba
and Dad; reporting to us today at wellY check visit that on 10/21/08 approx 1900 pt had fever Y of 104, responded### to treatment ###
of TYLENOL, in
ater had fever of 102.5 degrees, 103 Y degrees on the next day, controlled by TYLENOL/MOTRIN U every 42/23/2009
hours. Called2/24/2009
doctor the first day b
n has been received from a physician concerning an 85 year old female with a history of "lung Y cancer surgery"
2/8/2008who on 2/2/2009
08-FEB-2008 was v
n has been received from the patient'sY sister concerning
Y her sister with
4 no pertinent medicalUhistory or drug 9/10/2007
### who on un
was reported by a healthcare professional and described the occurrence of spitting up in a 6-month-old
U subject of unspecified gender who
was reported by a physician via another manufacturer and described the occurrence of pellet-like U stools in an infant subject of unspecified
Y and described theYoccurrence of intussusception
4 in a 3-month-old
N female subject
1/20/2009who 1/24/2009
was vaccinated with RO
was reported by a healthcare professional via a sales representative and described the occurrence U of swelling of upper arm in a child subje
was reported by a healthcare professional via a sales representative and described the occurrenceU of swelling of upper arm in a child subje
was reported by a healthcare professional via a sales representative and described the occurrenceU of swelling
2/1/2009of upper
2/1/2009
arm in a child subje
2/1/2009of upper
2/1/2009
2/1/2009of upper
2/1/2009
1st GARDASIL vaccination in Oct 2008 and ever Y since then I have been having high fevers, N between to 102-103.0.
10/1/2008 ###
arre Syndrome with loss of sensation Y in hands/feet
Y and proximal muscle17 weakness onset onN12/08/08. No improvement ### 12/8/2008 as of yet 4 days of
administered 2/05/09 in morning. Parents report Y mom picked up child 3 from crib for 9 p.m feeding.
Y Child was 2/5/2009
unresponsive
2/5/2009 and limp. Father
ately 4 days after immunization, pt had Y nausea Ythat went to fever, chills
14 and extreme diarrhea Y - went to urgent
11/3/2008care about
11/7/2008 1 1/2 weeks also
ropped off at Mall. At 5:30pm student Y called mother with Sx of SOB, grey lips, perspiration, pale
N skin color, 2/25/2009
numbness 2/25/2009
of legs, slurred speec
d ZOSTOVAX vaccine on 2/17/09 and three days later she developed shingles on right breast. 2/17/2009
d IZ on 2/18/2009, mother phoned 2/19/2009
Y fever 104 advised ER. Y 2/18/2009 2/19/2009
hed. Neurologist's assessment 2/20/09 Y - normal with coincidental viral infection with fever to N
102 on day 2/11/2009
of visit 2/20/09.
2/12/2009
fter vaccines given. Y 2/17/2009 2/17/2009
ots, pt complained of feeling "tired". This "feeling" lasted et mother reports had fever not measured
Y via thermometer-
2/20/2009 2/20/2009
24 hours after injection
after am shot, mom called to report itchy rash on left arm with some swelling. Patient complainedY of knee 2/18/2009
and elbow 2/18/2009
pain.
st immunization pt. c/o wheezing with Y exhalation. The Monday following 11/10 she came down N with flu-like symptoms### 11/3/2008
+ fever 101 degrees
ever, generalized aching 24 hour after vaccine given. Vomited 2 day after vaccine given. Y 2/13/2009 2/14/2009
VAX given IM Left deltoid on 2/18/09. Y On 2/19/09, pt returned to ofc with edema, pain and erythematous
U 2/18/2009
streaking from2/18/2009
injection site down
broke out at 4:30 pm 11/08/08. Rash or blister like over left eye- on forehead + into scalp + hair.N Not to painful but very uncomfortable espec
oday stating that the day after getting her shots she developed Blisters in her scalp and itchyYrash on her body.### She did not ###seek medical a
ash across abdomen with urticaria started 24 hour after Hepatitis B vaccine administration. Self Y treated with 2/26/2009
BENADRYL 2/27/2009OTC and topical h
rge reddened area with raised rash at injection site. 11 days after injection. Y 2/16/2009 2/27/2009
h severe redness/swelling & induration. Y Worsened over several days pt treated with ABX forYpossible cellulitis
2/23/2009 & steroids/BENADRYL
2/24/2009 for al
cellulitis. Treated with Omnicef 120/5/ml 3.5 ml twice daily for 7 days. U 2/18/2009 2/19/2009
gic purpura - developed 4-6 hrs after Y vaccine lasted 1 month - 2-3 developed nose bleed lasted N 2 months 10/1/2008
swelling ankles
10/1/2008 lasted 2wks - wh
cal lymphadenitis. U 2/16/2009 2/23/2009
or the 1st of three Guardisil
Y vaccinations.
Y I had a recent previous pap smear that normal, no N HPV, no abnormal
4/27/2007 cells,
7/11/2007
nothing. After another
d grouped papules and vesicles withYa red base on his left shoulder on 2/17/09. He was treated Y with Valtrex 2/3/2009
for 7 days.
2/17/2009
Papules, vesicles a
minutes of injection, arms felt heavy and tingly, tongue was tingling, felt nautious and felt dizzy,
Y collapsed in 3/5/2009
waiting area 3/5/2009
but did not loose co
was given IM Pneumovax in left detoid Y on 3/2/09 at clinic visit for cough and sore throat. RNUreported using 3/2/2009
one inch3/3/2009
25 gauge needle and
m swollen right bicep. treated with local care only, observation Y 3/3/2009 3/4/2009
D YELLOW FEVER VACCIN SQ, NOTICED REACTION SEVERAL DAYS LATER. REACTION Y CONSISTED 1/23/2009OF URTICARIAL
1/25/2009 REACTION
wheal (3 cm x 1 cm) and flare (5 cm x 6 cm). Started within 5 minutes of vaccination. At 10Yminutes was3/5/2009 still spreading
3/5/2009
without systemic s
DEVELOPED REDNESS TO INJECTION SITE (RIGHT ARM) WITH INDURATION AND SENSITIVE Y TO3/2/2009
TOUCH 3/3/2009
ceived flu shot at unknown pharmacy Y 6 months ago. Felt immediate pain in Left lateral upper N arm, and pain has persisted to the present da
d swelling of right eye with redness Y 1 hour after Immunizations, then developed swelling of leftY eye and approx
2/27/2009 2 hours
2/27/2009
later had hives on fa
edness for two days at site of injection. Right thigh. U 3/3/2009 3/3/2009
lled and reported that patient was pregnant when she received her third Gardisil. Y 2/4/2009
heals around injection site, right shoulder area, and trunks. Hydrocortison cream and Loratadine U given. 3/3/2009 3/3/2009
as very anxious when given his immunizations
Y at 11:30am. Immediately after he became pale Y and c/o nausea.3/2/2009 Less3/2/2009
than 5 minutes after v
m Red, Swollen, Hardness, warm to touch. Patient admitted to scratching the arm at the injection Y site. 3/3/2009 3/5/2009
he vaccine at 3pm, february 10, 2009. Suddenly became very dizzy at 4:30 pm. The extreme Y dizziness2/10/2009
slowly subsided
2/10/2009and was gone by
able crying for 6 hours after vaccine administration. No treatment. Y ### ###
ceived pneumococcal vaccine on 11/17/2008 and 2 days later complained that his right upper Y arm was hot to the ###touch red, ### and swollen. P
and swelling of L upper thigh measuring
Y 8 x 7 cm oval. U 3/4/2009 3/5/2009
zure while sitting and eating, talkingYneck twisted and fell to the floor while @ grandmother'sNhouse lasted9/8/2006
2min. Multiple6/5/2008
seizures since the
at 7:30pm child had a seizure lastingY about 1.5 minutes. No fever. Complained of feeling tired Y before and 3/3/2009
after taken 3/4/2009
ER treated and has a
ses of VARIVAX, developed 20-30 classic varicella lesions over axillary/trunk area, no cough,Ycoryza, URI 8/23/1999
symptoms,3/4/2009
otherwise well, lesion
iving all ten shots - PENTACEL, ENGERIX and ROTATEQ. Pt noted to have significant erythematosis Y lower
2/26/2009
extremities
2/26/2009
that lasted few min
ing and weakness in legs, feet, arms, Y hands and face; first noticed numbness in feet end of October,
U 2008. Progressed
### to###
legs, arms, hand
er (after 3rd DTaP) leg from thigh toYknee swollen and red spotty spot on inner thigh not at injection
U site but3/2/2009
near it, no 3/4/2009
fever, warm, tender.
Y 3/3/2009 3/3/2009
d swelling and soreness to injection site. She also had about 6 inches of redness around site. U 2/25/2009 2/27/2009
over body, very large and raised. Benadryl worked somewhat. Zyrtec (20mg) stopped the reaction N almost totally.
###However,
1/15/2009 after about a we
n has been received from a licensed Y practical nurse concerning a 26 year old female with noYknown medical history### and 1/1/2009
drug allergies, who
n has been received from a physician Y assistant and a licensed practical nurse, for GARDASIL, Y a Pregnancy 12/2/2008
Registry product, ### concerning a
Y concerning
Y a 14 year old
0 female patient who on U28-APR-2008 6/27/2008
was vaccinated
9/1/2008 with the first dos
n has been received from an advanced registered nurse practitioner concerning a 23 year old Y female diagnosed
2/24/2009 with
2/25/2009
epilepsy 2 years ago
n has been received from a physician Y concerning Y a female patient 31
who in July or August of 2008,
N was vaccinated
8/8/2008with 9/1/2008
her second dose of G
n has been received from a physician Y concerning Y an 18 week old male
2 patient with a historyYof reflux and umbilical
### infection ###when he was b
edness. Malaise. Chills. Headache.YCough. 3/26/09 Y Received hospital
2 medical records of 10/7-10/8/2009.
Y 10/3/2008
FINAL DX:10/4/2008
Percutaneous coron
ed chest heaviness, nausea, headache Y after administration of vaccine presented next day with U persistent2/9/2009
complaint. 2/9/2009
3/10/09 Received PC
elling and redness at sight. Y 2/6/2009 2/6/2009
ceived shingles vaccine on 2/9/09 at that time she did not note on VAR that she was immunoUcompromised. 2/9/2009
On 3/2/09
2/16/2009
the home healthcar
ed day after vaccines administered. Pt arm warm to touch. Pt complained of itchy & soreness. Y Cellulitis2/27/2009
of R arm- AMOXICILLIN.
2/28/2009
UMIST and came down with Influenza Y A anyway. Y ### 2/23/2009
nning one week after receiving MMR, Y Varicella + HepA vaccine. Rash on back and 5 total lesions-
U a few2/20/2009
appearing2/27/2009
like typical chickenpox
ven PEDIARIX at 4mo. WCC, HEP B was given too early, must re-vaccinate to insure immunization. U ###
ven Hep A vaccination, not in child profile or EMR immunizations. Found later in chart note, Pt received third 2/11/2007
Hep A vaccination today, rece
eceived HPV # 1 6-26-07. Patient returns 8/30/07 for HPV #2 and says that her legs were hurting Y - come6/26/2007
back 10/23/07 still c/o leg pain lab
abbing head pain, 2/14/09 chest pressure,
Y 2/15/09 back and neck pain, 2/16/09 all of above.N2/18/09 diagnosed
2/13/2009 with
2/13/2009
costiocondritis.
umbness in left leg, moved up bodyYto left arm, then went to other side of body. Headache severe. U Heart
11/5/2008
palpitations.
11/6/2008
Cramping in hands
ated generalized Rash in AM-deniesYSOB. Instructed Tx BENADRYL and/or MD or ER if worse. N Called mother
2/26/2009
3-2-09
2/27/2009
AM-she stated went t
dizziness, dysautonomia, fatigue. Has been treated for possible Meniere's disease and for anxiety. N Recurrent
9/19/2007
MRSA9/19/2007
skin infections since 9/
ge 5 was given the MMR/Varicella (Chickenpox)
Y shots on the same day, February 19th 2009.YOne shot in2/19/2009
each leg. 2/24/2009
On Tuesday February 2
in hives on 2/22/09. Worsened by Y office visit on 2/23/09. No known new products of foods Y treated with 2/20/2009
SOLUMEDROL 2/22/2009dose pack and hy
e fever, muscle aches, nausea and vomiting.
Y Y ### ###
ed hot left arm pain Tylenol and iceY Y ### ###
o nausea immediately after MCV4. Became pale and stated "I feel nervous and like I may throw Y up". BP 90/603/3/2009
placed3/3/2009
on floor in supine pos
e seizure. about 0300 -> ER had sz Ythere -> Home 0930 - another sz -> ER -> Home. (Dx: Otitis Y Media @ 2/19/2009
this ER visit
3/1/2009
& sent home w/AMO
ood up after injection, walked to closed door, slumped forward & said he didn't feel well, thenYthrew his head 2/3/2009
back, went2/3/2009
stiff & fell over unco
ticed a blister at site of injection 8 am on 1-27-09. On 1-28-09 area became red, swollen & sore; Y Clt developed
1/26/2009HA 1/27/2009
& head felt warm. No t
shingles vaccine- ZOSTAVAX- Resulting in break out of shingles. 2/24/2009
Y
& swelling at injection site. Skin warm to the touch. Y 2/23/2009 2/23/2009
ngestion, cough, decreased appetite, temp 104 degree F lasting 3 days. Also diagnosed with Y acute Otitis2/24/2009
Media on2/24/2009
day 3. Treated with AU
ted to office on 2/28/09 with red, swollen area on thigh where DTAP was administered. ShotYwas given on 2/26/2009
2/26/09. 2/27/2009
Family noticed redden
ing at site of injection Y 1/26/2009 1/27/2009
PREVNAR injection 2/23/2009. Late evening started having fever to 103 & fussy. Seen by Y Dr. 2/23/09 2/23/2009
- No orgin found
2/24/2009
for fever T-98.9 at
t swelling, redness, erythema, pain of left upper arm to elbow - lasting 6 days. After resolution,
Y depression 7/8/2008
remains 7/10/2008
in muscle of upper left a
& induration 10 inches around injection site. Y 2/27/2009 2/28/2009
ction redness swelling 4 cm x 5 cm LeftY thigh DTAP. U 2/23/2009 2/24/2009
o sore arm on 2-28-09. Mom noted Yredness, inflammation & warmth. Dad took patient to walk-in Y clinic on
2/26/2009
2/28/09. 2/28/2009
Dr. put him on antibiotic
ion right upper arm 2 - PNEUMOVAX RX: TYLENOL as needed ice to area as needed Y 2/24/2009 2/25/2009
l -> Per note from/by Dr. : "Patient suddenly
Y awoke from her sleep at 2:30 am early Weds. morning
U with 2/16/2009
shaking chills 2/18/2009
and "cold sweats" an
Telephonce call from school nurse to report that child came to her office in the AM with c/o U
severe itching, 3/4/2009
left upper3/5/2009
arm, after recieveing
ately 24 hours after administration ofY vaccine patient states she woke in the night feeling "hot",
Y and patient's 3/5/2009
cheeks apear3/6/2009
flushed. Patient
cine was administered on 2/13/09. As Y of 2/27/09 my son has had episodes of hives. Started Non lower extermities
2/13/2009and 2/27/2009
then moves to top (fa
e, lymph node reacted and created a big bump under the same arm that had the vaccine. Fever, very weak 3/3/2009
legs and knees.
3/3/2009 I still do not hav
6 PM vacine given- headache that night & the next day, flu like symtoms(aching, chills and diarrhea) started.3/2/2009
I still have
3/3/2009
them as of 3/6/09.
a rash 2 days after administration. She describes it as raised and hard, a big red area about Ythe size of her2/18/2009
palm. 22/20/2009
days later not as big or
eadache from back of neck up to head.Throbbing, general malaise. Sx began about 12 to 15Yhours later. Felt 2/3/2009
hot. 2/4/2009
RM AREA TO RIGHT ARM WHERE MENACTRA WAS GIVEN(03/04/2009).PATIENT WAS SEEN U BY DR.NAVE
3/4/2009 AND 3/6/2009
MOM WAS INSTRU
ps all over body that started 9 days after
Y vaccine was given. Y 2/2/2009 2/12/2009
RM AREA AROUND THE INJECTION SITE GIVEN IN THE RIGHT ARM. SEEN DR 09/06/2008 Y MOM WAS 9/4/2008
TOLD TO 9/6/2008
WATCH SITE AND A
ceived 4 vaccinations on 02-18-09. YLater in that same day, patient complained of right arm pain.
Y Per Mom,
2/18/2009
the deltoid
2/18/2009
site was erythemato
D ZOSTER VAX. ON 1/29.09. HIS WIFE CALLED CLINIC CHARGE NURSE 2/23/09 TO REPORT Y PT. 1/29/2009
HAD DEVELOPED 2/16/2009 A BLISTER WI
11/6/2003
ceived Gardasil and Menactra
Y vaccinations
Y on Y
Friday, Feb. 27th at about
2 2 pm. She also had Y completed2/27/2009
a course of3/2/2009
Zithromax, but had pr
ng after receiving the Tdap, along with a trivalent flu shot, the patient reported jaw pain on the
Y left side that "hurt
### like hell" ###
and persisted for
me swollen and red, several hours after
Y administration of vaccine. Area became painful.ThereY was quite 3/4/2009
a bit of swelling
3/4/2009
around the entire
veloped fever and light sensitive headache after receiving vaccines Y 3/4/2009 3/4/2009
nset full body myalgia and fever 102 less than 24 hours after injections. U 3/5/2009 3/6/2009
effect at injection site (R arm): round, erythematous without pustular lesion 1.5 cm x 1.5 cmYand tenderness 1/8/2009
on Right1/21/2009
arm.
er administrating ROTATEQ baby developed redness on face - chest & back. Administered Y @ 11:50 am -3/6/2009
rash 12 pm3/6/2009
(on 3-6-09).
ost vaccine child c/o pain (sharp) inYright hand (vaccine given in left arm) then later in day child
U c/o pins &3/3/2009
needle parasthesia
3/4/2009 X 4 extremitie
hs, patient had rash at location of immunization.

Y At 4 months with no alcohol or band aids used,
U patient had 3/2/2009
rash on legs
3/3/2009
where shots were
d #2 GARDASIL vaccine inj 2-17-09. 1st injection was given at another clinic. Pt called 2-25-09 Y & stated2/17/2009
shortly after
2/17/2009
she got home felt an
occurred after having vaccines. Vomiting lasted about 10 hours. Y 3/5/2009 3/5/2009
and low grade fever occurred after receiving vaccines, vomited X 1. Y 3/5/2009 3/6/2009
st yellow fever vaccination (SQ) memberY noted a small area of redness at the site of his vaccination.
Y By2/24/2009
this afternoon 3/4/2009
the area of redness
arm cellulitis - treated with SEPTRA Y Ds and NAPROSYN. Y 2/11/2009 2/19/2009
- severe, malaise- severe, fatigue severe, headache- moderate, swelling/induration, redness, Y diarrhea, chills-moderate,
1/29/2009 1/29/2009 pain-severe- took 5
d TDAP. He developed fever & headache x 4 days. Per mom they brought him to urgent care. Y Now he is better.
hours after injection patient experienced redness and a hard area about the size of a fist. Swelling
Y from injection
1/29/2009 site1/29/2009
to wrist. Warm to the t
fever for several days then "chicken pox" rash which eventually spread over entire body, fatigue N - I (her 2/23/2009
mother) have3/2/2009
ended up with about
sudamina rash developed on body trunk and upper extremities 30 min after administration. Vaccine Y is Trimovax
3/6/2009 of Sanofi
3/6/2009Pasteur Lot No s
very painful and swollen wrists, hands, and knee for duration of close to 2 weeks, appearingY2 weeks and2/4/2009 5 days after2/24/2009
administration of vac
ighly anxious after vaccines given. Reported tingling in mouth, numbness in feet, and diff. breathing.
Y States
3/8/2009
couldn't3/8/2009
move legs. Epinephri
n has been received from a nurse, for Y the Pregnancy Registry for GARDASIL, concerning a U 17 year old female
3/6/2008who on3/6/2008
06-MAR-2008 was
n has been received from a registered Y nurse, for the Pregnancy Registry for GARDASIL, concerning
Y a 15
9/18/2008
year old female who on 18-SEP-
n has been received by a drug wholesaler
Y representative
Y concerning three patients who on 20-JAN-2009
Y 1/16/2009
were vaccinated
1/17/2009 with a dose of P
n has been received from a Doctor of pharmacy Y concerning a 61 year old female patient whoN on 22-DEC-2008### was vaccinated
### with a dose
ort received 24 February 2009 from Y another manufacturer (document number 45214091), who received the report from a health care profes
AP & VARIVAX 3/3 0900 AM. 3/3/09Y 2330 To ER via ambulance with high temp muscle tremor, Y arm pain.3/3/2009
3/5 seen in3/3/2009
office with cellulitis (R
at site of injection- Soreness at site L arm and up into L neck. Temperature elevation up to 102 N degrees accompanied
2/9/2009 2/9/2009
by some nausea.
d TDAP, HEP A, MENACTRA 1-20-09. Y Mom called this am 1-22-09 states he is out on townUon basketball 1/20/2009
trip and 1/21/2009
called c/o stiff neck, sta
es onset of soreness + "Shooting pain " Left axilla last night, 2/26/09; 4/10 severity. (Also reports
Y mild/moderate
2/25/2009injection
2/26/2009 site tenderness/
d flu shot and came down with influenzaY A anyway. Y ### 2/22/2009
d flu shot and came down with influenzaY A anyway. Y ### 2/25/2009
up to neck-soreness still sore-sometimes more than others times- When sick or after other shotsN vaccines.
12/1/2008 12/1/2008
l headache, neck pain, body ache +Yvomited X 1 later same day and went to ER for evaluation. Y Received2/28/2009
IV fluids +2/28/2009
Toradol for pain Dx: V
g pain, particularly in knees for 24 hours after vaccine administration. IBUPROFEN administered Y by parent,3/3/2009
no further3/3/2009
treatment.
njection, pt. felt nauseated then proceeded to faint. Recovered after anonic inhalent used. AgainY c/o nausea,
2/26/2009 sleepiness.
2/26/2009 Was very pale a
ely after 4th injection (HPV) Pt had stiffening of body, gluteral oral sound, fixed stare, then fainted.
Y Vomited2/26/2009
after recovery
2/26/2009
from faint. Was pa
roximately 7 PM 1/23. About 2 hrs Y after onset fever/ vomited X1 Tylenol mother described seizure
Y activity.
1/21/2009
Seen at1/23/2009
emergency clinic. The
hest area pain and redness and swellingY at site of injection of VARIVAX. Vomited once yesterday
U morning.
2/23/2009
Today felt2/24/2009
tightness in chest.
se practitioner at clinic phoned to inquire
Y about side effects of Hep A vaccine as pt had presented
Y this AM
2/19/2009
with nausea,
2/20/2009
sinus congestion a
U 11/3/1998 3/3/2009
dministered 0945 1/28/09 and patient Y was discharged
Y 10:15. In the5evening hours at home,Ythe patient 1/28/2009
noticed onset 1/28/2009
of pain, swelling arou
flu shot on Thursday. Friday--the vaccine
Y site became red, hot to touch, and hard. Taken toYdoctor on Saturday ###as clinet ###
began having co
ely flushed and hot with infection of Twinrix. That passed and client complained of nausea and U warm feeling
2/27/2009
for next2/27/2009
1 1/2 hours.
ted on 2/11/09 and had a positive urine Y HCG. Pt received Anthrax, Typhoid, and Small Pox. U Error was identified
2/11/2009 on 2/11/2009
3/9/09 @ 0820. Pt had
ed having a rash on face spread to rest of body. Varicella vaccine given the day before. Rash Y blistered9/23/2008
and scabbed 9/24/2008
over - some itching.
. - swollen right thigh, reddened and hot, no fever; applied cold packs 10-14-08 - Unable to see Y doctor. Leg10/8/2008
(r thigh) apears ### to have redden
ceived vaccine on 3/3/09 in the afternoon patient then had fever of 102.7 at 3am on 3/4/09 was Y given tylenol.
3/3/2009
patient 3/4/2009
then had a seizure at 3
since 3-6-09; Bloody nose today 3-9-09, Cranky/fussy since 3-6-09; No rash, or fever. Referred Y patient to3/5/2009
physician for 3/5/2009
care.
ling, erythema, itching, significant increase in circumference of upper outer thigh Y 3/3/2009 3/4/2009
DACHE AND GENERALIZED MUSCLE ACHES AFTER VACCINATION. ARM OF VACCINATION Y SORE. 3/5/2009 3/5/2009
dministered 3/5/2009 3 pm. Friday am 3/6/09 individual noted site to be tender only, no erythema, Y but by Friday
3/5/2009 evening
3/6/2009
was experiencing
veloped high fever, erythema at injection
Y site, and cellulitis which resulted in an office visit toYthe pediatrician
2/25/2009
as well 3/5/2009
as an ER visit and a c
swelling,heat and firmness at site. Dark red for quarter-sized area around site and then lighter Y pink for an3/2/2009
area the size 3/3/2009
of a grapefruit. No t
rts a blister, smaller than a dime, appeared to back of left arm the day after vaccination. A smaller Y blister
2/24/2009
appeared2/25/2009
in same area the next d
hingles vaccine that my Dr said i should get. A few days after the shot every muscle in my body hurts so2/26/2009 bad i cant stand3/1/2009
it. And exhauste
d area swollen, tender and hot to palpation. Unable to move arm or flexion. Fever upt 10 103.0 U by history.3/7/2009 3/7/2009
ter DTAP given mom reports he had "inflamed blood vessels in legs and toes". Pt not seen by Y Doctor- when seen ###exam was ###normal.
offer IPV given child has developed stuttering, slowly improving but not gone yet. U 1/21/2009 2/23/2009
given. 3/06- arm swelled to size of tennis ball at site. 3/07 itching, discomfort. 3/08 Broke out Y on torso with3/5/2009
welts, rapid
3/6/2009
heart rate, discom
ed R upper area > resolved w/ Benadryl and 1 1/2 days of Prednisolone. Seen at urgent care. Y 3/5/2009
L thigh around vaccine administration site. Resolved with antibiotics. Y 2/18/2009 2/19/2009
she saw Dr for "horrible blurred vision...and
Y flashes on the left side of my left eye". Reports she Y also had12/3/2008
increased 12/3/2008
coughing (forceful) at th
0-15 minutes after injection given employee
Y became cool/clammy, face flushed, Rt arm red blotchy Y areas appeared.
3/3/2009 Stated 3/3/2009 "he felt dizzy an
induration and warmth at the injection site, measuring 5-6 cm in Diameter. U 2/23/2009 2/26/2009
induration and warmth at the injection Y site measuring 5-6 cm in Diameter. U 2/23/2009 2/26/2009
induration and warmth at the injection Y site measuring 5-6 cm in diameter. U
small rash over left upper eyelid & fever
Y 101 degrees approx. 20 hrs after vaccine. Next morning Y awoke2/24/2009
with eyelid2/25/2009
lid swelling & facial/bo
eloped a tight cough and progressive Y respiratory distress beginning 3-5 min after vaccination.Y On initial exam 3/5/2009
he has 3/5/2009
tachypneic tachycardia
ain, and pain in arm of ADACEL shot. Y 2/24/2009
ouch, redness 6 1/2cm X 5cm. U 3/6/2009 3/8/2009
e; 3/5 arm swelling redness dx "cellulitis"
Y urgent care KEFLEX; 3/6 flushed cheeks arm swelling Y dx "vaccine 3/4/2009
reation" 3/5/2009
DC KEFLEX.
ness, 2"/3" on Rt. thigh. Minimal induration itching. Y 2/27/2009 2/27/2009
/3/09 Pt. received HEP A #1 and VARIVAXY #2 wt. 280.6#, temp. 99 T. No reaction noted at Y time. 3/4/09 pt.
3/3/2009
returned3/4/2009
with c/c: Rt lower arm
ction to IMM. Left deltoid x 2 days. BENADRYL 1 1/4 tsp po q 4-6 hours prn. Y 3/3/2009 3/5/2009
d generalized pink maculo-papular rash on 3/8/09 about 24 hrs prior to being seen. No fever.UNo other symptons 2/24/2009 - completed
3/8/2009Augmentin fo
m raised, red urticarial-appearing patch upper outer L arm at site of Tdap immunization mile excoriationY at
9/22/2008
lower edge. 9/25/2008
BENADRYL 25mg @
nced pain, redness and swelling at injection site worsening after 2 days of flu & pneumo injection. U TYLENOL10/6/2008for pain.
ked into clinic stating she thought she was having reaction to HEP B vaccine. Began havingUelevated Temp 9/23/2008
101 degree
9/24/2008
F 2am on the 24th
Y ### ###
th Baseball sized knot warm at touch and with redness x 1 month after vaccine was administered. U 2/24/2009 2/24/2009
ure has been normal, it is a red, heated rash located on right thigh. The injection was given on U Friday 3/6/093/6/2009
the rash3/8/2009
appeared on 3/8/09. T
veloped rash to left chest. Left shoulder, and upper left arm. BENADRYL 25mg PO was given. Y 3/7/2009 3/7/2009
algias, N/V and arthralgias. U 3/5/2009 3/5/2009
days after his vaccine heYran a feverYof 102. I tookY him to the pediatrician
40 Y and heYbegan to have N a seizure. 10/2/2008
It lasted 45 minutes
### so he went
n has been received from a certified nurse midwife concerning a female who was vaccinatedYwith a dose of GARDASIL. On an unspecified
n has been received from a consumer concerning a child in her family who on an unknown date U was vaccinated with a dose of MMR II (dos
n has been received from a 60 yearYold male pharmacist with no allergies and hypertension
Y N
and cholesterol
1/10/2009
who on1/14/2009
10-JAN-2009 was vacc
weakness in legs and urinary difficulty, Y starting 2Yweeks after vaccinations.
4 Patient was hospitalized,
Y supportive
1/28/2009 care,2/12/2009
symptoms self-resolve
t shot- fainting began, headaches. Y 10/2/08-2nd shot- fainting + headaches continue Y inabilityNto sleep or concentrate,
8/1/2008 inability to see or hav
as given ZOSTAVAX vaccine in her Yleft arm and Pneumococcal -PPV-23 in her right arm. Approximately 15 3/6/2009
minutes after
3/6/2009
the vaccine admin
minutes after vaccination child passed out, jerking motions of extremities were noted. B/P elevated Y to 158/98.
3/4/2009
Recovered 3/4/2009
quickly. Referred t
adverse rxn, doctor did not do any treatment. Y 2/27/2009
istory of tic disorder in January 2009-exacerbationY of tics. Parent concerned
1 - poss. R/T GARDASIL
N administration.
### Persistent### exacerbation
ode after 1st GARDASIL 8/18/08. Dizzy episode after 2nd GARDASIL 10/22/08. See attached. Y ### ###
dness left deltoid & soft tissue swelling
Y - onset 48 hrs after vaccinations. T-97.5 PO. Y 2/23/2009 2/25/2009
ike a fever of 102, became "unconsolable and rigid" within 2 hours after receiving vaccine. Also Y site of vaccine
3/4/2009became 3/4/2009
"hard as a rock" an
perienced nausea and itching starting the day after receiving the injection. Y 2/9/2009 2/10/2009
covering 5 inch Diameter Area Around Y injection site, Raised Lump At injection Site. U 3/3/2009 3/4/2009
U ### ###
d and swollen x 4 days; better today but continues and now itchy. Used ice and Motrin. N 3/2/2009
d, swollen, itchy lump hurts when touched for 3 weeks. Size of a silver dollar. To date there isYa shadow similar 1/13/2009to a fading
2/1/2009bruise.
ebruary of this year my daughter came up with a few ringworm's on her stomach and thigh. I U bought the over-the-counter
1/29/2009 3/3/2009 medication and wa
cine on Tues. 3/2/09 about 10 am. No immediate reaction. Wed. am patient noticed itching. by Wed. afternoon, 3/2/2009 area of3/2/2009
injection red, swolle
ed 3/18/09-records received-office visit
Y office visiti 12/5/08-positive ANA, fatigue and arthralgias.N October 10/3/2008
had asthma flare### that required ste
e, nausea, vomiting, fatigue, chills and dizzy started about 48 hours after second dose and lasted Y about 24 hours. ### ###
- child experienced occasional vomiting episodes on 2/14 & 2/15/09. There was also redness Y & swelling 2/13/2009
@ site of 2/14/2009
DTAP vaccination on th
lowing vaccinations fingers of both hands became + 1 swollen and points of bending on hands Y itched as2/20/2009
well as both 2/21/2009
forearms. Day # 2 no
& small vesicles on neck, back upper Y thighs. U 2/20/2009 2/24/2009
Y 3/3/2009 3/3/2009
and puffy red @ site and all below all way to elbow, and hot and sore. Stayed for 7 days. Y 1/28/2009 2/28/2009
ot to my 4 yr old within 8 hrs my daughters
Y arm swelled & then she woke up with hives everywhere U on her2/24/2009
body. It is2/24/2009
10 days & they are stil
edness only 1hr after shot - Overnight Y arm began to swell & is warm to touch - MD cannot rule U out cellulitis3/4/2009
based on3/4/2009
exam.
.5, myalgias, with redness / swellingY upper arm X 2 wks; skin subseq sloughed off. Tx with Prednisone
Y X1/20/2009
7 days. 1/25/2009
Y 2/24/2009 2/25/2009
Y of joint pain0 in a male subject of unspecified
N age12/1/2000
was reported by a lawyer and describedY the occurrence of joint pain in a female subject of unspecified
N age
6/30/2000
dministered as part of annual physical Y exam caused a severe allergic reaction in right nostrilNand eye. Paient 9/29/2008
started 9/30/2008
losing vision in right e
aleness, weakness, dizziness, distortion of hearing, sweating, nausea, wretching and vomiting Y (small amount,
2/20/2009
no food)
2/20/2009
within about 5 minut
was given as no history of tetanus was known for a long time. Client had received one on 01-22-2008.Y This
3/6/2009
was found 3/6/2009
when I went to ente
REFERS DIZZINESS, PERSPIRATION AND PALENESS.LASTED FOR 20 MINUTES. RECOVERED Y AFTER
2/23/2009 LAYING
2/23/2009
DOWN.
d 4cm red hive with central elevation. Given 12.5 mg benadryl. Observed for 1 hour. No SOA. Y Redness 3/10/2009
improved3/10/2009
to 2 cm and no longer r
d shortness of breath, hives, itchingYall over approximately 30 minutes after being given PPD, Y Influenza vaccine,
1/27/2009 and1/27/2009
Tdap. Sent to ER; rec
minute of receiving Menactra inj, becameY pale, slid to floor out of chair. RN lowered to floor. Stiffened
Y body 2/26/2009
for approx 2/26/2009
15-30 secs, face redd
ng the gardasil vaccine three weeks ago, my daughter has severe back pain, general muscleNaches, fatigue 2/17/2009
and terrible
2/9/2009
headaches. She al
D 15 MONTH SHOTS 4 DAYS AGO- STARTED WITH SWELLING OF LEFT LEG. NO TEMPERATURE. U 3/6/2009
CAME TO 3/8/2009
OFFICE- 1" X 1.25" B
arted jerking/seizure for about 1-3 seconds. Then Y had about a dozen 1 episode's of the jerking/seizures
Y for2/10/2009
about 3-52/11/2009
seconds. The patient w
ite reaction: redness and soreness-next day and lasting 5+ days. Itching after several days. Y 3/5/2009 3/6/2009
pneumococcal vaccine trial, with severe COPD, was diagnosed with colon adenocarcinoma,Y metastatic.1/31/2008 Vaccination 6/27/2008
took place on 1/31/20
### N 3/13/2008 ###
usea and vometing, mental confusion.This is info taken from the patients mom. Stated pt recovered Y and2/20/2009
is now @ her travel destination. At
bilateral profound bilateral brachial weakness approx.
Y 6-weeks after 7having received the splitNinfluenza vaccination
1/8/2009 (injectable).
2/15/2009 Vaccine wa
M child felt warm. Mother did not take temperture. At 8:15 or 8:20 PM child 's temperture 103.3. Y Child started
3/9/2009to have 3/9/2009
a seizure. Ambulan
5 mins after Varivax given, pt developed erythema at and above injection site. Per drs orderYgave pt dose3/6/2009 of oral benedryl.
3/6/2009
esented to office with child (Melody) reported that Varicella was given 2/26/09. Papular rashUappeared on 2/26/2009
child 3/8/09. 3/8/2009
No fever was noted
2009 at approximately 2:45pm the above named pt. was in the clinic with her daughter who U was receiving 2/12/2009
services and2/12/2009
the pt came to me a
emely sore arm with mild warmth in the deltoid since day injection was given. He is on day 5 U of pain in that
3/6/2009
arm, which 3/6/2009
is longer than what
n in health center on 03/04/09 with a rash that started on 03/03/09. Rash scattered throughtout U body: slightly2/3/2009
raised 3/3/2009
or macular, erythemat
zy a few minutes after HPV vaccine. Pt also felt her L arm turning different color. Pt has notYeaten whole2/18/2009 day prior to 2/18/2009
vaccination. Pt given
nt received 0.4cc of Infants Tylenol. An hour later she received DTAP, IPV, Hepatitis B, Haemophilus Y Inf.1/26/2009
B, Prevnar1/26/2009
and Rotateq. The patie
my first and only dose of Gardasil in late September, I beleive it was the 20th. I found out inUOctober that 9/20/2008
I was pregnant.
10/2/2008 My due date ba
ely after vaccination, a few red hive-looking rash spots appeared on my son's face/neck/arm Y and knee. Also,3/10/2009
difficult3/10/2009
to console crying a for
hrs, had sore arm, legs, headache, fever of 101.3, tiredness, dizzy, lack of appetite. With Jr.UMotrin and cold 3/9/2009
compresses
3/10/2009 on arm and legs
as given her first flu shot with Fluvirin on October 29, 2008. To date she still has muscle tenderness at the injection ### site. ###
0/09 2 red areas 1 to inner aspect of (L) arm 1 to back of (L) arm (slightly raised) swelling noted U to axillary3/9/2009
gland (L).3/10/2009
en 2/27/2009. (left deltoid) seen in office
Y 3/4/09 for left delt was erythematous and tender. 4X4U cm area, 2/27/2009
no lymphadenitis
2/28/2009
but slightly tende
runk and local swelling, pain, itchingYat vaccination site. Antihistamines Prescribed. N ### ###
48 hours-entire leg 2x NL size feverYup to 104.2 degrees x > 2 day after vaccine. U 5/12/2008 5/13/2008
Rt shoulder tenderness, pain with motion,Y radiation of pain to wrist/hand - ACE wrap, ice or heat,
N IBUPROFEN,### light12/4/2008
duty at work 12/29/08 -
Y U 2/23/2009 3/9/2009
redness and tenderness to site of injection.
Y U 3/3/2009 3/4/2009
n has been received from a physician Y concerning Y a female patient "in her 80's" who
Y "over a N year ago" was vaccinated with "single dose" of
n has been received from a physician Y concerning Y a 22 week male who Y on 15-DEC-2007 (lotNnumber 657673/0904U),
3/14/2008 3/14/2008
14-MAR-2008 (65991
n has been received from a consumer who saw via video clip online last month concerning aNmale "little kid" who was vaccinated with MMR
n has been received from a consumer concerning her 3 year old son with allergies to certainNepilepsy medication (unspecified which ones)
n has been received from a physician Y concerning a female who was vaccinated with a 0.5mlYdose of GARDASIL. 3/25/2008On 3/30/2008
an unspecified date, a
was reported by a healthcare professional andYdescribed the occurrence of cellulitis in a subject U of unspecified age and gender who was va
was considered medically important. Information regarding PREVNAR was received from a U consumer regarding a patient who developed a
rmation was received on 26 November Y 2008 from a health care professional in the USA. A 55 N year old female
11/6/2008patient
11/6/2008
received a right arm i
by the hospital that I had no recourse,Y I workedYas a nurse for 1 yr before all of this,
Y volunteered
N as an instructor. ### ###
o injection site, no redness or discharge noted. 3/4/2009 3/6/2009
ed: Had L) upper arm swelling starting 3/8, swollen lymph node under L) arm 3/9, Flu like sx Y chills, HA, neck 3/7/2009
ache 3/10, 3/8/2009
Inj site red, swollen
ed area size of 1/2 dollar - vaccine give 2/26/09 - and 2/28/09 area turned red and hot to the Y touch and swollen.
2/26/2009 Cheeks
2/28/2009
had a red rash with
le ADMS is referred to the FBVHC from Y WAMC Allergy department for persistent leucopeniaUsince receipt 1/27/2009
of multiple2/2/2009
vaccines. 3/18/09-rec
minutes after vaccines administered, Y patient became flushed in face with some rash, drooling, Y runny nose, 3/10/2009
gagging,3/10/2009
and coughing. Sent to
3-9-09 with 101-102 degree fever for 5 days previous r. nose cough & 15 "spots" on torso. Mother U called 3/18/2008
3-10-09 to report
3/9/2009
at least 100 more
V & MENACTRA @ 08:30 AM FeverY Pm - abd pain & facial hives - given BENADRYL - wentYER @ 6 PM. 3/10/2009
Given IV 3/10/2009
steroids & BENADRYL
poor feeding for 7-10 days after vaccine,
Y no fever, no seizures. Y 1/5/2004 1/6/2009
ection started to ache 3/5/09 pm. Unable to raise arm and fever. Recd. 1. Ibuprofen 600mg qY6-8 hours with 3/4/2009
food PRN 3/5/2009
discomfort 2. BENAD
dministered 3-3-09, on 3-4-09 Pt experienced redness and pain around the injection. DeniesYitching, or fever. 3/3/2009
Redness 3/4/2009
is about size of 50 c
inistering Tdap vaccine the patient fainted. TR, BP, WNL. Water given. Was all better <1 minute. Y 3/4/2009
area of erythema/tenderness (L) deltoid area (-) fever. Located above the area the injections were given. 3/4/2009
cellulitis secondary to immunization injection given 11/24/2009. Seen in clinic 12/8/08 placed Y on DURICEF 500mg ### BID
12/4/2008
x 10 days.
(inconsolable) crying over 3 hours Y in next 24 hrs with fever to 103. Y 3/4/2009 3/4/2009
l syncope- twice, oral fluids, juice remain
Y supine Trendelenberg. She was treated in our facility.
Y 2/15/2008 2/15/2008
e itching/hiving @ site & lip tingling. YNo other symptoms BENADRYL by mouth given + sent Y to ER for further3/9/2009
obs -> no 3/9/2009
further Rx needed.
nd sweaty about 30 min after receiving Y vaccine stated "I feel- not like I can't swallow but my throat
Y feels tight-
3/5/2009
like when3/5/2009
I take MORPHINE a
h of 104 degree F vomiting X 1. Y Y 3/5/2009 3/5/2009
Dtap + PREVNAR on 2-5-09 @ 16:30. 300/am 2-6-09 reported temp 104.7 continued running Y temp with 2/5/2009
no other symptoms
2/6/2009for 3 days. D
ed scream, inconsolable for 3 days after vaccine administration per mother's report. Y ### ###
chills started about 9 hours after vax admin. 3-3-09 was given TWINRIX and ADACEL. StillUfeverish 24 hours 3/3/2009
later but
3/3/2009
feels better. (R) arm
Dizziness, body aches, fever, headache. Y 2/24/09- Headache, nausea, body aches. 2/25/09- Dizziness,
Y neck
2/23/2009
and back 2/23/2009
pain, body aches, fev
d VARICELLA lesions 9 days after receiving VARIVAX. Y 1/29/2009 2/7/2009
arms and torso consistent with mild VARICELLA vaccine on 3/2/09, onset of rash 3/7/09. NoUother symptoms. 3/3/2009 3/7/2009
hecks, forearms, hands similar to varicella but also with papulovesicular lump character. Vaccine U given 3/02/09,
3/3/2009 onset
3/7/2009
3/7/09. No other sys
ought she had shingles, no visible outside
Y rash, had pain all over her body. Contacted MD for U pain medicine.2/27/2009 3/9/2009
onset 3 hrs after vaccine lasted 8hrs. Y 3/5/2009 3/5/2009
TDAP 3/6/09. Within 1-2 days developed fever of 102, body aches tender arm & hard bump Uthe size of a 3/6/2009 coin where injection given.
ceived a 3rd dose of varicella vaccine in error. Y 2/4/2009
rash around injection site, approximately 24 hour post injection. No itching/pain. Normal sideUeffect. 3/3/2009 3/4/2009
nduration at site of KINRIX 36 hours following administration. No systemic symptoms. Resolved Y spontaneously. 3/5/2009 3/7/2009
Y 3/9/2009
eumonia vaccine was given in left arm. Pt on Tuesday 3/3 am, hurt on Tuesday pm, the armUswollen and 3/2/2009 red, warm to 3/3/2009
touch and was fever
complains of dizziness approximately 15 minutes after receiving injections per employee report Y she got 3/10/2009
dizzy after 3/10/2009
smoking cigarette. Tem
ports evening 3/05/09 Pt developed swelling and redness at L thigh. U 3/5/2009 3/5/2009
ulated self on Right index finger. Lesion
Y developed. Also developed lesions in mounth and on Y Pharynx (stated 3/3/2009she 3/10/2009
put finger in mouth) una
rts pt with hard red area 2 1/2 inch in diameter. Fever of 104.0. Advised to give benadryl andYtylenol along3/5/2009
with use of3/6/2009
warm compress at th
2007 - Back and Hip pain Winter, 2007/08 - addition of shoulder and elbow pain, ankle pain
N and weakness,8/2/2007 increase
11/1/2007in back and hip p
TO CHICKEN POX AT DAYCARE. WOKE UP ON 2/13 WITH A FEW SAMLL BUMPS ON HEAD Y AND UPPER
2/27/2008 CHEST, AS DAY WENT O
ncussion and with the stitches they gave me a tetanus vaccine. My arm since has hurt a great N deal. I cannot
3/9/2009
move it. 3/9/2009
I have a very large lum
ccinated with Flu vaccine on 10/29/08 Y and developed syncope on 10/30/09 and passed-out.YCT scan of head was ### negative, ###probably not a
ling, redness, hotness, hardened area increasing over several days. started antibiotics on 3/6/09;
Y symptoms 3/2/2009
resolved3/3/2009
by 3/8/09
ery patches and itchy without pain all below injection site of left arm. Y 2/19/2009 3/3/2009
Tdap vaccine patient developed "twitching "over the left index finger initially and then generalized
U to the entire
3/4/2009arm/arm 3/5/2009
also had become s
oster rash 2 x 4 cm right thorax, pain right ribs, both for past 7 days. U 2/20/2009 3/4/2009
7/29/2008 N 7/22/2008 7/26/2008
TION SITE BECAME RED, HARD AND HOT TO THE TOUCH THE DAY AFTER BEING IMMUNIZED Y 3/9/2009 3/10/2009
, pt developed intermittent fussinessYand apparent abdominal pain (legs curling up). Worsened Y over next 2/16/2009
24 hours, then 3/7/2009
passed a bloody/m
ately 7 hours after vaccination on 3/10/09, started feeling febrile (no temperature was taken),Ychills, sweating,
3/10/2009weakness,
3/10/2009
full body muscle a
given to this patient. No reaction or adverse effects noticed as yet. Y 3/11/2009 3/11/2009
d area of erythema (1 cm diameter) and induration (2 cm diameter) in area of vaccine administrationU on right
3/9/2009
thigh 3/11/2009
CLAIMS THAT AS SOON AS SHE YWAS ADMINISTERED THE VACCINE (TETANUS BOOSTER) Y ON HER3/1/2009
RIGHT ARM,3/1/2009 AS SOON AS S
old had INTUSSUSCEPTION, hadYpreviously Yhad 3 doses of Rotateq 1 at correct schedule, last
Y dose on 10/20/08 ###10/20/08-office
3/8/2009 visit-well
(9 MARCH 2009): EVENING - HEADACHE, CHILLS. LATE NIGHT - HEADACHE, MILD FEVER., N TUESDAY3/9/2009
(10 MARCH3/9/20092009): HEADAC
st wanted to touch basis with Dr on Y some rough reactions to the Tdap injection pt received lastU Thursday (3/5).
3/5/2009Following the injection pt ret
swelling at site 5" long X 2" wide. (2) Inj site red. (3) some dizziness. Y
tous, edematous at vaccines site on right arm. BENADRYL, apply ice. Y 3/9/2009 3/9/2009
2/17/2009
lurred speech. 8-13-08 EquallibriumYoff. 3/18/09-records
Y received for4 DOS 8/21-8/25/08-DC U DX: Viral encephalitis.
7/14/2008 In8/9/2008ED C/O dizziness, slu
bling; Questionable seizure episodes Y 8 days after
Y 6 month vaccines2administered on 2/5/2009. N 3/23/09-records
2/5/2009 received
2/13/2009
for DOS 3/2-3/4/0
Immunizations client sitting in waiting
Y room reported "not feeling well". Head dropped to left U side, became 3/11/2009
pale, went 3/11/2009
into deep sleep-snorin
Y 3/10/2009
ceived DTaP, IPV, MMR and VARIVAX Y on 3/9/2009. Pt developed blistery rash on 3/10/2009 U and temperature.
3/9/2009 Patient
3/10/2009
presented on 3/11/2
fussy 20 days after administration of vaccines. Rash on face, chest, back and arms. ErythematousU macular/papular
2/18/2009 rash 3/8/2009
with areas where
ed rash similar to classic measles rash- (without oral lesions). U 2/23/2009 3/3/2009
t was received from a health professional on 09 May 2008. The patient is one of three patients U reported as part of a cluster. A child (exact a
t was received from a health professional on 09 May 2008. This patient is one of three patients reported as part of a cluster. A child (exac
t was received from a health professional on 09 May 2008. This patient is one of three patients reported as part of a cluster. A child (exac
ort was received 04 September 2008Y from a health care professional. A five-year-old patientYreceived an8/22/2008 injection of8/22/2008
DAPTACEL (lot numbe
ort received on 15 September 2008 Y from a healthcare professional. A 5 year old male patient, Y with no medical
8/22/2008 history,
8/23/2008
no illness at the time
rmation was received from a health Y care professional on 06 October 2008. A 19 month old male Y patient 10/2/2008
with no known 10/3/2008
allergies received a
ort was received 17 October 2008 from Y a health care professional. A 2-year-old female patient N with no past
10/1/2008
medical10/1/2008
history, had received a
was received from a consumer on 22 April 2008. A consumer reported that her four-year-old N daughter experienced
8/12/2004 "ongoing sicknesses s
ort received on 22 September 2008 Y from a consumer, who is the patient's mother. A 26 yearUold female 9/18/2008
patient, with9/19/2008
no medical conditions
-old female patient with a medical history of neurogenic bladder, reflux and spina bifida, had Ureceived an injection
9/9/2008of MENACTRA, lot numb
ort was received 12 December 2008Yfrom a health care professional. A 14-year-old female pregnant U patient
12/5/2008
had received ### a left deltoid injec
ort received from a physician on 29 October 2008. A female patient (age and date of birth unknown) U had received
7/1/2008 a dose 8/1/2008
of MENACTRA (l
rmation was received on 14 OctoberY2008 from a health care professional. A 12 year old female U patient 8/20/2008
with a history of acne, ### bronchitis, a
oe rash, respiratory distress, elevated Y temperature,
Y (102 and higher),3 tachycardia. TreatmentUrequired three 3/10/2009
trips to 3/10/2009
the emergency room w
n has been received from a licensed Y practical nurse
Y concerning her374 year old mother with Ncontrast dye2/27/2009
allergy and 3/1/2009
a history of varicose v
n has been received from a registered nurse concerning an unknown number of patients who U were vaccinated with a dose of MMR II (dose
Y nurse concerning a 34 year old female with asthma and Y no drug allergies
1/19/2009 who1/19/2009
was vaccinated with h
n has been received from a consumer concerning her son with no medical history (APGAR scores N noted 6/7/2001
to be 9 at birth)
6/7/2001
or drug allergy wh
1/11/2009 N 1/5/2009 1/11/2009
volvement, nerve inflammation:
Y numbness,
Y tingling, burning, facial and head neuralgia, migraine-like
N headaches
11/7/2008 (It began ### with nerve pain a
U 5/7/1999 3/4/2009
er surface of skin. Small and hard. Y 3/4/2009 3/6/2009
redness and itching past normal. Advised to take BENADRYL and if not cleared see primary U care doctor.3/6/2009
Was getting3/6/2009
better at the time.
induration, warmth, erythema, & TTP - Treated for possible cellulitis. U 3/3/2009
anorexia, SOB on mild exertion, asthenia - arrhythmia (? PVC). Sx on day 1 and 2, began to Y decrease on2/25/2009
day 3 and 2/26/2009
by day 6 was nl. Starte
ap given instead of DTap # 4 at 18 mos well child check. U 1/8/2008
gan noticing rash on chest, spreading to arms, flanks & legs. Reports that rash does itch. Patient U also stated
3/4/2009
that she
3/8/2009
has been utilizing ta
administered to patient. Pt. left office well and happy. Twenty minutes later mom carried pt.Yin. She reports 3/9/2009
pt. started
3/9/2009
c/o chest hurting an
e 99 degree-102.4 degree temps, watery eyes, loss of appetite, fatigue. Also, reddened, hard, U warm to touch
2/23/2009
3 "diameter
3/6/2009
circle around inje
ports his daughter has had fever, up to 102.4, this morning. Ibuprofen takes fever down to 101.2. Y 3/5/2009 3/6/2009
d, swollen, firm, hot @ area of injection site for 48h after receiving Meningitis vaccine. Y 2/25/2009 2/25/2009
U 1/3/2007 3/6/2009
U 7/31/1997 3/5/2009
PREVNAR / VARIVAX administered 2-25-2009, Lt Leg induration and erythema started 3-06-2009. U 2/25/2009 3/6/2009
hr after receiving immunization, child Y developed hives over entire body, no respiratory symptoms.Y Mother3/6/2009
called clinic
3/6/2009
and was advised to
mes in 3 days later. Her VARICELLAYvaccine Rt. Humerus caused a circular patch of blistersUto form along3/3/2009 with redness3/5/2009
& warmth on the si
1 day; afebrile and fine the following day Y 3/11/2009 3/11/2009
ous swelling at the site of the DTaPYimmunization. slightly tender, has a boggy nontender feel. U approximately
3/10/20093x3 inches.
3/11/2009 first noticed 24
LLED STATING CHILD HAD SEIZURE THE FOLLOWING Y MORNING 3 ON 3/10/09. TAKEN TO U EMERGENCY 3/9/2009
ROOM 3/10/2009
AND HOSPITALIZED
r state child had a fever, hives, and Y wheezing. Hives developed on 03/04/09 around neck and Y shoulder.Wheezing
3/2/2009start 3/4/2009
on Saturday 03/07/0
EL IMMUNIZATION GIVEN INCORRECTLY (TWO VIAL INJECTION) - THE PENTACEL IS A Y RECONSTITUTED
3/5/2009INJECTION WITH IMMU
th difficulty breathing, itching in throat,
Y and hive like reaction to scalp. Patient never given fluYshot in our clinic
3/3/2009
but reported
3/3/2009 having it in prior
on 3-10-09, right deltoid. Right arm is now sore with limited ROM in right shoulder. Right deltoidU swollen3/10/2009
and warm 3/12/2009
to touch; no redness. A
tely 25 minutes after Stacey recieved Rabavert, she stated her ears (bilaterally) felt hot, andYthat radiated3/5/2009
to her jaws3/5/2009
and cheeks. When s
9 13:45 Immunization administered. 13:55 Injection site red, puffy/size of quarter, painful. Cool Y compresses 3/11/2009
applied3/11/2009
with no adverse sympto
spitalized 4 months prior to service for Y Guillain Barre.
Y 2. Denied Previous
3 Y hospitalizations onNentrance physical.
3/5/2009 3. Denied
3/5/2009 Previous diagno
ed anthrax shot and one hour later he Y returned with visual changes. Pt states he blacked outY and when he 3/5/2009
woke he as 3/5/2009
seeing red. Pt state
Shingles Vaccine Zostavax. By evening Y had flu symptoms, sore throat and bronchitis. Have Ybeen sick for 3/2/2009
10 since. Zostavax
3/2/2009is made by M
d any types of warts. After the gardasil
Y injections, I got a filiform wart on my eyebrow that had Y to be removed because it affected my visual
hitis and flu like symptoms after getting
Y the vaccine. Y 3/2/2009 3/5/2009
d with intussusception 8 days after 4 month vaccines.
Y Neede surgery6 and was discharged 2Ydays later, 3/16/09
3/2/2009 Received
3/10/2009hospital medical
EL IMMUNIZATION GIVEN INCORRECTLY (TWO VIAL INJECTION) - THE PENTASEL IS A Y RECONSTITUTED
3/5/2009INJECTION WITH IMMUN
09, AN MMR AND A VARIVAX Y WERE Y ADMINISTERED
Y TO THIS PATIENT
2 BY THE OFFICEYMEDICAL 2/24/2009ASSISTANT. 3/10/2009
ON MARCH 10, MOM
nd redness of left deltoid region 11cm x 4cm 3/11/2009 3/12/2009
d shingles 19 days following vaccination. Y 1/31/2009 2/19/2009
ATE FEW MINUTES AFTER VACCINE PT COMPLAIN Y OF PAIN LOWER1 BACK RADIATINGU TO BOTH 3/11/2009HIP AND LEGS 3/11/2009
THEN GOT WOR
n at and around injection site. Pain through entire hand, shoulder and neck is accompied by nauisa U 3/10/2009 3/11/2009
questing VAERS done...one Y month after receiving MENACTRA & 1st GARDASIL on 9/10/08, Y Pt had blurred
9/10/2008
vision. 3 months### later diagnos
vere headache and was admitted toYhospital several Y occasions at ER2 after not sure if relatedYto vaccination. 5/26/09
### medical ###records receiv
ction w/ erythematous rash. Admitted to hospital. Y IV Vanco --> BACTRIM.
1 4/8/09-for DOS 2/20-2/20/09-DC
Y 2/17/2009
DX: Cellulitis-presented
2/18/2009 to ED w
of VARIVAX (L) shoulder - 3-10-09 returned 3-12-09 - Erythema 8x8 cm2 Induration 3x3 cm2YHeat 3/10/2009 3/11/2009
e, joint aches/pains, chills - arms swelling/
Y redness. U 3/9/2009 3/9/2009
fever developed 1 week after MMRYseen in ER and diagnosed with measle-like flat rash mostly Y at the trunk2/2/2009
and back.2/12/2009
Lasted 2 days.
ven Td & pneumonia vaccinations. 10 min later SOB and chest tightness with hives on local Yreaction. EPINEPHRINE 0.3mg 1:1000 and B
len, hard, lump "the size of 2 Quarters" no c/o discomfort noted. U 3/11/2009 3/12/2009
tion, INFANRIX, given on 3-3-2009. Patient's mom noticed large, red swollen area on right upper N arm on 3/2/2009
3-5-2009. Patient
3/4/2009 seen today, 3/5
received @ bedtime T-101.0; pt woke Y parent up in am (3/10/09) with febrile Sz (temp in ER 102.7
Y (R)) tonic-clonic
3/9/2009 upper
3/10/2009
extremities stiffeni
t in by aunt to have PPD read. No Tx needed. Aunt stated mom noted redness to left deltoidYarea no other3/6/2009 sx noted. 3/8/2009
1 1/2 cm X 7 1/2 cm sl
her (L) arm has been sore ever since she had the BOOSTRIX. She has shooting pain with certain N movements,### for weeks
1/7/2009
she couldn't raise
e, vertigo, tingling in arms, pain bothYaxilla. 3/17/09-records received for EDvisit 3/6/09-C/O headache
N two 3/5/2009
epidsodes 3/6/2009
of syncope and body a
d late on 3-9-09 a red swollen area to (R) arm - Today 3-12-09 Dad noted a rash around (R) arm to deltoid3/9/2009 region child3/9/2009
had a fever 101 on 3
after injection c/o severe pain Lt arm-fever that afternoon - temp not checked -Fever with chills Y - Left school
12/1/2008
next day 12/1/2008
because of temp.
after shot given swollen fore arm. ShotsY given in deltoid. N 3/10/2009 3/11/2009
Y 3/9/2009 3/11/2009
dverse RXN to PCV Pt. requested PCV. Pt. received .05 ml on 3/3/09 in (R) arm no RXN @ time of shot. Pt 3/3/2009
called on 3/4/2009
3/4/09 (advised to com
with tingling in the heel surface of his feet (bilateral). No difficulty with ambulation or LE weakness. On 3/93/5/2009
pt noted additional
3/8/2009 tingling in his
er ZOSTAVAX numbness (L) side of cheek - client very nervous about vaccine (Dental work 6 months) tingling 3/12/2009in jaw
3/12/2009
up to eye. Hx HTN, B
nutes of receiving HPV vaccines, became light headed pale, nauseated, weak, vomited, had Ymuscle weakness### until next day.
### Mother refuse
er receiving PENTACEL, PREVNAR, HBV, ROTATEQ mother brought pt in for evaluation onN1) swelling of 3/6/2009
outer thigh3/6/2009
involving area includ
swelling at site of vaccination on Wed. following vaccine began itching and cotton mouth. Began U taking BENADRYL.
3/9/2009 3/11/2009
d area, red, swollen and warm to touch.Y U 3/10/2009 3/11/2009
VAX administered SQ R arm on 3/11/09. Y Developed edema, erythema, warmth from upper 1/3 U arm to elbow.
3/11/2009
Accompanied
3/11/2009by pain & stiffn
haped 9 x 9 cm erythematic area cellulitis, cellulitic area. U 3/9/2009 3/10/2009
red KINRIX as "catch up" immunization to 8 year old. Y 3/10/2009
ped mild case of pyelonephritis whileY taking oral typhoid course. Y 3/4/2009 3/5/2009
n has been received from a physician concerning a female who was vaccinated with VAQTAUvaccine. Subsequently the patient experience
Y from a nurse concerning a 19 month old female infant Y with no pertinent ### medical
12/8/2006
history, drug react
n has been Roche Pharmaceutical (manufacturer report # 540009) a 64 year old female reported U she was vaccinated with VAQTA and RE
n has been received from a company representative concerning a 6 month old female who on U an unspecified date was vaccinated with PE
ort received on 24 February 2009 from Y the patient's parent. A 16-year-old female patient hadYreceived a dose of MENACTRA on an unspec
ort received 23 February 2009 from a health care professional. An 18-year-old male patient had N received a first### dose,
12/1/2008
left arm injection of A
ort received 23 February 2009 from Y a consumer, who is the patient's parent. A 14-year-female U patient had2/20/2009
received 2/20/2009
a first dose intramuscul
serious case was received on 20 FebruaryY 2009 from a health care professional. A 13 year oldN female patient who### inadvertently
### received a
ort received on 11 February 2009 from Y a healthcare professional. A 17-year-old female patient, U with an allergy
2/10/2009
to penicillin,
2/10/2009 received a first l
Y from a physician and a nurse concerning a 10 month N old male who had ###a history### of being born pre
n has been received from a consumer Y concerning her 14 month old niece, with no medical history
Y and no allergies,
### who on ###10-DEC-2007 w
n has been received from a consumer Y concerning her 13 month old son with no medical history and an allergy### to amoxicillin###who on 10-NO
n has been received from a Nurse Practitioner,
Y (N.P.), concerning a 2 year old male patient Y
who on 10-DEC-2007 ### was vaccinated
### IM i "left
Y from a registered nurse concerning a 3 year old female
U with chronic ear infections and nasal cong
follow-up information has been received from a physical therapist concerning a 5 year old female,N who on 26-OCT-2007
### was vaccinated w
n has been received from a physician Y concerning a 15 month old male with no illness at the Ytime of being 12/3/2007
and no pre-existing ill
n has been received from a physician and a medical assistant concerning an 18 month old female Y patient1/3/2008
with a peanut1/9/2008
allergy, who on 03
n has been received from a consumer Y concerning his approximately 15 month old daughter N who on 12-DEC-2007 ### was vaccinated
### with a do
n has been received from a physician Y concerning Y a 4 month old female patient who on 26-JAN-2008
Y was1/26/2008
IM with a dose of PED
n has been received from a physician Y concerning a 7 month old female with no pertinent medicalU history1/24/2008
and no drug 1/24/2008
reactions or allergies,
n has been received from the fatherYof the patient (a "doctor") and a physician concerning the Y reporter's 2 month###old son who ### on 17-NOV-2
n has been received from a consumer concerning her 12 month old son who on 28-NOV-2006 Y was vaccinated### with10/8/2007
the third dose of PEDV
n has been received regarding a case in litigation from a lawyer via paralegal articles concerningU a 6 year1/1/2001
old female child with enterovirus
n has been received from a mother concerning her 12 month old son with an unremarkable N medical history
2/14/2008
and no allergies,
2/14/2008who was vacc
n has been received from a occupational therapist concerning her 5 year old daughter with pertinent
Y medical history and drug reaction/aller
n has been received for a case in litigation from information obtained from a published literatureU article concerning
6/24/2002 a6/24/2002
4 month old female wh
n has been received from a physician via medical records concerning a 16 week old female Y with no known1/11/2008
drug allergies,
3/4/2008a gastrointestina
n has been received from a consumer Y concerning her 1 year old daughter with a murmur and N no drug reactions/allergies
### who
### on 15-NOV-2
n has been received from a physician concerning a 9 month old female infant with a possibleUallergy to CERON ###DM, a maternal
### grandmoth
n has been received from pediatric medical records and a pediatrician concerning a 19 weekNold male patient 4/11/2008
with a4/18/2008
history of respiratory s
n has been received from a physician Y in the form of pediatric medical records which were received
U and reviewed
5/9/2008concerning
6/1/2008an approxima
n has been received from a physician Y in the form of medical record concerning a white female U patient who5/15/2008
on 18-MAR-2008
6/25/2008was vaccinate
n has been received from a Licensed Practical Nurse concerning a female patient with allergic Y reaction to antibiotics cefaclor who was vacc
n has been received from a physician Y concerning a 16 week old female with a history of nasal Y congestion 7/22/2008
and constipation
9/11/2008 who on 22-JUL-
n has been received from a consumer concerning her 6 week old son with sensitivity to milkYprotein in formula 8/8/2008
and no8/9/2008
other allergies who w
n has been received from a physician Y concerning a 23 week old male with a history jaundiceYand group 7/21/2008
b betahaemolytic
8/4/2008
streptococcal pos
male (unknown age) took the first dose of VIVOTIF (Batch no. : unknown) on unknown date.U Within one day he experienced severe nause
ort was received on 22. Jul.2008 from a physician. This 9-year old patient took first dose of VIVOTIF
U (Batch
7/21/2008
no.: unknown) on 21.JUL.2008
was reported by a physician (also the Y father of the subject) and described the occurrence ofUencapsulation 3/2/2009
reaction in3/3/2009
a 2-year-old male su
as given vaccines on 2/25/09, developed a red cluster of bumps on right leg where vaccine N was given on 2/25/2009
3/6/09, and3/6/2009
by 3/8/09 a full body
ptoms was my left arm where flu shot was given, began to be very sore days later.Y ContinuedNthroughout the whole ### arm and ###my hand, wrist
ther of child) called to clinic on 3/4/09. Info vax received today. Spoke to MOC, states child had Y reaction of3/2/2009
3" redness, muscle hard and itch
me rash in palms and plantar feet, with right ankle swelling - 8 days after HEB B #4 and HEB Y A# 1 given. 2/23/2009 3/3/2009
around shot area. Tingling of lips. Y 2/6/2009 2/7/2009
d fever 101.8 with chills; red, raised rash on arm and legs within 24 hrs of vaccine. Symptoms Y resolved over 2/6/2009
4 days. 2/7/2009
and erythema 10X13 cm below area of vaccine site. U 2/7/2009 2/8/2009
n has been received from a 72 yearYold male patientY with allergy to 0
several unspecified medications,
N Parkinson's
9/1/2008disease,
10/1/2008 hypertension and
n has been received from the mother Y concerning her 16 year old daughter with no medical historyY and no allergies
### reported, ###who on an uns
n has been received from a medicalYassistant for the pregnancy registry for GARDASIL concerning Y a 15 year
3/4/2008
old female
3/4/2008
patient with type 1
rmation was received on 02 March 2009 from a health care professional. A 15 year old female U received an 8/16/2008
intramuscular 1/8/2009
left arm injection o
HIGH BECAME RED, WARM TO TOUCH, Y AND SWOLLEN. WENT TO LOCAL ER, RECIEVED Y 10 DAY SUPPLY 3/9/2009 OF 3/10/2009
AUGMENTIN AND B
RECIEVED ANTHRAX VACCINE ON 7 MAR 09. SWELLING AND DISCOLORATION A THE U SITE OF THE 3/7/2009
INJECTION.3/8/2009 MEMBER STAT
swelling, nausea, headache, low grade fever. U 3/10/2009 3/11/2009
ports the following: Child had normalY behavior throughout day until approximately 7 hours post Y vaccination,3/10/2009
(7 PM) the 3/10/2009
child became letharg
5pm c/o sore right armpit, took ibuprofen 800mg,11/1/08 3pm injection site size of a quarter, Yfever & chills, temp ###101 degree: ###11/2/08 injecti
IA PRESENTED ITSELF ABOUT 5 HOURS AFTER ADMINISTRATION N 3/12/2009 3/12/2009
PED HERPES ZOSTER 5 MONTHS AFTER RECEIVING VARICELLA VACCINE. UNILATERAL Y VESICULAR 10/1/2008RASH 3/11/2009
FROM MID ABDOME
after immunization she noticed a raised,
Y red area (slightly bigger than a silver dollar) on herYright deltoid. 2/6/2009
Broke out2/13/2009
in "little bumps" around
EATION OF LEFT ARM. ARM IS SWOLLEN& RED FROM TOP OF LEFT SHOULDER TO ELBOW Y (18 3/10/2009
CM). CIRCUMFERENCE
3/11/2009 ABOVE
perienced pain in R arm continually since receiving vaccine-worsens with exertion of extremity. N A "divit" at10/9/2008
injection site
10/9/2008
1st appeared about
ck, neck shoulder and head pain, Headache,
Y and disorientation, could not concentrate, malaise,
U weakness, 3/10/2009
tired. Went
3/11/2009
to my family doctor
BROUGHT PATIENT IN WITH COMPLAINTS OF RIGHT UPPER ARM RED AND SWOLLEN U (WARM TO 3/11/2009
TOUCH). 3/12/2009
ONSET OF SYMPTO
3" long by 1&1/2" oval. It is red and inflamed. Not raised and no pain associated with it. WillUtake Tylenol 3/11/2009
or Advil if3/13/2009
it starts to hurt and will
REDNESS ON VACCINATION SITE. REACCTION U 3/6/2009 3/6/2009
mall blisters in a circular pattern around the injection site approximately 2 inches in diameter.-notY sure if exact vaccination
### ###
date is correct
with balance within an hour of vaccine. Fever 103 began that night, lasted several days. Child had episodes of twitching during fever. Child
ated baby cried nonstop for eight hours Y straight.YMother stated no fever 1 or swelling around shot Y site. Mother 1/8/2009
stated took 1/9/2009
to ER, and the bab
nduration approx 12 hrs after injected. No fever, HA respiratory symptoms, G1 symptoms. Y 3/9/2009 3/9/2009
given DAPTACEL on 3-5-09, on 3-6-09 her legYwas red about 1-2",1on 3-7-09 swelling and redness Y was about
3/5/2009 5-6 inches
3/6/2009 around, no fever
ately 24 hours after admin, Pts arm Y developed sore, red, inflamed rash- diagnosed at ER as U allergic Rx. 2/28/2008 3/1/2009
njection site - repeated Benadryl X1. Y
ody x 2 weeks. Pt got chicken pox. Y ### 3/5/2009
redness, swelling at site of DTaP injection. Y 3/4/2009 3/5/2009
redness, swelling at site of TDAP injection. Y 2/23/2009 2/25/2009
n eve., pt. noted onset "stiffness" rightY knee joint; next a.m. (3/12) awoke & noted stiffness w/swelling
U @ 2/27/2009
left knees (R 3/11/2009
> L) & "stiffness" in m
d HIB and DTAP into left thigh. Erythematous macular lacy area 13cm X 13 cm surroundingYinjection site. 3/11/2009 3/12/2009
al temp Friday eve 3/06/09 beginning around 7pm. Temp remained in that area with Tylenol +Y Motrin alternating. 3/6/2009 All day
3/6/2009
Saturday 3/7/09. Su
ately 24 hours after receiving lZ's mmr & Dtap in Rt arm, pt. mom noticed pt. arm red, warm to Y touch & swollen
3/11/2009 in area
3/12/2009
where lZ's were give
hematous hyperemic plaque covering Y lat aspect of L arm. U 3/10/2009 3/12/2009
es developed on right shoulder. C/oYwarm ear (right) 12:50 and itchy all over. ZYRTEC - given Y in office 3/13/2009
10 mg. orally. 3/13/2009
20 mins. later hives
cular erruption with subsequent cellulitis
Y of RLe + inguinal LAB. Tx: ORAPRED 15 mg qd xNsd; AUGMENTIN 250 mg bid x 10d.
ed rash - hives on chest, back, arms & face. Started < 24 hrs after vaccines were administered. Treated3/12/2009 with diphenhydramine.
3/13/2009
ced he had hives / whelps to right cheek on his face, right arm/shoulder, and right leg. She put Y child in bathtub
3/11/2009 & called
3/11/2009
the doctor on call.
ollen, hives (Lt arm), Lt arm red, hotYswollen pain in Lt arm no fever, no problems breathing. Y Will given Benadryl
3/4/2009 3-6-093/5/2009
(per doctor direction
ADACEL 430 PM. 3/11 That night, developed vomiting and headache. On 3/12 developed N fever to 1023/11/2009
which responded3/11/2009 to TYLENOL. V
hrs after receiving ROTAVIRUS vaccine, pt. developed diarrhea, blood & mucous present atNtimes for next 2/25/2009
2 weeks.2/26/2009
Pt. was evaluated by
RDASIL #3 Pt. c/o stomach pain after 2 days mother report her daughter is doing fine.
ately 10 minutes following injections, pruritis and urticarial rash developed. Rx BENADRYL liquid Y 1 tsp. 3/12/2009 3/12/2009
Urticaria around (L) Deltoid area and both hands x 10 days. Patient given Allegra 180 mg # U 14 and told 2/18/2009
to F/U as needed2/28/2009 for change in con
unt of hives noted in groin area approxY 5 hours after vaccination, rash next day much more U extensive involving
3/13/2009 entire
3/13/2009
trunk -hives with targ
and seizures. 4/16/09 MR Y received from PCP from 2/18/09 to 4/13/09. Pt presented on 2/18/09 N for 3rd Gardasil
2/18/2009 vaccine
3/14/2009
1757U. RTO for f/u
tis 24 h after guardasil vaccination. Right temporal-occipital
Y T2 flair 7on MRI with negative HSV PCR. 3/26/09 2/12/2009
Received
2/13/2009
hospital medical re
dministered as part of routine PEx 2/18/2009.
Y Pt
Y seen on 2/23/20094with pain and redness inUthe vaccination 2/18/2009
site and3/5/2009
neck soreness. She w
nistered Hep B vaccination at 3 days Y old, 4 hours
Y later had a seizure. 4 Immediately after vaccination
Y she became
1/3/2009sleepy1/3/2009
and slept until she
eving first round of Gardasil shot- three
Y weeks later noted small red spoches on chest area( Sat N AM), Sun 2/2/2009
day felt weak,3/7/2009
back cramps, and n
d burning rash on arm 4in in diameter. Experiencing chest pains and joint pains.As well as cold U sweats. 3/12/2009 3/13/2009
igh with erythematous, tender nodule. U 3/13/2009 3/14/2009
ort received from another manufacturer Y (document number 45214356), who received the report U from a health care professional. A female p
n has been received from a physician Y concerning an 84 year old male patient with Y diverticulitis
N and a history12/5/2008
of malaria
12/5/2008
who on 05-DEC-200
t was received from GlaxoSmithKline Y and was Y assigned manufacturer 0 report number A0769858A U for KINRIX.
2/19/2009This 2/19/2009
case was originally repo
n has been received from a consumer concerning her son who was vaccinated with all the doses U of MMR II on unspecified dates. Subsequ
eeks s/p ROTATEQ vaccine, Y child had intussusception.
Y Vaccine 12/29/09,
2 admitted for intussusception
Y 1/15/09.###3/26/09
1/15/2009Received hospita
tions given 2-26-09 had not been entered into system & mom did not bring immunization record. U 3/12/2009
5.5 - 6.5cm SL. red soft area - warm -> hot to touch. U 3/6/2009 3/9/2009
U 3/10/2009
9 sudden onset of knot in left neck Y area, swelling from left neck to left arm & left facial swelling
N & twisting 2/5/2009
of face - 3/12/09
2/18/2009 cont. high BP &
d urticarial lesions on back, face + extremities 5 days after MMR, varicella, Hepatitis A + influenza N vaccines 2/13/2009
were given.
2/18/2009
Pt had no other sym
ed child cried 4-5 hours after having PENTACEL. Notified provider prior to next scheduled dose. Y Next dose not ### given of PENTACEL.
### Only H
sode of a fainting spell/?seizure. PtYfell on ground and lifted arms in air 'stiff'. Pt then vomited.Y Vitals were 3/12/2009
w nl and pt 3/12/2009
was stable and was s
3/4/09 (MMR, VARIVAX, PCV, HepY A) had fever 3/7 (100-101) and 3/8, 3/9) developed rash U on back and3/4/2009
neck is cranky.
3/7/2009 Sat night 3/7 scr
eft arm at 8am, around 9-10 am Left Y hot, swollen and red. T99.8. U 3/9/2009 3/10/2009
ates noticed L arm swollen 24hrs. after Imms. with redness. 48 Hrs later blisters appeared around Y Imms. area.
3/2/2009
Applied3/4/2009
topical Benadryl and
t arm pain started 24 hours after immunization with MENACTRA. Pt stated his arm was difficult Y to move and 3/5/2009
"felt heavy"
3/6/2009
for a day or so. Pt
ebellar ataxia Y U 2/24/2009 3/3/2009
vere outbreak of herpes zoster. Patient received vaccine 1/0/08 then on 12/29/08 had a severe outbreak of 1/9/2008
herpes Zoster.###
L injection, fever headache, nausea 3/12/2009
N UNEXPECTED GOOD EFFECT RATHER THAN AN ADVERSE EFFECT! Since I don not know where 1/24/2009
else to report
1/24/2009
this I am making th
ely after receiving Hepatitis A, Flu, MMR, MCV4 and Varicella, the patient stated he didn't feel Y well. His color
3/10/2009
became 3/10/2009
pale and he passed o
rea of shot. immobility - mild pain. Taking
Y MOTRINE. N 3/10/2009 3/10/2009
oropharyngeal swelling. Vomiting, Y flushing and hives on whole body. Y 3/5/2009 3/5/2009
covering body. U ### 3/10/2009
erythema with induration at injection site. U
monia vaccine was given in my left arm at around 10:30 A.M. on 03/06/2009. I began experiencing Y the usual
3/6/2009
pain and3/7/2009
fever at the injection
after injection + returned to hotel room
Y @ 12:30pm stated noticed itching @ injection site (left Y deltoid) and3/9/2009
she applied 3/9/2009
Hydrocortisone (1%
U 2/18/2009
d an ileo-colic intussusception which presentedYto the ER 2 days after 2 vaccine administration. Y It was reduced
2/23/2009
with an
2/25/2009
air enema and patien
r, hysterical laughing, nonsense speech, rash on legs especially right thigh has a bright red rash U area about 3/4/2009
two inches3/13/2009
in diameter
ild's mom reported fever, redness and hardness on left thigh today which began 3-2-09 p.m. The doctor's3/2/2009 office told 3/2/2009
her to check the temp
hone call on 3/11/09 from client's mother
Y stating she took ct to dr for rash and swollen lymphYnodes. Dr diagnosed2/17/2009 her 2/25/2009
with reaction to MMR
received 2 doses of Varicella vaccine per appropriate schedule. 08-23-04 dose 1 and 08-19-08 Y dose 2. Developed
8/23/2004 2/20/2009
rash consistent with chi
to facility approximately one hour post injection c/o numbness in throat moving to back of tongue Y and roof 3/16/2009
of mouth 3/16/2009
given Benadryl po at 10
ported very hard, red, warm and swollen area to left upper arm and fever of >103 degrees F Ywithin 3 days 2/12/2009
after receiving
2/15/2009
the vaccines. She
Boostrix in right arm on 03/05/09. Noted swelling, discomfort and pain at injection site on 03/11/09,Y 6 days3/5/2009
after vaccination.
3/11/2009Contacted fac
d area cellulitis at innoculation site. Y Y 3/4/2009 3/13/2009
d Cellulitis at innoculation site. Y Y 3/4/2009 3/13/2009
cm induration, redness, itchiness at site of injection. Rx for Benadryl and hydrocortisone 1%Y 3/13/2009 3/14/2009
arp pain and swelling right arm focussed on injection site for Tdap. Pain into axilla, shootingUdown arm and 3/11/2009
into shoulder
3/13/2009and neck. No dy
llen left arm. Fever, nausea, headache. Symptoms developed 24 hours after injection and continued N for 3/12/2009
48 more hours.3/13/2009
Patient was unable
nued L upper arm pain and numbness down to elbow, cannot raise L arm above 90 degrees.UStates vaccine caused ### these symptoms. Has
ES ONE WEEK AFTER VARICELLAY VACCINE ARM BECAME RED AND SWOLLEN. MILD,GENERALIZED 3/2/2009
RASH 3/9/2009
BEGAN TWELVE DAY
d generalized diffuse macular rash, herpetiform vesicles on neck Y ### ###
PPV shot around 10:45 a.m. after aYyearly physical with Dr. I have asthma, therefore shouldUbenefit from3/12/2009
getting the3/12/2009
vaccination. I was feel
and pain at axilla on left side. Was prescribed
Y MEDRAL Pk, antihistamine and KEFLEX BID. Y 3/10/2009 3/11/2009
lling, redness at injection site. Headache, nausea, vomiting, fatigue, fever 24 hrs. Y 3/11/2009 3/12/2009
adaches, myalgias, sore throat about 6 days after immunization given. N 3/4/2009 3/11/2009
listless, not self for 1 wk post immunization. Y 1/12/2009 1/12/2009
e like 1 cm raised area 1 inch from injection site R arm where varicella was given SQ. Notified Y M.D. via phone.
3/9/2009He ordered
3/9/2009BENADRYL liqu
ied us 48 hours after vaccines that child
Y had had hives and increased temp 101 degrees F -Y102 degrees 3/11/2009
F 24 hrs after
3/12/2009
vaccine given. Her
dness / itch on L mid arm upon D/C home size 4.5 cm and lump felt about a quarter size, HOUnotified /seen 3/14/2009
Pt. and instructed
3/16/2009 to apply warm
ess on nape of neck @ HS on 3/12/09. Y Dx with hives by MD on 3/13/09 Hives prominent on N trunk, groin 3/12/2009
+ axillary with
3/12/2009
intense itching.
0 min after immunizations the Pt fainted. No resp. arrest initial V/S BP 109/57 HR 97 RR 24 O2 Y Sat 98-100%3/13/2009
Room 3/13/2009
Air, monitoring and nutr
d they noticed redness on 3/16/09 (L) upper deltoid & swollen. Today I notice a little rednessYaround the 3/13/2009
vaccine area.3/16/2009
No swollen no indura
ped a large red swollen (10cm X 11cm) Y notice 24 hours post injection. Pt says site is painful Y
and warm to3/14/2009
the touch. 3/14/2009
ted with 30-50 lesions on arms and Y trunk. Afebrile. Dx with Varicella. Y 6/11/2002 3/13/2009
est pains, heaviness on chest, shortY of breath, neck and shoulder pain in right side where injection
Y was given.
3/4/20093/30/09 MR received from O
ain, Fatigue, and nausea. Pain goes up into her neck. And dizziness. Y 2/20/2009 2/20/2009
lateral injection site. Y Y 3/2/2009 3/4/2009
ous after - then tired/fatigue- wheezing.
Y Taken by ambulance (911) to ER. Released. ORAPRED, Y CAREDIN.3/11/2009 3/11/2009
alsy 2 weeks after MCV4 vaccine. TreatedY with Prednisone, Acyclovir. 4/29/09 MR received U from PCP with2/27/2009
DX: Bells3/13/2009
Palsy. Pt presented i
ed erythema multiforme exanthem dev. x 8 days after vaccination (was on amoxicillin). U 3/6/2009 3/14/2009
and swelling around injection site, three inches in diameter. Slight pain around site. No otherUsymptoms reported.
3/11/2009 3/13/2009
enopathy of R axillary nodes causingY significant swelling, mottled rash and pain in the R axilla.U Improving3/11/2009
slightly with
3/12/2009
ibuprofen on day 4.
oint pain after immunization until 3/08. Y ### 2/13/2008
hematoma at injection site. No redness. N 2/6/2009 2/6/2009
n has been received from a physician concerning a 7 month old patient who was vaccinatedUwith the first dose of ROTATEQ (lot # not prov
n has been received from a consumer concerning her son who, "as an infant", was vaccinated Y with a dose of ROTATEQ. Subsequently th
n has been received from a physician concerning a 31 year old female nurse who on 17-FEB-2009 U while2/17/2009
she was orally
2/17/2009
administering a ch
n has been received from a licensed Y practical nurse (L.P.R.) concerning a 9 month old patient
U who on 17-FEB-2009
2/17/2009 2/17/2009
was inadvertently give
n has been received from a registered Y nurse with medical records concerning a 12-month-old Y male patient
1/18/2008
with no medical
8/4/2008 history or allerg
n has been received from a medical assistant concerning a male who on 01-AUG-2008, 01-OCT-2008 U and
2/10/2009
10-FEB-2009
2/10/2009was vaccinated w
Y a 13 month old patient who on 05-MAR-2008 U was vaccinated3/5/2008
orally with the first dose of ROT
n has been received from a healthcare worker concerning a 28 day old patient who on an unspecified
U date was vaccinated orally with the fi
n has been received from a physician concerning a 12 month old male who on 13-SEP-2007Ywas vaccinated 1/18/2008
with a 28/6/2008
mL first dose of ROT
Y concerning an 18 week old male patient who on Uan unspecified date was vaccinated with the fir
n has been received from a physician concerning a "4 month old" male who was vaccinatedUwith a 2 ml second dose of ROTATEQ (lot # w
n has been received from a consumer concerning his son who at age of 16 weeks was vaccinated N with the first dose of ROTATEQ and at 6
n has been received from a medical assistant concerning herself who got ROTATEQ (no lotU# provided) in her eye and on the skin around
n has been received from a physician Y concerning a 2 month old male who was born at 29 weeks Y gestation,
2/2/2009
who on approximately
2/2/2009 02-FEB-
n has been received from a physician concerning a 4 month old male patient who in approximately Y 06-DEC-2008,
12/6/2008 was12/6/2008
vaccinated with sec
n has been received from a physician who reported that an extra dose of ROTATEQ (lot notUreported) may have been given at the same vi
n has been received from a physician Y concerning a 23 weeks old patient who on 19-FEB-2009 U was vaccinated
2/19/2009orally
2/19/2009
with the first 2 ml dos
n has been received from a physician Y concerning a 7 month old patient who on 24-FEB-2009 U was inadvertently
2/24/2009 vaccinated
2/24/2009 orally with the f
n has been received from a physician concerning a female who on 21-FEB-2009 was vaccinated N with first
2/21/2009
0.5mL dose2/22/2009
of GARDASIL. Ther
n has been received from a consumer concerning her daughter a 13 year old female who in NOctober 2008, was ###
vaccinated
12/1/2008 with a third dos
n has been received from a physician Y and medical assistant concerning a 18 year old female N who received
11/1/2007
all 3 doses
2/16/2009
of GARDASIL. The
Y a 14 year old female who was vaccinated withNGARDASIL (Lot# not reported). After receivin
n has been received from a registered nurse concerning an approximately 25 year old female Y who in November
1/21/2009 2008,
1/23/2009
was vaccinated with
Y a 13 year old female patient who on 10-DEC-2008
U was vaccinated ###with her ###
third dose of GAR
n has been received from a consumer concerning her daughter who was vaccinated with a dose U of GARDASIL (dose, route and lot numbe
Y a female patient who on unspecified dates was Y vaccinated with the first and the second 0.5 m
n has been received from a physician Y concerning a female patient who on an unspecified date U was vaccinated with a 0.5 ml dose of GARD
n has been received from a MedicalYAssistant concerning a 17 year old female patient with no U pertinent 2/23/2009
medical history
2/24/2009
and no drug reactio
n has been received from a certified medical assistant concerning a 15 year old female with allergic rhinitis
1/26/2009
who on 1/26/2009
26-Jan-2009 was vaccin
n has been received from a physician concerning a 21 year old female with Raynaud's syndrome N and hypertension
2/26/2009 2/26/2009
who on 26-FEB-2009, a
n has been received from a physicianY concerning a female under 18 years old with no pertinent
Y medical2/18/2009
history who2/20/2009
on 18-FEB-2009 was v
n has been received from a consumer concerning her daughter who was vaccinated with a dose U of GARDASIL (dose, route and lot numbe
n has been received from a nurse concerning a patient who was vaccinated with a dose of GARDASIL
U (Lot# not reported). After receiving
n has been received from a licensed Y practical nurse concerning a 20 year old female patient with no medical
2/26/2009
history2/26/2009
and drug reactions wh
n has been received from a nurse practitioner concerning a female who was vaccinated withUthe second dose of GARDASIL 0.5 mL. Abou
n has been received from a registered nurse, for the Pregnancy Registry for GARDASIL, concerning
Y an 3/24/2008
18 year old3/24/2008
female who on 14-JAN
n has been received from a physician's
Y assistant concerning an approximately 17 year old female
U patient who was vaccinated with the first
n has been received from a consumer concerning her 22 year old daughter, with no known drug N reaction/allergies and 2/19/2009
no pertinent medica
n has been received from a consumer concerning her son with no pertinent medical history, U no drug reaction/allergies, who on unspecified
n has been received from a 26 yearYold registered nurse, with no known medical history andYdrugs allergies, 2/12/2009
who two 2/12/2009
weeks ago was vacc
n has been received initially from a registered pharmacist who reported the pharmacy technician's
N daughter
10/1/2008
was given the third dose of GA
n has been received from a consumer concerning a female who was vaccinated with GARDASIL U (Lot # not provided). After receiving GAR
n has been received from a consumer concerning Y a female who was vaccinated with GARDASIL U (Lot # not provided). After receiving GAR
n has been received from a physician concerning a female who was vaccinated with GARDASIL U (Lot # not reported). The patient experien
n has been received from a health professional concerning a patient who on 18-FEB-2009 was U vaccinated 2/18/2009
with the first dose of GARDASIL
n has been received from a physicianY concerning a 20 year old female patient with no pertinent
Y medical history
1/8/2009and no1/8/2009
known drug allergie
n has been received from a physician, for the Pregnancy Registry for GARDASIL, concerning U a 19 year 9/18/2008
old multiracial
9/18/2008
female with no histo
n has been received from a consumer concerning a 15 year old female patient who started therapy
U in August
1/1/2009
2009 with
2/8/2009
the first dose of GA
n has been received from a medicalYassistant concerning a 14 year old female who on unknown N date was vaccinated with two doses of GA
Y concerning a 15 year old female patient with endometriosis
Y 8/13/2008
who on unspecified dates was va
n has been received from a nurse concerning a 24 year old female patient who on 28-NOV-2008 Y was vaccinated ###with
12/3/2008
first dose of GARDA
Y assistant concerning her relative, a female who on an U unspecified date was vaccinated with GARDA
n has been received from a registered nurse concerning a 14 year old female student with no U known medical2/14/2009
history and drug allergies, wh
n has been received from a physician concerning a female who was vaccinated with three doses U of GARDASIL (Lot # not reported). The pa
n has been received from a consumer Y concerning her 16 year old daughter with allergy to AMOXICILLIN
N 10/1/2008
who in August
11/1/2008
2008, was vaccina
Y nurse concerning a 20 year old female patient with noNpertinent medical history and no known drug a
n has been received from a nurse midwife
Y concerning an unspecified number of patients whoU were vaccinated IM with the second dose 0.5
n has been received from a physician concerning several hundred patient who on unspecified U dates were vaccinated with doses of GARDA
n has been received form a physician concerning a female who was vaccinated with a 0.5 ml Y dose of GARDASIL. Subsequently the patien
n has been received from a nurse concerning a female patient who was vaccinated intramuscularly
U with her first 0.5 ml dose of GARDASIL
n has been received from a consumer concerning her daughter who became ill after received U her second dose of GARDASIL. The consum
n has been received from a physicianY assistant student concerning a 16 year old female who N on 06-JAN-20091/6/2009
was 2/25/2009
vaccinated with first dos
n has been received from a consumer Y concerning her 15 year old daughter with no known medical
N history
6/26/2008
or drug allergies,
7/1/2008 who on 26-JUN
n has been received form a 23 year old female patient, with no known drug reaction/allergiesNand no pertinent1/1/2009
medical
2/12/2009
history, who in Janu
n has been received from a consumer concerning her daughter (a 16 year old female) who in Y March 2008, 3/1/2008
was vaccinated
3/1/2008 with her first do
Y her 20 year old daughter who was vaccinatedNwith her third 6/29/2007
dose of GARDASIL
8/31/2008 (lot # not ava
n has been received from a physicianY concerning a 38 year old female with no medical historyY or drug allergies
8/7/2008who was
8/7/2008
intramuscularly va
N medical 2/16/2009
history and2/16/2009
no drug reactions or a
n has been received from a registered nurse concerning a 15 year old female patient with noUpertinent medical
2/17/2009
history
2/17/2009
and no known drug a
Y concerning a 26 year old female patient with allergy
Y to sulfa
10/9/2008
and asthma10/9/2008
and a history of "bra
Y history 2/20/2009
and no known 2/20/2009
drug allergies who o
U with a 0.5 ml IM dose of GARDASIL. Su
n has been received from a consumer concerning her 16 year old grand daughter (patient) who Y on 08-JUN-20076/8/2007was6/8/2007
vaccinated with a firs
n has been received from a physician concerning a health care provider's 20 year old son who Y was vaccinated with the 7/1/2008
second dose of GA
n has been received from a nurse concerning a 17-year-old female with no known relevant medical
Y history
2/10/2009
nor drug2/11/2009
allergy, who on 10-FEB
n has been received from a physicianY concerning a 16-year-old white female student, with no U known relevant
1/15/2007
medical2/26/2007
history nor drug aller
n has been received from a Registered Nurse concerning a 14 year old female with a historyNof back pain2/4/2009
and pin in 2/4/2009
hip, and no drug react
n has been received from a physician concerning a 14 year old female who was vaccinated U with the first dose
1/8/2009
of GARDASIL (lot# not repor
n has been received from a company representative concerning a female who was vaccinated U with GARDASIL (LOT# not reported). After
n has been received from a 20 yearYold female healthcare student who on 6-FEB-2009 was Yvaccinated with 2/6/2009
a first dose
2/6/2009
of GARDASIL. On
n has been received from a physician,
Y for GARDASIL, a Pregnancy Registry product, concerning U a 14 year
12/1/2008
old female
12/1/2008
with asthma and no
n has been received from a female 21 years old who on 14-DEC-2007 was vaccinated with N the first doses6/26/2008
of GARDASIL6/26/2008
0.5 ml. On 12-FEB
n has been received from a female consumer who on an unknown date, was vaccinated withUGARDASIL (lot # not reported). Subsequentl
n has been received from a patient's
Y mother concerning a 19 year old female who was vaccinated
N with second of GARDASIL. The patient's
Y concerning a 25 year old female who on 17-FEB-2009Ywas vaccinated 2/17/2009
with the
2/17/2009
first dose of GARDAS
Y concerning a 17 year old female who on 02-DEC-2008 Y was vaccinated
12/2/2008
with the first###
dose of GARDA
n has been received from the immunization
Y coordinator concerning a 20 year old female patient
Y who in approximately
9/1/2008 9/1/2008 September 2008, wa
Y concerning a female patient who on 26-OCT-2007 was N vaccinated with the ###first dose ###of GARDASIL (
Y Nurse for the pregnancy registry for GARDASIL, concerning
Y a 25 5/2/2008
year old female
5/2/2008
patient with anxie
n has been received from a physician concerning a 38 year old male with hypertension who Non 13-FEB-2009 2/13/2009
was vaccinated
n has been received from a physician concerning a female who was vaccinated intramuscularly Y with a dose 9/3/2008
of GARDASIL
9/4/2008 (lot number not
Y concerning a 15 year old female who was vaccinated
U with the second2/18/2009
dose of GARDASIL (lo
n has been received from a registered nurse concerning a female patient with a history of jump
U roping injury who was vaccinated with GAR
n has been received from a consumer concerning her 28 year old daughter with no pertinentNmedical history, allergies ### 11/1/2008
or drug reactions, wh
n has been received from a certified medical assistant concerning a female who on 13-FEB-2009Y was vaccinated
2/13/2009with 2/13/2009
the first 0.5 ml dose
Y concerning a 13 year old female who in July 2008, was N vaccinated7/29/2008
with the first1/1/2009
dose of GARDASIL.
n has been received from a consumer via internet concerning a female who on an unspecified U date was vaccinated with GARDASIL (lot nu
n has been received from a nurse concerning a 17 year old female with no medical history and Y drug allergy who ###on 26-NOV-2008
### was vac
n has been received from a physician concerning a 20 year old female patient who on an unspecified
U date was vaccinated with the third do
n has been received from a consumerY concerning her 12 year old daughter with no medical N history and drug allergies1/1/2009
who was vaccinated
Y for the Pregnancy Registry for GARDASIL, concerning a 17 year old 8/25/2008
female with
8/25/2008
no medical history a
n has been received from a Medical Assistant concerning a 17 year old female who 12 weeks U ago was vaccinated ### with the first dose of GA
Y nurse concerning a female who was vaccinated with Y GARDASIL. Awhile back the patient fainted aft
n has been received from a physician concerning a 16 year old female who on 20-NOV-2008 Y was vaccinated with ### the first###
dose of GARDA
n has been received from a Registered Nurse (R.N.) concerning a 16 year old female with aNhistory of asthma 2/16/2009and amoxicillin
2/16/2009 allergy who o
n has been received from a medical assistant concerning her daughter with a history of RSV (respiratory syncytial virus infection) as a child
Y concerning a female patient who on an unknown dateUwas vaccinated with GARDASIL 0.5 mL IM. S
Y concerning Y a 15 year old female
0 who was vaccinated U with a 0.5 ml dose of GARDASIL about a year
n has been received from a consumer concerning her 13 year old daughter with drug allergies N to codeine 10/9/2008
and IMITREX 1/17/2009
and no other pertin
Y her daughter who on an unreported date was U vaccinated IM with the second dose of GARDA
n has been received from a registered nurse concerning a 23 year old female patient with noYpertinent medical2/4/2009 history,
2/9/2009
no drug reactions/a
n has been received from a licensedY visiting nurse concerning a 15 year old female patient with
Y no pertinent 6/26/2008
medical history and no know d
Y concerning his granddaughter (a 15 year old female) withY a family history
1/1/2009 of allergies
1/1/2009 who was vaccin
Y concerning his 22 year old daughter with no pertinent N medical history and no known### drug allergies w
n has been received from a patient with positive history of papilloma viral (HPV) who on 22-SEP-2008
N and
9/22/2008
08-DEC-2008 was vaccinated w
Y nurse concerning a 17 year old female who on 25-JAN-2009N was1/25/2009
vaccinated with2/1/2009
a first dose of GAR
Y concerning a 21 year old female with attention deficit/hyperactivity
N disorder
1/1/2007and2/1/2007
a history of depressio
n has been received from a nurse concerning a female patient who in "August 2008" was vaccinated
Y with8/1/2008
the second 10/1/2008
0.5 ml dose of GARD
n has been received from a registered nurse (R.N.) concerning her daughter, a 14 year old female
Y who was vaccinated with a second dose
Y concerning a 14 year old female with no pertinent
Y medical History
2/2/2009 and 2/2/2009
no known drug reactio
Y concerning a 24 year old female patient who on 04-FEB-2009
Y was 2/4/2009
vaccinated 2/5/2009
with the third 0.5 ml do
n has been received from a consumerY concerning Y her daughter who0on Y an unspecified date U was vaccinated with a dose of GARDASIL. Th
Y concerning a 22 year old female patient who in approximately
Y 2008 ("about a year ago") was vaccina
n has been received from a physician concerning a 16 year old female with a history of irregular
N periods who 8/1/2008
has not8/1/2008
had her period since
n has been received from a consumer concerning his girlfriend with no medical history or drugY allergy who 1/22/2009
on 22-JAN-2009 was vaccinated
n has been received from a medical assistant concerning a female with AUGMENTIN allergyNwho on 22-JAN-2009 1/22/2009 was vaccinated with the
n has been received from a Nurse Practitioner (N.P.) concerning a 31 year old female who on N 06-FEB-2009 2/6/2009
was vaccinated
2/6/2009intramuscularl
n has been received from a case in litigation for WAES # 0902USA01678 from a consumer who U reported "her daughter's anemia became w
Y a 20 year old female patient who on 08-JAN-2007
U was vaccinated with1/8/2007 the first dose of GAR
n has been received from a physician concerning a female patient who on an unspecified date U was vaccinated with a dose of GARDASIL (
n has been received from a Nurse practitioner (N.P.) concerning a 15 year old female who on Y 01-OCT-2008 10/1/2008
was vaccinated
10/1/2008with a 0.5 ml d
n has been received from a female , for GARDASIL who in December 2008, was vaccinatedUwith GARDASIL 12/1/2008
(number
12/1/2008
in series not reporte
n has been received from a health professional concerning a 15 year old female with no known Y medical history, ###
who on 29-DEC-2008
### was
n has been received from a physician concerning a 17 year old female student (weight 134.8Y pounds, height 2/2/2009
65.5 inches)
2/2/2009who on the aftern
n has been received from a physicianY concerning a 15 year old patient who on 14-JAN-2009Uwas vaccinated 1/14/2009
with the
1/14/2009
n has been received from a health professional concerning a 15 year old female with no allergies
Y who on an unspecified date was vaccinat
n has been received from a nurse practitioner concerning her sister who was vaccinated withY a first dose of GARDASIL in arm. On unknow
n has been received from a 29 year old female consumer who in April 2008, was vaccinatedNwith the first 6/1/2008
dose of GARDASIL. On June 20
n has been received from a consumer Y concerning her 14 year old daughter with sulfa allergyNand with no previous ### medical### history reported
n has been received from a certifiedYmedical assistant concerning a 17 year old female with asthma and4/28/2008
no known drug12/1/2008
allergies who on 0
n has been received from a registered nurse concerning a 23 year old female patient with allergy
Y to VICODIN
1/21/2009who on
1/21/2009
21-JAN-2009 was va
n has been received from a consumer concerning someone she saw on the television news,Ua female who was vaccinated with GARDASIL
n has been received from a physician concerning a female who was vaccinated with a dose Uof GARDASIL. The patient's relevant medical
n has been received from a physicianY concerning a 11 years old female patient who on 02-FEB-2009
Y at afternoon
2/2/2009 was 2/2/2009
vaccinated with the
n has been received from a nurse practitioner concerning a female who was vaccinated withYa first dose of GARDASIL in arm. On unknow
n has been received from a physician concerning a 23 years old female with allergy to CIPRO Y and a history 2/2/2009
of mitral 2/2/2009
valve prolapse who on
n has been received from a physician concerning a 23 year old female with a history of papanicolaou
U smear
7/12/2007
abnormal1/16/2009
in January 2006 but
n has been received from a physician concerning a female patient who was vaccinated with Ua 0.5 ml dose of GARDASIL (lot # was not pro
Y nurse concerning a 33 year old female who was vaccinatedU with her
1/1/2009
first dose1/1/2009
of GARDASIL (lot num
U intramuscularly
5/15/2007 with her first, second a
n has been received from a consumer concerning her daughter who developed soreness onUher arm and neck after receiving a dose of GA
n has been received from an immunization coordinator concerning a 24 year old female patient. Y "Sometime1/29/2009
last week"
1/29/2009
the patient was vac
n has been received from a physicianY concerning a female (approximately 24 year old) with U history of an abnormal
9/5/2007 Atypical squamous cells
n has been received from a Nurse Practitioner (N.P.) concerning a 14 year old female with aNhistory of contact
1/22/2009dermatitis
1/22/2009
who on 22-JAN-2
n has been received from a consumer concerning her daughter (a 21 year old female) with diabetes
Y as well
2/4/2009
as allergies
2/5/2009
to heat and penicil
n has been received from a physicianY concerning a 14 year old female who on 01-MAY-2008 N was vaccinated8/2/2008
with the first dose of GARDA
n has been received from a physicianY concerning an approximately 15 year old female patient Y who in December
12/1/20082008,12/1/2008
was vaccinated with
n has been received from a medical assistant concerning a female patient who in approximately N February2/1/20092009 finished
2/1/2009
the series of GARD
n has been received from a 23 yearYold female patient with no pertinent medical history and Nno known drug 1/15/2009
allergies/drug reactions who on
n has been received from a 29 yearYold female consumer who was vaccinated on an unspecified U date with the second dose of GARDASIL
n has been received from a consumer Y concerning her 15 year old daughter with no pertinentNmedical history 1/17/2008
and no11/1/2008
drug reactions or allerg
n has been received from a 37 year old female with no allergy and medical history who on 18-AUG-2008
Y was vaccinated
### 11/8/2008 with a first dose o
n has been received from a nurse practitioner concerning a 15 year old female patient with aYhistory of appendectomy conducted in Decem
n has been received from a consumer concerning her daughter who in December 2008, wasNvaccinated12/1/2008 with a first 0.5 ml dose of GARDAS
n has been received from a physicianY concerning a female with a history of injection site reaction
Y (vaccine1/20/2009
unknown) 1/22/2009
Y worker concerning her daughter, a 15 year old female N with no pertinent### medical
1/5/2009
history and no know
n has been received from a physician concerning a nurse's daughter who was vaccinated with U GARDASIL a year ago. Coincidentally, the p
n has been received from an office manager concerning a female patient who in 2008 was vaccinated
U with the first dose of GARDASIL (lot
Y nurse for the Pregnancy Registry for GARDASIL concerningU an 1812/2/2008
year old female
12/2/2008 patient who on 2
n has been received from a Nurse concerning
Y a female patient who was vaccinated with theUfirst dose of GARDASIL (Lot # not reported). P
n has been received from a consumer Y concerning her 14 year old daughter who on 26-NOV-2007 Y was vaccinated ### with a 0.5###ml dose of GA
n has been received from a physicianY concerning a 12 year old female patient with no drug reactions
U or 1/14/2009
allergy who1/15/2009
on 14-JAN-2009 was v
n has been received from a physicianY concerning a 20 year old female patient with no pertinent
N medical 4/29/2008
no known allergies/dru
n has been received from a nurse concerning a 11 year old female patient who on 04-DEC-2008 U was vaccinated
12/4/2008with 12/6/2008
GARDASIL (lot# 661
n has been received from a consumer concerning her daughter, a 21 year old female with no N medical history
1/16/2007
or drug9/1/2007
allergy who was vacc
n has been received from a physician's assistant concerning a female patient who in October Y 2008 was 6/12/2008
with the third dose of G
n has been received from a nurse concerning a patient who was vaccinated with a dose of GARDASIL
U and
9/19/2008
may have 10/1/2008
an unspecified reacti
n has been received from a nurse practitioner concerning a 24 year old female who on unspecified
Y dates was vaccinated with the first and
n has been received from a consumer, concerning her daughter who in October 2008 and December N 2008,
12/1/2008
was vaccinated
12/1/2008 with her first an
Y concerning a female patient who was vaccinated N with three dose of GARDASIL. Subsequent
n has been received from a physicianY concerning a 20 year old female patient with no drug reaction/allergies
U 1/16/2009
history1/16/2009
who on 16-JAN-2009
Y a female with no medical history or allergy who N on 26-DEC-2008### was vaccinated with the firs
n has been received from a physician concerning a 22 year old female who was vaccinated N with three dose
8/1/2007
of GARDASIL between Februa
n has been received from a consumer concerning herself (a 24 year old female) with migraine N who received the first two doses of GARDAS
n has been received from a 21 yearYold female with no pertinent medical history or drug allergy N who on 20-NOV-2008
1/15/2009 1/15/2009was vaccinated with
n has been received from a nurse practitioner concerning a female who was vaccinated withU3 doses of GARDASIL on unspecified dates. S
n has been received from a registered nurse concerning her daughter who on an unknown date U was vaccinated with a dose of GARDASIL.
n has been received from a registered nurse reporting that she received an e-mail from a woman U who stated that she received the complet
n has been received from a medicalYassistant concerning an 18 year old female with asthma, Y bipolar disorder,
6/11/2008
LEXAPRO6/11/2008and PAXIL allerg
n has been received from a RegisteredY Nurse concerning a 22 year old female with psychiatric Y disorders1/29/2009
and a history of pyelonephritis wh
n has been received from a certified medical assistant (C.M.A) concerning a 19 year old female Y with no medical
1/8/2009 history
1/8/2009
and no known aller
n has been received from a consumer, for GARDASIL, a Pregnancy Registry product, concerning U her daughter
1/22/2009 an 18 year old female with
n has been received from a registeredY nurse, for Y the Pregnancy Registry0 for GARDASIL, concerning
Y a 17
12/5/2007
year old female
3/20/2008with no previous
n has been received from the Merck Pregnancy Registry from a 22 year old female with no pertinent Y medical history
### who on ###17-DEC-2007
n has been received from a certified nurse midwife concerning a 23 year old pregnant female Y who is bipolar
1/9/2008
and has1/9/2008
a history of depressio
follow up information has been received from a certified nurse midwife for the Pregnancy Registry Y for GARDASIL,
12/4/2007 concerning
2/15/2008 a 22 year old
rmation and follow up has been received from a physician for the pregnancy registry for GARDASIL Y concerning
5/21/2008a 24 year old female who o
n has been received from a consumer and a nurse practitioner for the Pregnancy Registry for Y GARDASIL 4/29/2008
concerning 4/29/2008
herself, a 26 year old
n has been received through the pregnancy
Y Registry for GARDASIL from a nurse concerning Y a 20 year 5/29/2008
old female 5/29/2008
with no pertinent medic
rmation has been received from an 18 Y year old female with no pertinent medical history or drug Y reactions11/1/2007
or allergies, 5/29/2008
for the Pregnancy Re
Y from a nurse, for the Pregnancy Registry for GARDASIL, Y concerning
5/19/2008
a 23 5/19/2008
year old female smoker
n has been received from a licensed Y practical nurse through the pregnancy registry for GARDASIL U concerning
6/2/2008an 186/2/2008
year old female with a
n has been received from a nurse practitioner concerning many patients that complain of pain U after receiving GARDASIL. The nurse practit
n has been received from a Licensed Practical Nurse (L.P.N.) for GARDASIL, a Pregnancy Registry U product,
11/6/2008
concerning
11/6/2008
an 18 year old pre
swelling, heat and hard spot at site of
Y injection 24-72 hours after initial injection. Low grade fever
U of approximately
3/10/2009100 3/11/2009
degrees farenheit 48
N
N
Y N
n has been received from a 91 yearYold femaleYpatient with an unspecified 0 thyroid disorder, recent
N diagnosis
3/26/2008
of hypertension,
4/26/2008 nitroglycerin a
n has been received from a licensed Y practical nurse, concerning a 64 year old male patient with N no known drug### reactions/allergies
### and no p
Y nurse concerning
Y a 25 year21 old male with Y
cystic fibrosis
N and a history of renal transplant and 2 or 3 s
n has been received from a consumer concerning two males who were vaccinated with a dose U of MMR II. The patients developed autism a
n has been received from a consumer concerning her 5 year old son who "a couple years ago" N was vaccinated with a dose of MMR II (Lot
n has been received from a consumer Y concerning Y her 18 month old2son with gastric issues, N reflux and no8/1/2005
known drugs 5/1/2006
allergies, who in ap
-24 hours after vaccines. In ER. Oxygen,
Y Acyclovir,
Y Rocephin, propofol,5 succinocholine, endotracheal
Y tube.
3/5/2009
RSV negative,
3/6/2009influenza = nega
evening upper left arm was red, swollen,
Y itchy. Y
Following day, more 2swelling, hot to touch, very Y itchy. 4 a.m. 12/14,
### severe### swelling in knees
mor" type incident "weird cry" X 20 min. Arms flailing,
Y eye looking to2left - unfocused. T101.4Y gaze deviating 3/2/2009
rapid eye3/2/2009
blinking. 3/18/09 R
03 for 72 hours, severe sore throat and cough lasting more than a week, nausea. U 3/8/2009 3/9/2009
her neuropathy symptoms and triggered a flare of her Trigeminal neuralgia. 3/2/2009 3/2/2009
se effects observed. Father instructed on after care. Look for fever, soreness in thighs. Possible Y mild case3/9/2009
of flu in next 2 weeks.
her Rt arm has been hurting since injection 4 months ago. N ### ###
d shots Monday afternoon. Tuesday Y morning mom noted redness and induration on right thigh N around injection
3/9/2009 site3/10/2009
and child complained o
h erupted day post vaccination. -> treated
Y with BENEDRYL. Y 3/6/2009 3/7/2009
3/13/2009
de in the deltoid region and lymphadenopathy
Y in the left axillary region. Some erythema of the U injection site.
3/3/2009 3/15/2009
09. Severe welts (red, puffy) 2-23-09 to 2-25-09 (peak discomfort) 1 tablet BENEDRYL 2/25.Y Itch relief w/ 2/17/2009
AQUAFLOR 2/21/2009
topical area : Head
of head left side bottom started aching
Y within about 1hr later that day around noon. I started feeling flush 2/20/2009
10:00 am and 2/20/2009
my throat felt like it w
miting approx 6-8 hr post injection - vomiting cont with dizziness, lightheadedness & soreness Y @ site of immunization
3/10/2009 3/11/2009
Sl. swelling, no redne
s, Dizziness, Mild Nausea - 20 Mins after injection - feeling (mild) of throat closing VP (Briefly) Y 2/23/2009 2/23/2009
ite was warm/hot to touch, touch tender, pt. febrile and chills, oral temp 99.8 after chills. FeverY started 29 3/5/2009
hours after 3/6/2009
injection - remained fe
ely after shot, had onset of headache Y dizziness. Onset of fever 12:00am 3/3/09, temp 103.9.YReceived Advil, 3/2/2009
water, cold
3/2/2009
pack. Headache, n
rhea, Pale, Lethargic, Weak, (Per mother) lasting 2 Days. Y 1/28/2009 1/28/2009
parent called and reported that the child had a lump on her right outside thigh area. It was not U red or sore.
2/23/2009
Lump under 3/2/2009
skin. There is a scr
after vaccines were administered developed hives on injection site, right deltoid and scattered Y in the back.
3/10/2009
injection of MENACTRA. Patient developed palpitations, was dizzy, weak and pale. Symptoms Y resolved in3/9/2009
24 hours.3/10/2009
ulitis at site of injection resolving with
Y AUGMENTIN. Y 3/5/2009 3/7/2009
as given 3 GARDASIL vaccines in 2008 by her PMD. PAP smear results on 3/4/09 shows LGSIL N with HPV changes.
hed medical records. Y Y 2/24/2009 2/24/2009
en to a 7yr old will count as a valid dose, but requested VAERS form submitted. 2/24/2009
ash - maculopapular, fine, to chest, back, face & upper extremities no fever, chills, arthralgiasY 2/26/2009 3/10/2009
st to report accidental (unintentional) administration of 23-polyvalent (PNEUMOVAX ) vaccineY to a 2 1/2 hour 3/14/2009
old newborn. Infant doing clini
GI upset, "flare of Ulcerative Colitis".Y Patient reports symptoms began within 1h of vaccine administration.
Y 3/6/2009
Patient seen3/6/2009
in acute care clinic
, dizziness, stiff and sore everywhere starting approx 8-12 hours after receiving the Menactra Y vaccine 3/10/2009 3/11/2009
ormed nurse that he usually faints after receiving injections. Patient given one injections (Hepatitis
Y A) while
3/16/2009
lying on3/16/2009
exam table. 10 minute
veral days of her second shot - she was Y unable to walk without much pain to her feet. WithinN2 weeks she 7/28/2008
was diagnosed ### with RA and now
ter patient was given the Flu Shot his Y right eye Yshowed signs of not 4 moving properly. It looked
U as if he were going ###crossed-eye.
### 24 hours la
mber on Mobilization Orders. He received
Y his 1st Anthrax Vaccine on 15 Mar 2009 in his leftYDeltoid Region.
3/15/2009
He reported
3/15/2009
to facility complai
mber of the military. Vaccine was administered
Y 15 Mar 2009, during Mobilization Orders activity.
Y Vaccines3/15/2009
were administered
3/15/2009 at the facility.
PRESENTED WITH RED, PAPULAR Y LESIONS ON FACE,HEAD,TORSO,ARMS AND LEGS Y 2/23/2009 2/21/2009
Varivax, and Havrix administered on 11/6/08. Pt. noted abrubt onset of blurred vision in left N eye on 11/26/08.
11/6/2008
Seen by a neuro-ophthalmolo
###
Yellow Fever vaccine 2/27/09. According to patient, started having itchy grouped rash on right Y arm area2/27/2009
and continues 3/6/2009
to spread to other a
administration: myalgias, subjectiveYfever. Starting the second day after administration: muscle U soreness3/12/2009
in the forearms
3/13/2009
with weakness an
neck, swelling and redness of eyelids, lips and ears Y 2/27/2009 2/27/2009
well appearing and presented to clinic Y for varicella vaccine. Patient received first varicella vaccine
Y too early
3/13/2009
(before 3/13/2009
one years old)and recec
tions given 3/16/09. Client returned to clinic 3/17/09 stating during the evening of 3/16 her left N arm was painful,
3/16/2009 w/pain
3/16/2009
radiating down to ha
ber was examined in flight medicineYclinic on 04Feb09. Her symptoms The patient filled out SF Y 600 Small1/23/2009
Pox questionaire
2/3/2009and responded
ven #2 HPV and left area went to pharmacy,
Y weYhad a Fire Drill pt walking
5 out to car and fainted.
Y Hit head, 2/18/2009
LOC, was2/18/2009
taken to Hospital foun
### N 12/4/2008 ###
ember was a basic trainee and received multiple Y vaccines at the end
10 of September 2008 and N then developed
9/29/2008
lower extremity
### weakness an
Y 3/17/2009 3/17/2009
- immunization administered. 3/11/09 Y Am - increased redness, swelling at injection sites, iceYapplied, TYLENOL
3/10/2009 given.
3/11/2009
3/12/09 6pm - seen
scess left thigh. Y 3/12/2009 3/15/2009
7/5/2009 Y 117 U 3/6/2009 3/11/2009
iltrate L anterior thigh: indurated, reddened, not tender. Y 3/4/2009
ately 30min after receiving MMR vaccine Y Pt's lips + face + ears started swelling, face + headYpruritic +mild
3/17/2009
difficulty swallowing.
3/17/2009 No resp. dis
3/17/2009
as given pneumococcal vaccine in L Deltoid on 3/14/09 @ 1722. Patient noted that her arm was U very sore. 3/14/2009
On 3/15/093/15/2009
@ 2038 RN noted th
ports developing a pruritic rash on her Y face, fatigue and joint pain within 2 hours of vaccine administration.
Y 3/9/2009
She subsequently
3/9/2009 developed pa
izure - ER visit treated with MOTRIN Y and TYLENOL. Y 3/6/2009 3/15/2009
evere muscle aches all over body - sore muscles with touch. 3/20/09 Note received from PCP. U Pt has not been### seen at all###
since DOV. TC f
r - up to 103- March 13-14-2009 FullYbody rash- March 15-16-17-2009 MMR-given 3-02-09 U 3/2/2009 3/13/2009
Y ### 3/16/2009
was considered medically important. Information regarding DRYVAX was received from a literature U source regarding a participant enrolled
n has been received from a consumer concerning her son, who received the routine vaccines N (names and5/1/2002
manufacturer5/1/2002
unspecified) at five
n has been received from a consumer concerning Y her 12 month old3son Y who on 21-AUG-2002 N was vaccinated
8/21/2002 with8/22/2002
an only first dose of MM
n has been received from a consumer concerning her son who on 27-DEC-2001 was vaccinated N with the first dose
### of MMR II (Lot # 63870
orted in a published report, title stated above regarding a case in litigation concerning an approximately
U 17
4/23/1998
month old male who on 23-APR
Y concerning a 23 year old female who on 09-JAN-2009
N and 3/9/2009
09-MAR-2009 was vaccinated wi
Y a 14 year23
oldYfemale patient with noNpertinent medical### history,
1/10/2008
no drug reactions/a
n has been received from a consumer Y concerning Y his 14 year old granddaughter
2 with a history
N of migraine 9/1/2008
who in September
10/1/2008 2008, was va
n has been received from a registered nurse concerning an adolescent female between 14 and U 17 who was vaccinated with GARDASIL. T
es vaccine last week. Got shingles this week. 3/10/2009 3/16/2009
ead and neck 2 hours after vaccinesYwhich lasted about an hour, then went away. Father ofYbaby said 23/12/2009 small red dots
3/12/2009
appeared again sam
l from mom- stated when child wokeY up this AM- She was experiencing some facial edema,Ydifficulty opening 1/6/2009 her mouth,
1/7/2009+ difficulty swallo
/4 hrs post pneumonia vaccine started Y having some problems with swallowing & felt bad. During Y that night had### problems swallowing,
### breat
other, reports client had episode of Y dizziness and blacked out at school. Ambulance took him Y to hospital.2/13/2009
Reports he 2/17/2009
had mental confusion
Y and described theYoccurrence of convulsion
0 syndrome in a 5-month-old
U female
2/27/2009
subject2/27/2009
was reported by a physician and described the occurrence of incorrect storage of drug in anUinfant subject of unspecified gender who was
was reported in a literature article and described the occurrence of WELL's syndrome in a 7-year-old
Y male subject who was vaccinated wit
d TDAP instead of rec. TD. No reactions reported. Pt contacted of error. Rec. ACIP recommendation. 3/16/2009
r administer- flushed cheeks- then wentY home, nausea, urine retention and fever 102-103- condition
Y persisted
2/23/2009 + Pt.2/24/2009
went to ER-fu evaluatio
ith swelling / Erythema. U 3/3/2009 3/5/2009
as small bump on chest, back, and head / some painful to touch. Member was seen by Dr and U she stated3/7/2009
it was Type 3/15/2009
II hypersensitivity - s
st vaccination, pt presented with 7cm Y area of redness on (L) deltoid with warmth/redness. Y 3/16/2009 3/17/2009
2 days. Red spots on face and body. Y N 3/4/2009 3/11/2009
Y 3/13/2009 3/13/2009
knot at injection site R upper leg. Y 3/10/2009 3/17/2009
le ADSM is referred by Research Nurse Y for inclusion in the Anthrax study. SM reports increased
Y erythema,
5/11/2007
swelling, and ### pain after each of
at 10:20 to Immunization clinic and stated
Y she had broken out in hives and her throat was swelling
Y up, pt3/18/2009
was then instructed
3/18/2009to call 112 (am
aricella vaccine in error, should have been given zostavax. No adverse reaction noted. Zostavax Y will be 3/4/2009
given in 4 weeks,
3/4/2009 due to it being a
omitting, headache, pain, 100.3 fever, pain at injection site U 3/17/2009 3/18/2009
ction. 40mm X 26mm area of erythema and itching at site. No systemic symptoms. Similar toYprevious reaction 2/9/2009 to MMR2/11/2009
on 6/2/08.
mplained of a itchy, painful rash begining the day after the injection was recieved U 3/12/2009 3/13/2009
Tdap vaccine. Approx. 18 hours later, felt a combination of chills, fever, body aches which lasted
Y approximately
3/16/2009 2 full
3/17/2009
days.
ately one hr. after receiving vaccinations c/o itching to left cheek then progressing to right cheek,
Y chin and 2/17/2009
ankles. Red 2/17/2009
raised "pimple-like"
ately three hours following vaccination c/o itching on neck, cheeks and chest areas. Also reports Y accompanied
2/17/2009 by red,raised
2/17/2009rash. Sympto
ped a rash, resembling chicken pox, on both arms and both legs, starting the night after she Y received the3/13/2009
vaccines. 3/13/2009
Still evident 5 days late
ot had a period after receiving her third
Y vaccine. It's been ten months since she Y had a period.4/2/09-records
N 5/27/2008received 6/1/2008
for DOS 3/17/09-offic
h where vaccine was administered was reddened, swollen and had a rash with raised vesicles Y similar to chickenpox.
3/5/2009 3/12/2009Symptoms started 7 d
cieved vaccines on 3/17/09 around 1600 Mom reports that infant woke up in the middle of the U night with 3/17/2009
102.5 fever.3/18/2009
Patient did recieve am
rms red, raised rash. Warm to touch. N 3/16/2009 3/18/2009
at 7AM on 3/12/2009 with fever of 101, Y pain and redness at the administration site, pain all over
Y including 3/11/2009
jaw, joints3/12/2009
and muscles. Pt also
esented day after vaccination with redness and swelling to site of shot administration on rightYthigh (MMR 3/16/2009
injection site)
3/17/2009
Dr. prescribed Zyrt
ately 1 week after shot was given, my Y son developed a large hive at the injection site, a measles
U like rash, 3/10/2009
a high fever 3/17/2009
102.5, refusal to eat
episode condition and vitals monitored Y 3/17/2009 3/17/2009
d to clinic 2 days after vaccine given with red raised wheal around injection site. Y 3/11/2009 3/13/2009
RNED TO CLINIC WITH RAised red wheal measuring 9cm by 7cm . Area was warm to touch Y. 2/24/2009 2/26/2009
vere abdominal pain; muscle aches,Ylethargic, has Y asthma now, also1developed skin indentions N (tissue break down ### up underneath
### the skin)
3/17/2009 N 3/13/2009 3/17/2009
d swollen and reddness noted approx. 3 inches over deltoid area. pt told to applt cold comperss U and to give 3/17/2009
tylenol or 3/18/2009
motrin according to we
spontaneous report of status epilepticus, dehydration
Y and fever was0 received from a physician,
Y concerning a 36-month-old
### ###
male subseque
orted of experiencing heavy chest, rashes swelling Y throat 1 1/2 hour1after vaccination, went to Y E.R and received
3/16/2009 BENADRYL/Epinephrine.
3/16/2009 R
edness, pain, increased temp 101 degrees
Y U 3/16/2009 3/17/2009
B # 3, DTaP # 4, PCV # 4 and MMRY# 1 on 12/4/08. At 8pm that night, pt had seizure with 104.2 Y temp. Went 12/4/2008
to medical
12/4/2008
center ER. TX with
th cough 1900 15MAR09, progressed Y to headache, nausea, sore throat, tachycardia, fever (103Y degrees3/15/2009
F), muscle3/15/2009
ache, general weakne
after vax, jogged for 3 1/2 hours with 2-3lb weights. At 2p had lunch and became nauseous,Y dizzy and weak 10/1/2008 so went10/1/2008
to sleep. Woke up at
C to reporter who states patient experienced redness & pain at anthrax site right arm & had Ylimited mobility 3/15/2009
w/right arm,
3/15/2009
using left arm to lif
tous induration area at the injection site on (R) thigh. Treated with BENEDRYL/ KEFLEX. U 3/16/2009 3/17/2009
ness and swelling 13 x 10 cm on the L thigh. Noted approximately 30 minutes after Imms. Given Y BENADRYL 3/11/2009and warm3/12/2009
compresses. Resol
diagnosis of thrombocytopenia during routine physical. Menorrhagia (excessive menstrual bleeding) Start: 11/15/2004 ###
and LOC x 30 sec, about 10 min after vaccination. Y 3/18/2009 3/18/2009
8, Pt was 7mo old and received a Tdap instead of DTaP. No known injury. Y 5/28/2008
/o feeling as though she were goingYto pass out as she was checking out with secretaries. Secretary
Y called
2/5/2009
M.A. and2/5/2009
they assisted Pt to si
study report of right lower lobe pneumonia wasY received from an investigator,
1 concerning a Ufour-year-old female ###subject number
### 1-08-0294
2/19/2009 female who
ious, spontaneous report of gave expired FLUMIST in a 33-month-old female patient was received Y from 2/11/2009
a nurse practitioner.
2/11/2009On 11-Feb-20
ious, spontaneous report of gave expired FLUMIST in a four-year-old male patient was received Y from a nurse
2/11/2009
practitioner.
2/11/2009The patient's me
ious spontaneous report of administration of expired product was received from a RegisteredYNurse concerning 1/24/2009 a child.
1/24/2009
FLUMIST was adm
ious spontaneous report of "29 patients received expired FLUMIST" was received from a physician Y concerning
1/6/2009
a four-year-old
1/6/2009 male. The p
1/6/2009
a four-year-old
1/6/2009 female. The
1/6/2009
a 36-month-old
1/6/2009 male. The p
1/6/2009
a four-year-old
ious spontaneous report of "29 patients received expired FLUMIST" was received from a physician Y in the 1/6/2009
concerning1/6/2009
a 36-month-old femal
1/6/2009
a 36-month-old
1/6/2009
a three-year-old
1/6/2009 male. The
ious, spontaneous report of administration of full dose in one nostril was received from a nurseY concerning a female### child of ###unknown age s
ious spontaneous report of administration of expired product was received from a nurse practitioner
Y concerning
1/22/2009 a four
1/22/2009
year-old male, which
ious spontaneous report of administration of expired product was received from a nurse practitioner
Y concerning
1/29/2009 a 41-month-old
1/29/2009 female, who
n has been received from a case in litigation via a case report concerning a 63 year old femaleU with pre-diagnosis and pre-vaccination med
n has been received from a case in litigation via a case report concerning a 48 year old femaleU who on 12-NOV-1992,
5/25/1993 6/21/1993
18-DEC-1992 and 2
n has been received from a case inYlitigation via a case report concerning a female who on 29-MAR-1999
U 3/29/1999
was vaccinated
4/12/1999with a dose of RE
n has been received from a female who in 1994 or 1995 was vaccinated with RECOMBIVAXYHB (manufacturer unknown). In 1994 or 1995
Y nurse concerning a 21 year old female patient who onY an unspecified date as a child was vaccinated
n has been received from a physicianY concerning a 12 weeks old female with no known drugNallergies and 8/17/2008
born with9/10/2008
vocal cord paralysis, h
n has been received from a case inYlitigation via a case report concerning a male who in 1997, U received the usual infant 1/1/1998
vaccinations that y
n has been received from a consumer Y concerning her approximately 5 year old son with no N known allergies or pertinent medical history wh
n has been received from a physician concerning an 8 week old male with no known drug allergiesU and a5/29/2008
circumcision and family
n has been received fromY a registered
Y nurse concerning a female child who on an unspecified Y date was vaccinated with RECOMBIVAX HB
n has been received from a physician concerning a 16 year old male with no pertinent medical U history who was vaccinated with a dose of R
Y concerning a 50 year old female with hypertension and N no history 10/1/2008
of drug reactions/allergies,
10/2/2008 who o
n has been received from a pharmacist concerning a 1 day old male infant who on 19-NOV-2008 U was inadvertently
### vaccinated### SQ with RE
n had been received from a physicianY via pediatric medical records concerning a 40 day oldUfemale who7/30/2008
on 30-JUL-2008 9/8/2008
was vaccinated w
n has been received from a physicianY assistant concerning a 30 year old female patient withUno pertinent medical ###history and### no known dru
n has been received from a physician concerning an adolescent patient (exact age not provided) U who on an unspecified date was vaccinat
n has been received from a physicianY via medical records concerning a 51 day old white female Y infant with8/22/2008
bottle feeding ###
and a history of c
n has been received from a physician via pediatric medical records concerning a 10 day old Yfemale with 6/13/2008
no known drug6/16/2008
allergies who on 13
n has been received from a pharmacist,
Y with no medical history of allergies, 43 year old female,
Y who on 11-NOV-2008 ### was###
intramuscularly
n has been received from a lawyer regarding a case in litigation concerning a 39 year old female
U with variety of ailments (general symptom
n has been received for a case in litigation from information obtained from a published articleUconcerning a female with acne who was vacc
n has been received from a medical record via a pregnancy registry concerning a 6 month old Y female with4/11/2008
bilateral feet
4/11/2008
inversion most likel
n has been received from a medicalYrecords via of a health professional concerning a 1 day U old male who 4/27/2008
on 27-APR-2008
n has been received from a physicianY concerning a 2 day old, 6 pound 12 ounce black infantUfemale. On 7/11/2008
11-JUL-20089/11/2008
she was vaccinated
n has been received from a medical assistant concerning a 35 year old female with no pertinent N medical9/30/2008
history or drug
10/2/2008
reactions/allergies
n has been received from a physicianY concerning a 25 year old female with PENICILLIN allergy N who on 9/25/2008
25-SEP-2008 9/28/2008
was vaccinated with
n has been received from a physicianY through medical records concerning a 1 day old, 3345Ugram, white 7/2/2008
male who on 02-JUL-2008 was va
n has been received from a nurse practitioner concerning a female who at the age of 13 (approximately
U 1996) was vaccinated with a first d
n has been received from pediatric Y medical records and a physician concerning a 15 week old U female with6/30/2008
diaper rash
8/20/2008
who on RECOMBIV
n has been received from a physician through medical records concerning a 1 day old, 3608Ygram, 21.56/12/2008inch, white6/14/2008
male with a head circum
n has been received from a certified medical assistant concerning a patient who "years ago"Ywas vaccinated with RECOMBIVAX HB (manu
n has been received from a certified medical assistant concerning a 34 year old female patient Y who 20+ years ago (approximately 1988) wa
follow up information has been received from a Registered Nurse (R.N.) concerning a 26 year Y old (also 9/29/2008
reported as10/1/2008
24 year old) female wit
n has been received from a medical assistant concerning a 22 year old female who was vaccinatedY with a dose of RECOMBIVAX HB, on a
n has been received from a lawyer from a case in litigation concerning a 43 year old patient Y who on 20-JUN-2003
6/20/2003 was vaccinated with a fir
n has been received from a pharmacist concerning a patient (age and gender unspecified) who Y was vaccinated on an unspecified date with
rmation has been received from a vaccine nurse and follow-up information was received fromY the physician, concerning a patient who in 20
Y concerning
Y an 11 year0 old female who was vaccinated
Y with RECOMBIVAX HB (manufacture
Y nurse concerning a 32 year old male with sulfonamide Y and penicillin allergy
### who on### 12-NOV-2007 a
n has been received from a physician concerning a 49 year old female with thyroid papillary N carcinoma, asthma
9/3/2008and 9/3/2008
drug hypersensitivity to
rmation has been received from theYphysician's office via medical records concerning a babyYgirl with a history
3/31/2008
of neonatal
5/1/2008 jaundice, mongo
n has been received from a pediatrician concerning a 14 day old female baby with a history N of exposure to GARDASIL
### 12/4/2007
while in uterus (app
n has been received from certified physician assistant (PAC) concerning a 3 day old, 7 pounds, 5 ounce, 4/9/2008
19.75 inch, 4/12/2008
female with a history o
medical records were received and received
Y concerning an 6 week old male with cleft lip andUa history of4/29/2008
jaundice, spitting
5/19/2008 up and blood bili
n has been received from a female pharmacist concerning herself who in earlier 2008 was vaccinated
N with a first and second dose of RECO
n has been received from an office manager concerning a male who on unspecified dates was U vaccinated with three doses of RECOMBIVA
n has been received from a nurse practitioner concerning a 34 year old, unemployed, femaleUpatient with7/10/2008
depression 7/31/2008
and a history of hepat
follow up information has been received from a nurse practitioner concerning a 20 year old female
U who on an unspecified date was vaccina
n has been received from a registered nurse concerning a 46 year old female with a history Y of knee problems
8/12/2008
and an8/13/2008
allergy to band aids, w
follow-up information has been received regarding
Y a case in litigation
0 from information obtained
U from a published
1/9/2002article
1/12/2002
concerning a fema
n has been received from a nurse practitioner via the patient's mother concerning her daughterY with a history of bulimia who about 9 years
n has been received from a medical assistant concerning a 20 year old female who was vaccinated
Y with RECOMBIVAX HB. Concomitant
n has been received from a nurse practitioner concerning a 14 year old female who was vaccinated
Y with the first dose of RECOMBIVAX HB
n has been received from a 50 yearYold female registered nurse with hypothyroidism and allergyN to non-steroidal
7/2/2008anti-inflammatory
7/13/2008 medicat
Y nurse concerning her daughter who sometime in 1998 U was vaccinated with a dose of RECOMBIVAX
n has been received from a nurse concerning a dialysis patient who was vaccinated with fiveUdoses RECOMBIVAX
2/19/2008 HB (dates of vaccinatio
n has been received from a nurse practitioner who heard that a female who was vaccinated Ywith a dose of hepatitis B virus vaccine (manuf
n has been received from a consumer concerning her friend's son who in 2008 (also reported Y as 2001) was vaccinated with one dose of RE
n has been received from a physician concerning a patient who was vaccinated with RECOMBIVAX U HB. Subsequently the patient experien
n has been received from a consumer concerning her daughter who in 1995 was vaccinatedUwith RECOMBIVAX HB. In 1995 the patient w
Y nurse concerning a 32 year old female with a history Y of migraine headaches,
6/6/2008 PENICILLIN
6/6/2008 allergy, hy
Y concerning an approximate 35-year-old female N with a history of ###
motor vehicle ###accident that r
n has been received regarding a case in litigation from a physician concerning a 30-year-oldUpatient who was vaccinated with a second dos
n has been received from a case inYlitigation via a case report concerning a 53-year-old maleN who on 04-NOV-2000
### with a
n has been received from a health professional
Y medical1/14/2008
history, drug
1/15/2008
reactions or allergie
Y nurse concerning a 22 year old female with no medical Y history or 1/15/2008
allergies who 1/16/2008
on 15-JAN-2008 was
n has been received from a pharmacist concerning a 23 year old female with a history of unspecified
N surgery and contemplated blood dona
Y nurse concerning a female in approximately her mid 40's N with no allergy
2/6/2008
to yeast
2/7/2008
(any other allergies
Y via medical records concerning a 4 week old female who Y on 30-JUN-2006
6/30/2006was 7/28/2006
n has been received from a registered nurse concerning a Caucasian female with allergies to Y CODEINE,8/28/2007
METHANOL and### PENICILLIN wh
n has been received from a nurse practitioner concerning a female who was vaccinated withYa nurse practitioner concerning a female who
n has been received from a registered nurse concerning a 14 month old female patient with Y no pertinent medical history
2/28/2008
or drug allergies w
n has been received from medical records
Y concerning a female infant (full term normal babyUgirl weighing9/17/2007
7 pounds9/28/2007
8.4 ounces with a lengt
Y concerning a 65 year old female with allergiesYto DEMEROL, codeine, and "DARVIN", and a
Y concerning an 8 month old black female with no known U drug allergies,
8/2/2007
who on 02-AUG-2007
### was vac
Y concerning a 1 day old Caucasian male infant (a normal U 9 lb 0.2 oz, male ###infant with ###no abnormalitie
n has been received from medical records and a health professional concerning a 4 week old U female infant with ###
small
11/1/2007
heart murmur and va
n has been received from a case in litigation concerning a female physician who on 03-SEP-1996,
U 11-NOV-1996
4/3/1997and 03-APR-1997 was va
n has been received regarding a case
Y in litigation which was reported in Litigation Report concerning
U a 48 year###old female who in Novembe
Y in litigation concerning a 43 year old female with carpalU tunnel syndrome and numbness in hand (bo
n has been received from a Nurse Practioner (N.P) concerning a 49 year old female patient N with sulfonamide
3/13/2008
allergy3/13/2008
who on 13-MAR-2008
n has been received from medical records
Y concerning a 5 week old infant male who on 28-JUN-2007
Y was6/28/2007
vaccinated8/1/2007
intramuscularly with w
n has been received from a pharmacist concerning a 66 year old female patient who in 1997Uor 1998 was vaccinated with a dose of RECO
n has been received from a patient who was vaccinated with a dose of RECOMBIVAX HB. U Subsequently, the patient reported that she fell
n has been received from a mother concerning her daughter who in August 1993, was vaccinated U with a first
1/1/1994
dose of RECOMBIVAX HB (m
n has been received from a registered nurse concerning a 21 year old male with a history ofNyeast of allergy who stated that he had an "alle
Y from a physician and from medical records concerning N a 27 year5/5/2006
old white male physician with gilb
n has been received from a mother concerning her son who was vaccinated with a second dose U (date unspecified) of RECOMBIVAX HB (m
n has been received from a registered nurse concerning a patient (age and gender unknown), U who on 24-JUN-2008
6/24/2008 6/24/2008
was vaccinated with a
n has been received from a 52 year old male physician who in 1998 was vaccinated IM withYa second 0.5 ml dose of RECOMBIVAX HB an
n has been received from pharmacist concerning a patient who on unspecified date was vaccinatedN with the third dose 7/2/2008
of RECOMBIVAX H
was reported by a healthcare professional and described the occurrence of dizziness in a 28-year-old
Y female
8/21/2007subject8/22/2007
who was vaccinated
Y and described the occurrence of near fainting in aY 13-year-old 2/2/2008
female subject 2/2/2008
who was vaccinat
Y and described the occurrence of rash in a 15-month-old
Y male1/24/2008
was vaccinated with H
was reported by a healthcare professional and described the occurrence of high fever in an U adult male subject2/5/2008 who was vaccinated with HA
was reported by a healthcare professional and described the occurrence of night terrors in aY2-year-old 2/27/2008
male subject 2/27/2008
was reported by a physician via a sales represented and a health care professional and described
Y the occurrence
5/14/2008 of rash in a 15-month-ol
was reported by a consumer (also the subject) and described the occurrence of shooting pain U up the neck 5/6/2008
in a 18-year-old
5/6/2008 female subject
was reported by a healthcare professional, via a sale representative, and described the occurrence
N of swollen
4/30/2008 gland 5/3/2008
in a 41-year-old femal
Y and described the occurrence of injection site redness
U in a 47-year-old
1/7/2008 male subject who was va
was reported by a healthcare professional and described the occurrence of diarrhea in a 45-year-old
N female
2/15/2008
subject who was vaccinated w
Y the occurrence of dizziness in a 45-year-old female
U subject who 2/8/2008
was vaccinated
2/8/2008with HAVRIX,
Y the occurrence of laboratory test interference in N
a female subject in her late 20's who was vacc
was reported by a consumer and described the occurrence of abnormal laboratory test value U in a 27-year-old1/1/2008 female subject who was vacc
was reported by a healthcare professional and described the occurrence of low grade fever U in a 1-year-old 3/19/2008
female subject
3/19/2008who was vaccina
Y and described the occurrence of sweating in a 20-year-old
Y female
3/20/2008subject3/20/2008
was reported by a healthcare professional and described the occurrence of pruritic papular rashY in a 65-year-old
2/28/2008male 3/9/2008
subject who was vac
was reported by a consumer and described the occurrence of tingling feet in an adult femaleUsubject who was vaccinated with HAVRIX (Gl
was reported by a healthcare professional, via an agency sales representative, and described U the occurrence 5/1/2008 of injection
5/1/2008
site soreness in a
was reported by a consumer and described the occurrence of a nonspecific reaction in a female U subject of 5/1/2006
unspecified age who was vaccin
was reported by a healthcare professional and described the occurrence of arm pain in a subjectU of unspecified age and gender who was v
was reported by a healthcare professional and described the occurrence of burning in a female U subject of unspecified age who was vaccin
was reported by a healthcare professional and described the occurrence of burning in a male U subject of unspecified age who was vaccinat
was reported by a healthcare professional and described the occurrence of vaginal yeast infection
N in an6/12/2008
adult female 6/18/2008
subject who was vacc
was reported by a healthcare professional and described the occurrence of localized inflammatory
Y reaction
6/27/2008
in a 10-year-old
6/27/2008male subject w
was reported by a physician and described the occurrence of vaginal yeast infection in a 17-year-old
N female
6/12/2008
subject6/13/2008
Y and described the occurrence of injection site hives
Y in a 3 year-old6/10/2008 female6/11/2008
was reported by a healthcare professional (also the subject) and described the occurrence of Y injection site 5/1/2008
redness in5/1/2008
a 67-year-old female
was reported by a healthcare professional, via a GSK sales representative, and described the U occurrence of injection site soreness in an u
was reported by a healthcare professional via a sales representative and described the occurrence
Y of hive
6/27/2008
in a 8-year-old
6/27/2008male subject wh
N of hives
6/27/2008
in a 3-year-old
6/27/2008 male subject wh
was reported by a healthcare professional and described the occurrence of heart palpitation in a 25-year-old 4/2/2008
female 4/2/2008
was reported by a healthcare professional and described the occurrence of accidental overdose Y in a 5-year-old
7/16/2008 female
7/16/2008
subject who was va
U of an unspecified, severe event in a pe
was reported by a healthcare professional via a sale representative and described the occurrence
U of an unspecified, severe event in a ped
was reported by a physician and described the occurrence of sweating in a 13-year-old maleY subject who8/2/2008 was vaccinated with HAVRIX (Gl
Y and described the occurrence of purpura in a 19-month-old
Y male
8/12/2008
subject8/12/2008
was reported by a physician and described the occurrence of anaphylaxis in a 1-year-old subjectU of unspecified gender who was vaccinate
was reported by a healthcare professional and described the occurrence of an accidental overdose
Y in a 2/20/2008
1-year-old female
2/20/2008subject who was
was reported by a physician and described the occurrence of fever in a 2-month-old male subjectY who was 7/3/2008
vaccinated 7/3/2008
with HAVRIX (Glaxo
was reported by a healthcare professional and described the occurrence of bleeding from cut N in a 52-year-old ### female subject
### who was vac
Y the occurrence of fussiness in a 2-month-old male Y subject who 11/7/2008
was vaccinated
11/7/2008 with HAVRIX (G
ct's medical history included high blood
Y pressure and high cholesterol. Previous and/or concurrent
Y vaccination
4/30/2008 included
5/3/2008
inactivated IPOL; u
was reported by a healthcare professional and described the occurrence of vaccination complication
U in a 6-year-old
### female ###subject who wa
Y the occurrence of fever in a 10-month-old female Y subject who was### vaccinated###with HAVRIX, G
was reported by a physician via a sales
Y representative and described the occurrence of hives Y in a 22-year-old ### female subject
### who was vac
was reported by a healthcare professional and described the occurrence of low grade fever Yin a 6-month-old male ### subject### who was vaccina
was reported by a consumer and described the occurrence of colic in a neonate subject of unspecified gender 12/1/2006 who was exposed to HAVRI
N
old child had received their two and four month YHib immunizations (manufacturer,
0 lot numberNand dates of administration not reported) and
ort received on 13 March 2009 from Ya health care professional. A 20-month-old male patient U had received 3/4/2009
on 04 March 3/5/2009
2009 a fourth intram
n has been received from a consumer concerning her son with no medical history or allergies N who on 20-SEP-2006
9/20/2006 was vaccinated with a
n has been received from a pharmacist concerning Y a 54 year old male
5 Y with hypertension,
Y obesity,
U diabetes,
3/3/2009
atherosclerosis,
3/4/2009asthma and he
n has been received from a nurse practitioner concerning her approximately 30 month old grandson U with a little autism prior to receiving the
n has been received from a consumer Y concerning her 5 year old son with no medical historyNor allergies who 3/1/2006
was vaccinated with a dose o
n has been received from a consumer concerning her 18 month old nephew with no medicalNhistory who in 1/1/2008
January 2008, was vaccinated
n has been received from a consumer who reported that she has 3 friends whose children were U vaccinated with a dose of MMR II and deve
n has been received from a registered Y nurse, for the Pregnancy Registry for GARDASIL concerning Y a 15 5/6/2008
year old female with attention def
rmation has been received through the Merck PregnancyY Registry for
0 GARDASIL from a registered
Y nurse 6/3/2008
concerning6/3/2008
a 20 year old female
min. of vaccines pt. hadYcough, sneezing.
Y Tongue
Y and mouth pain. 1 Doctor found periorbital edema
Y with 3/17/2009
wheals, no 3/17/2009
swelling of lip or tongue
9 pt. received 3rd dose of PENTACEL, Y HEP B, PREVNAR & ROTATEQ. Within 4 hours pt. Ydeveloped large 3/10/2009
area of3/10/2009
confluent erythema (s
24-28 after 12 pt. noted swelling redness & heat @ inj. site on left upper arm 4 cm X 2 cm area. Y Instructed 3/12/2009
to use compresses
3/14/2009 & TYLENOL
gling in arms/legs, feeling weak, nauseated 10/13 - see doctor 1st time & twice more in OctNOct - tingling 10/6/2008
in arms/legs, feeling
### weak, nause
d flu vaccine & got INFLUENZA B anyway.
Y Y ### 3/10/2009
at 3:00 pm vaccines were given Within Y 5 minutes of vaccines, she was feeling nauseated and Y a numbness 2/2/2009
in right arm
2/2/2009
which started to sp
somnolence and headache. Y Y 2/20/2009 3/2/2009
acular papular rash. Y U 2/24/2009 2/25/2009
a fast food restaurant after leaving Your office. Halfway there she got a pain in mid-sternal toYepigastric region.
2/26/2009 Then
2/26/2009
she felt very flushed,
non-stop crying. Y ###
ements of head to right Y
Varicella and Hepatitis A vaccine in L arm on day prior to visit. This AM noted significant swellingU erythema
3/17/2009
@ injection
3/18/2009
site. Area of erythem
as given HEPATITIS B vaccine on 2/25 @ 17:30. The second dose was given on 2/26 @ 02:00. Y 2/26/2009
en, painful (L) upper arm at area of Y injection. Mild erythema & cellulitis. PREDNISONE/CEPHALOXIN. Y 3/5/2009 3/5/2009
er the vaccine the site became red itchy swollen with scattered hives around the site & on trunk. Y 3/9/2009
.7 48 hrs after administration cellulitis
Y left anterior thigh. 3-4 cm annular area erythema and Ywarmth. Tenderness 3/16/2009 to3/18/2009
touch.
t 8:00PM on 3/18/09 Temp of 101 degrees. 3/19/09 Temp 102.9. To use Tylenol or Motrin. UTo take to ER 3/18/2009
if lethargic
3/18/2009
or not doing well.
Y concerning a 20 year old female with not drugYreactions or2/20/2009
allergies who2/21/2009
on 20-FEB-2009 wa
n has been received from an aunt concerning
Y her 15 year old niece with asthma who in JulyN2008, completed 7/1/2008
her three
2/23/2009
doses GARDASIL.
ving chills, achy joints, shoulder (left) and neck pain (left arm received vaccine) around 2200Non eve of vaccine. 3/16/2009 Began
3/16/2009
running fever of 100
PED ACHING/ FEVER ABOUT 24 HOURS AFTER ADMINISTRATION OF TDAP. TEMP 102 Y DEGREES,3/5/200948 HOURS 3/6/2009
LATER. BODAY AC
HROUGH ROTAVIRUS DISPITE 3 DOSES Y OF ROTATEQ AT 2, 4, & 6 MTHS OF AGE Y 9/2/2008 3/6/2009
of 102, hurts to move,body achy all over, crying from pain, has not called MD, called at 10:30 this am. encouraged 3/18/2009 3/19/2009
to call MD.
lling developed that has been increasing in size with time. It has not resolved as yet. My wifeUis now taking 3/16/2009
zyrtec, pepcid
3/17/2009
and Keflin 500 m
n to patient in error, should have gotten HepB Y 3/4/2009
e administered at 10 a.m. when I was 34 weeks Y and 5 days pregnant. 4 This was a twin pregnancy
Y with lots of monitoring
### (ultrasounds,
### etc.)
Y 3/19/2009 3/19/2009
NOTED HIVES ONCE AGAIN, ONLY THIS TIME WORSE, MOTHER GAVE PATIENT BENEDRYL Y AND 2/11/2009
PUT SOME 2/11/2009
CREAM ON HIVES T
ly immunized and pretty much on schedule
Y but was still diagnosed with pertussis per PCR on Y 3/13/2009. Immunizations
### 2/10/2009
dates were 11/16/2
eloped hives 22 hours post immumizations
Y on neck, trunk, and legs. No swelling of lips nor Y difficulty breathing.
3/12/2009 Consult
3/12/2009
to allergy clinic
ew hours after receiving 4 vaccines, patient developed a rash over both upper arms that spread U to lower 3/17/2009
arms, back,3/17/2009
and face. He had no re
ck dot on patient's left arm after administration of Varivax #2 using VanishPoint 5/8" syringe.U 1/13/2009 1/13/2009
d 5 minute tonic clonic seizure withYtemp 101 on evening shots were given. Patient had a history Y of prior3/17/2009
febrile seizures.
3/17/2009 Seen at Hospita
ack dot on patient's right arm immediately after administration of MMR. U ### ###
mplained of tightness and pain in his Y chest, wentY to the clinic at the 2Hospital on 15 Mar 09. Y The clinic then 3/4/2009
transferred
3/15/2009
him to another hosp
cular lymphadenopathy on same shot was given for gardasil #1 and #2 U 3/12/2009 3/19/2009
ymptoms, frequent urination, burningY on urination beginning 11 days after initial dose, continuing U sporadically6/11/2008
to present
6/23/2008
time, 9 months late
8/18/08; HPV #2, 10/20/08; HPV #3,Y3/3/09. Hospitalized
Y within 2 weeks
25 of each vaccine for severe
Y depression
3/3/2009 exacerbation.
3/10/2009 3/23/09 Rece
ular, vesicular, asymptomatic chin, upper/lower
Y extremities left ear very red, swollen 2/7/09 Y 2/4/2009 2/6/2009
ht thigh swollen, red, pain. 3/17/2009 3/18/2009
ted 03/16/09 and developed generalized rubelliform rash- continues to today though now defervesced. U 3/2/2009 3/16/2009
as given MMR vaccine on 3/16/09. Route IM the right lower thigh, Mom noticed reaction nextYday. Swollen. 3/16/2009
Warm to3/17/2009
touch. Large ring aroun
ed with redness to right thigh at around
Y 10am 3/18/09. Redness worse & area getting swollen N leg looks3/17/2009
more swollen.
3/18/2009
Child seen at 8am
out" for a few seconds then felt dizzy. Y 3/19/2009 3/19/2009
and warmth to deltoid site. Y 3/16/2009 3/17/2009
en 03-16-09. Called by mom about red hot areas on arm. Came in for eval. No resp. problems. Y Relaxed and reading 3/17/2009
book. R arm (delto
th local reaction, left upper thigh. Warmth and redness about 10x6 inches. U 3/17/2009 3/19/2009
8x10cm red oval. mild edema and tender to exam. U 3/18/2009 3/18/2009
ast 15 yrs, pt has had single spot zoster breakouts on her gluteal area approx every year. She N received ZOSTAVAX
11/7/2008 11-7-08. Since that tim
eloped on entire torso 7 hrs after MMR #1 given- Y 3/17/2009 3/17/2009
oe macular papular rash. Purplish face Y coloring, fussiness, fever, runny nose and swollen face.
N 3/18/2009 3/19/2009
ameter erythematous lesion on the (R) Y upper arm. Site of varicella shot 24 hrs after injection.
U 3/17/2009 3/18/2009
ox 3/18/09 after 2 vaccinations for VARIVAX 9/26/05 12/9/08. Y 12/9/2008 3/18/2009
Experienced diarrhea, vomiting and fever (102.0) for 24 hrs. Had same reaction to Hep B # 1Yof 3 on 11/17/2008. 3/13/2009 3/14/2009
n has been received from a manager Y concerning a 46 year old female hospital employee with Y allergy to 2/12/2009
LIPITOR, diabetes,
2/12/2009 hypertension, h
rmation has been received through the Merck Pregnancy Registry from a medical assistant concerning
Y a6/19/2008
19 year old6/19/2008
female with asthma wh
n has been received from a consumer Y reported that "her former student's sibling was diagnosed
N with autism after receiving MMR II the pati
Y from a certified medical assistant for the pregnancyYregistry for 9/21/2007
GARDASIL concerning a 22 year o
n has been received from a consumer concerning her 4 year old granddaughter who on an unspecified
N date was vaccinated
n has been received from a consumer Y concerning her approximately 26 month old daughterNwho in April 2000, 4/1/2000was vaccinated
4/1/2000 with a dose
n has been received from a consumer concerning her friend's son who on an unspecified date U was vaccinated with a dose of MMR II. It wa
n has been received from a consumer concerning her 16 month old son with no pertinent medical N history 9/1/2005
and no allergies
9/1/2005reported, who in
n has been received from a consumer concerning her grandson who on an unknown date was U vaccinated with MMR2/1/2001 II. It was reported that
n has been received from a consumer concerning her approximately 16 month old daughterNwith no pertinent 2/13/1995
medical
2/13/1995
history of drug reacti
n has been received from a consumer concerning her now 5 year old daughter with no drug Nreactions/allergies 3/22/2004who on 3/1/2005
22-MAR-2004 at the
n has been received from a consumer concerning her now 22 year old son with an allergy toYyeast who in "1988" at approximately 12 mont
n has been received from a consumer concerning her approximately 24 month old son who U on an unspecified date was vaccinated with the
n has been received from a consumer concerning a male patient who was vaccinated with aNsingle dose of MMR II on an unspecified date.
n has been received form a nurse concerning a 23 year old female who on 21-NOV-2008 was Y vaccinated injection ### with the ###first dose of GA
was reported by a pharmacist and described the Y occurrence of tremor in a 11-year-old subject
U of unspecified gender who was vaccinated w
after 4 month vaccines given, pt withYfever, multiple
Y episodes of emesis
1 and several cyanoticYspells. 1 spell 3/3/2009
lasted 30-603/4/2009
seconds - patient w
serious case was received on 27 February 2009 from a health care professional. A child received PENTACEL (lot number not reported) on
rregular area to left delt. Nt, slightly warm N 3/17/2009 3/18/2009
Y U 3/17/2009 3/18/2009
ever to 102, hives under bilat axilla,Ypain and redness at injection site, perceived wheezing and
Y dry mouth 3/18/2009
with nausea.
3/19/2009
Patient went to ER
40 pm MA had just finished giving pt IZZ's, when pt's foster mother asked if it was normal for Y pt to be all red
3/17/2009
MA turned3/17/2009
to see pt and he was
ythema at injection site noted several hours after receipt of vaccine - lasted 3 days and no c/oY pain or discomfort.
3/11/2009 3/11/2009
nstop crying for 3 + hours Y 3/11/2009
3/16/2009
Lymphadenopathy, cervical, BIL. Y 1/14/2009 1/15/2009
oe rash and headache. Reported by parent, did not see rash. Referred to family doctor. Unable Y to reach client
3/6/2009
for follow-
3/11/2009up information.
Herpes Zoster Vaccine 5/8/2008 gotY rash on L eyebrow - forehead (slight) no blisters. Oct 11, U 2008 - went5/8/2008
to eye Dr - clear. ### Nov 23 2008 -
es, abdominal pain ( <5 min from gettingY shot). Within minutes, trouble breathing, emesis. POY BENADRYL 3/12/2009
given initially
3/12/2009
before resp distres
local swelling including entire arm and
Y proximal forearm with localized pain and urticaria. Y 1/23/2009 1/23/2009
after vaccinations pt. noticed back ofY left arm sore & redness around injection site. The redness
Y continued3/9/2009
to spread,3/10/2009
was not to the touch.
es that eve after a shower noted area was red & swollen with a pinpoint flat rash that extended Y down from1/9/2009
injection site1/9/2009
3 fingers width. C/o
-103 degrees F wouldn't crawl or sleep or eat for 2 days very uncomfortable and just wantedUto be held. 4/13/1995
I get angry4/13/1995
because I could have g
fever to 103 degrees. Fever was noted Y (rectal) 102.7 on admit to ER, uncontrollable vomiting.Y Dehydration. Neuro ### signs intact.
### Received IV
orts that she had a softball size knot on left arm the day after her last TWINRIX on 2/11/09. ItY"had local fever
2/11/2009
and I itched
2/12/2009 and was very sor
-sized redness @ site of injection yesterday after school. This morning pt c/o slight pain andYsite was itchy. 3/9/2009
Mom noticed
3/10/2009 that redness had
ports approximately 40 min after receiving
Y vaccine became lightheaded, pale, clammy & thenY became semi 3/5/2009
unresponsive.
3/5/2009 Co-workers call
fter the vaccine was given, subject experienced tenderness, irritation, and swollenness in her Y left arm. Tenderness
3/17/2009 3/18/2009
and swelling has decre
d shot 12/30/08 - Raised red area around shot site is still red - not swollen just red - pt. is notYin pain just doesn't###like mark on arm.
mmatory reaction. 7x7 warm erythematous area assoc w/ persist fever. DX cellulitis, secondary Y to sterile3/17/2009
abscess from 3/18/2009
DTap vax.
veloped raised red "bumps" all over (L) arm 2 days after shot. States area itching but betterYnow. Instructed 2/24/2009
to notify
2/26/2009
MD for further instruc
ine VARICELLA. Y 8/8/2007 3/15/2009
iagnosis of chickenpox Received VARICELLA vaccine 3/1/02. Sibling had chickenpox - 2 wks U prior had not3/1/2002
received 3/12/2009
VARICELLA vaccine
d ZOSTER & TD BOOSTER vaccinations on 6Mar2009. Pt received vaccines on R deltoid.YZoster vaccine 3/6/2009
caused localized
3/7/2009 rxn to include
Limited movement of right arm. Y N 8/12/2008 8/13/2008
9 pt. called to report "hive-like rash" appeared on face within 2-3 days of 1st Hep-B vaccine Y given on 3-03-09.
3/3/2009
Rash now 3/5/2009itchy and spreadin
on Rt thigh hard red lump, warm to touch,Y no fevers using BACTROBAN oint and warm compresses. Y 2/23/2009 3/3/2009
esented to the clinic on the 19th of March complaining of a rash across his back and chest as Y well as behind
3/8/2009
his ears 3/18/2009
and some on his legs
veloped pain and redness at the injection site of Flu vaccine. His entire right shoulder turned Y purple. 1/17/2009 1/19/2009
nstop from 1am-8am. Shots were given at 3:20pm the day before. U 3/19/2009 3/20/2009
3/13/09 for 10 year old well child visit.Y Recieved varivax #2. On 3/15/09 developed large area Y of redness, 3/13/2009
pai, and warmth
3/15/2009 on left arm. See
ries of Hepatitis B vaccine(6/10/08, 7/15/08, and 11/25/08), the post-vaccine surface antibody N on 3/10/2009 was negative.
eveloped erythema swelling and lymphedema on the upper arm at the injection site. He had severe pruritis. 3/7/2009
Symptoms 3/11/2009
started on 11 Mar.
ries of Hep B vaccine (4/20/07, 12/21/2007 and 02/15/2008) post-vaccine HBsab was negative Y (titer on 3/10/09).
03.4, muscle spasm, r thumb-treatedY with anti-pyretics, time U 3/19/2009 3/20/2009
d adacel vaccine on 3/18/09. TodayY3/20/09 noticed rash on left forearm that is itchy, raised, were 9 bumps 3/18/2009
initially,3/20/2009
now only 3. No other
iving the second dose of the Gardasil vaccine, I had a large lump under the skin at the injection U site that 3/12/2009
felt almost 3/12/2009
like a marble. The skin w
n at 0930am, developed erythematous wheal, 4 cm & warm, almost immeditely and small hives U down both 3/19/2009
arms and 3/19/2009
face.
an ugly looking rash, which she describes as bright red and a lengthwise oval that is about 2-3" Y long. She 3/18/2009
notes that3/20/2009
it may be slightly raise
a faint red rash around the injection site. It was about 1/2" X 1&1/2" in the shape of a lenthwise Y oval. It does
3/18/2009
not itch.
3/19/2009
ported to Health Dept. that pt. wokeYup on the morning of 3-19-09 complaining of being dizzyYand unable3/18/2009 to get out of 3/19/2009
bed. He followed up
after receivng vaccines patient had temp (102F), n/v, chills and malaise. Mom treating with tylenol U and fluids.
3/19/2009 3/20/2009
EVED ANTHRAX VACCINATION AS A TUBERCULOSIS TEST ON HIS LEFT FOREARM. HE Y HAD THE 3/20/2009
NORMAL3/20/2009SIDE EFFECTS OF TH
eared on 3/19/09 and a vesicular rash around injection site. Treated with benadryl Y 3/12/2009 3/19/2009
soreness/tenderness in upper arm near site of injection. Mild sore throat and diarrhea. N 3/19/2009 3/20/2009
area of inderation at the site of the chicken pox injection. No rash in the area. I felt it was an uncommon reaction.
3/6/2009 3/19/2009
symptoms in Nov - Dec. Y Flu symptomsY 1st Jan.YSaw P.C. 1/5/09, showed
60 Y signs of choking often,
U called paramedics ### 1/18/2009
1/18/09 - could not stan
after vaccines (and after dinner + dessert),
Y developed
Y hives, lip/tongue
1 swelling, throat and chest
Y discomfort
2/26/2009
and dyspnea;
2/26/2009 then syncope.
itching and shortness of breath. Y 3/18/2009 3/19/2009
arm swelling, redness and tenderness. N 3/18/2009 3/18/2009
minutes of receiving 3 vaccines - MENACTRA, ADACEL, and GARDASIL, pt developed a macular/papular Y 3/18/2009
rash L arm 3/18/2009
and trunk. BENADRY
sion, Nausea. Vomiting 20-25 mins.Y Prior to EMS being called. Treated with a cold compress Y until EMS3/18/2009
arrived. 3/19/2009
d to have Erythema Multiforme 7 days after receiving vaccines. Also had mild URI, so E. MultiformeY could
3/10/2009
be due to3/17/2009
viral etiology. ? Possib
of swelling in legs, knees, elbows and hands. Mild pain in quads, sweating, sensation of dyspnea.U Treated
3/18/2009
2 weeks3/18/2009
prior for hives due to ib
ollen around site. Y 3/18/2009 3/20/2009
nstead of TDAP Y 1/27/2009
nstead of TDAP. Y 1/27/2009
= Legs and arms. No other symptoms. Occurred after shot. Disappeared after Benadryl. Y 3/19/2009 3/20/2009
@ site of injection. Post 12-12 hours later redness, hot to touch and swelling. U 3/19/2009 3/19/2009
ter had her 4yr old injections, she has Y always had a slight fever with each vaccination. This time
N however3/19/2009
she hasn't3/19/2009
been producing much
er first shot, daughter started having Y weakness/tingling in left arm. Also, dizziness. Within aNweek after second
3/9/2009 shot,3/12/2009
she began to have mo
nset of fever accompanied with febrile Y seizuresYapproxmitatly 9 days1 after vaccinations wereYrecieved. visited
3/10/2009
ER after3/19/2009
first seizure on 3/19/
MINISTERED (L) DELTOID 3/6/9 @Y1045. PT NOTED HIVES & ITCH @ SITE 3/11/9. PT CONTACTED U 3/6/2009
DR 3/12/9 3/11/2009
& WAS BROUGHT IN
atient started to loose muscle
Y and in May 2003, was diagnosed with ALS. 4/22/09 Y MR received
N from neuro 9/1/2001
2/7/05 to 9/1/2002
4/6/09 with DX: Proba
ceived both a pneumovax and influenza injection on 10/21/08, The influenza vaccination wasUgiven in patient's### right arm, and ### the pneumov
e clinic and within 1-2 hours had 103-104 temp and is still having extremely high fever and chills U today. 3/19/2009 3/19/2009
ously healthy 22-month-old male had Y the following
Y vaccinations on 1/20:
1 4th HIB, 1st hepatitis
U A, and 1st1/20/2009
varicella. The1/21/2009
following day, he de
ebrile seizure (15-20 min of generalized
Y T-C seizure
Y but with eye deviation
1 to the right). Fever
Y 39. Hoarseness. 3/2/2009 RSV3/21/2009
antigen positive. Rec'd
N
Y 0 N 5/20/1998
ort received 09 March 2009 from a health Y care professional which involved a cluster of two patients.
U Two patients,
9/1/2008also 3/1/2009
reported as employe
was received from a health care professional
Y on 13 March 2009. A 17-year-old male patient,Nwith a one-week 3/11/2009history3/11/2009
of upper respiratory in
ort received on 17 March 2009 from Ya literature collection. "An 8 month old female patient developedY a left sixth nerve palsy 6 weeks after D
n has been received from an office Y manager concerning a patient who on an unspecified date, Y was vaccinated2/10/2009 with2/10/2009
PNEUMOVAX 23 (lot#
n has been received from a doctor of Y pharmacy concerning a 77 year old male patientY with arthritis
N of wrist, enlarged
### prostate ### (benign), hyp
n has been received from a consumer Y concerning her 15 year old daughter with no Y past medical
N history 8/20/2008
n has been received from a consumer Y concerning his daughter (a year old female) with no medical
N history3/3/2006
or drug allergies who on 3-MAR-
n has been received from a consumer concerning her son (a "43 year old" male) who "developed U autism after receiving a dose of MMR II".
n has been received from a consumer concerning her daughter who became autistic after receiving U a dose of MMR II. Upon internal review
n has been received from a consumer Y concerning her 36 month old son with gastrointestinalNissues who7/24/1998 on 24-JUL-1998 was vaccinated w
n has been received from a consumer Y concerning his 9 year old daughter, who on an unspecified N date, was vaccinated with MMR II (Lot nu
n has been received from a consumer Y concerning a her 4 year old son with allergy to metalsNand a history 2/10/2004
of high fever
2/11/2004
in approximately in
n has been received from a consumer concerning her 8 year old grandson with no medical history N who in 2001 was vaccinated with a 0.5 m
n has been received from a consumer concerning her grandson, a now 10 year old male, with N no known drug reaction/allergies and no per
n has been received from a consumer her son, with no known drug reactions/allergies and no N pertinent medical history, who on unspecified
2/15/2009 N ### 2/13/2009
cal swollen, red , warm on lateral leftY arm. No fever. Y 3/2/2009 3/2/2009
a of erythema, fever to 101.5 degrees F 24 hours after injection of ADACEL left arm. Y 3/17/2009 3/10/2009
given 2/23/09. Patient monitored 30 minutes post vaccines. No problems or complaints reported. Y Patient
2/23/2009
returned2/24/2009
for visit 2/26/09 & repor
9 Pt presented here with vesicular like lesions to tip of nose and another vesicular like area with Y redness2/26/2009to left side3/12/2009
of nose. Normal eye an
ulopapules x 3 clustered on left upper anterior thigh at site of VCZ vaccine. U 3/6/2009 3/15/2009
izure seen at Hospital on 03-08-09.YNo activity since. Y 2/26/2009 3/8/2009
ped rash approx 10 days post SPV inoculation.
Y Petechiae also noted. Pt also had a dental surgery
Y the day2/9/2009
following2/19/2009
SPV inoculation and w
red, hot and swollen x 6 days measured 10cm x 6cm. ZYRTEC given and started on 3/10. Y 3/10/2009 3/11/2009
and tenderness at injection site when seen one week later. U
08 patient presented as a new patient and I found she was under immunized needing one polio Y and two tetanus ### boosters.### I elected to give
nted and hit her head, applied ice pack and examined by Dr. Waited in clinic for 1/2 hour after Y and was fine. 3/23/2009
Did have 3/23/2009
a bump on her forehe
Y 1/26/2009 2/2/2009
hema with superficial swelling 5x6 cm over vacc site apparently on the next day. Adv Motrin,UOTC Benadryl, cold compress.
ped papulovesicular lesions which developed into a rash along the T8 dermatome approximately Y Pt called 2/17/2009
back 2 days 2/21/2009
after ZOSTAVAX.
th knee pain on 11-19-08 - Motrin, knee Y brace - C/o stickling knee with pain on 12-17-08; numbness
U in toes-INDOCIN
### with###MRI (L) knee wit
n has been received from a consumer, for GARDASIL, a Pregnancy Registry product, concerning N her daughter
9/2/2008 in law,
9/2/2008
an 18 year old fema
n has been received from a 20 year old female with no medical history and drug allergies who Y in February2/1/2008
2008 was 2/1/2008
vaccinated with her fir
ed disease of pericardium Y U 12/8/2008 ###
raised area at injection site hot to touch and lump felt under the area Y 3/19/2009 3/19/2009
fic myocarditis Y U 1/12/2009 1/22/2009
carditis, unspecified Y U 12/9/2008 ###
carditis, unspecified; Unspecified disease
Y of pericardium. U ### ###
ricular tachycardia, dizziness, chestYpain. Brought Y to emergency room 7 by ambulance and admittedN to a cardiac
1/21/2009 telemetry
1/28/2009unit for 7 days. Nu
iven IM to LD and MMR given on 03/18/09. Mom returned on 03/19/09 and child had edema Y at injection3/18/2009
site that started
3/18/2009 2 inches above in
resented for follow up after recieving his small pox vaccine and anthrax on the 8th. On the 17th U he had erythema 3/8/2009and 3/20/2009
itching at the site. On
ceived the zoster vaccine at the VA clinic 2/5/09. At his f/u visit 3/3/09 he reported he'd developed
Y a shingles
2/5/2009
rash approx
2/15/2009 10 days after the
ccine was given on 3-6-09 @ 9:35 am. On 3-16-09 @ 2 pm patient developed a mild headache. N Between 3/16/2009
5:30 and3/18/2009
6 pm she developed g
09 BROKE OUT WITH 3-4 CHICKEN Y POX LIKE SORES WITH PINS & NEEDLES LIKE PAIN N AND CONTINUED 3/11/2009WITH 3/20/2009
BREAKOUTS UNT
RM SWOLLEN FROM SHOULDER TO ELBOW AND WARM TOO TOUCH, STARTED ON SATURDAY U 3/17/2009
3/21/09 3/21/2009
nt received the Tdap immunization without complications on Friday, March 6, 2009. Pt stated Y she felt fine3/6/2009
with no problems
3/11/2009 until Wednesda
M RED & SWOLLEN FROM SHOULDER TO ELBOW Y 1/20/2009 1/23/2009
9, approximately 24 hours after injection, left arm red, hard, swollen, hot and c/o itching. Over Y the next 33/19/2009
days, redness,
3/20/2009
swelling and itchin
ped his initial symptoms of low back pain within a month of his 3rd anthrax vaccination.Y His N
low back pain 12/3/2007
was later determined
### to be due t
mmediately following injection of HPV vaccine. No fall or injury. Rapid recovery - regained consciousness
Y 3/19/2009
when client3/19/2009
placed in suppine po
post vaccine patient developed feverY102 F. Mom was on her way to taking child to ED whenYchild had a3/18/2009 seizure in 3/19/2009
the car
Shingles Vaccine and Tetanus, DiphtheriaY Pertussis (Tdap) Vaccine received from Dr. Reporting Y administered
2/12/2009vaccines
2/23/2009
here rather than un
c symptoms started in my left hand within 2-3 weeks of a vaccination in my left arm. Y It startedNwith lots of7/18/2008
tremors and8/3/2008
then certain fingers in
24 hours after Meningococcal Vaccine,the
Y site of injection and surrounding area was red, painfull,swollen,
U 3/19/2009
tender, and
3/20/2009
very hot to touch. H
like exanthem 20 days post vaccination. Y 3/3/2009 3/21/2009
ash 2 weeks after admin of vaccine. 1/29/2009 2/19/2009
MMR on 2-2-09. Paperwork signed by pt & guardian that she is not currently pregnant, no possible way she 2/2/2009
is pregnant & understands shou
wollen, red, hot to touch from shoulderY to elbow. 3/20/2009 3/21/2009
ut of exam room after vaccinations and experienced syncope at check out desk. Event witnessed Y by/patient
3/20/2009
helped3/20/2009
down by nursing who d
in arm for over a month - Stinging pain, unable to lift arm. N 2/6/2009 2/6/2009
arm cellulitis Deltoid area. Y Y 3/6/2009 3/6/2009
ays after receiving VARIVAX left DeltoidY Pt developed erythematous papular left Deltoid which U have persisted
3/11/2009
about3/17/2009
1 week with minor loca
veloped hives 2 dys after vaccines were given. Y 3/13/2009 3/15/2009
00 x 2 days. Rash x3 days - red circularY hives. Right TM red - CEDAX, 1 tsp every day ORAPRED U 1 tsp 3/20/2009
po every day 3/20/2009
x 5 days.
rythema on L thigh around Dtap & polio Y site with induration. Pt on AUGMENTIN. Y 3/18/2009
ection 3/17/09 - 1st 8 hours painful 3/19/09 rash behind knee. 3/20/09 rash to arms & legs, & N then surrounding
3/17/2009 area3/19/2009
of injection. Red papul
important efect was today the Dr.toll me his LIVER get a little damage,the result from the laboratory
Y give as this matter, he always have BIG
upper left thigh started to swell within a day after receiving the shots. Area was warm to the touch,Y VERY2/27/2009
swollen, red,2/27/2009
and I could feel a ha
Y a 14 year old female patient with a Y
history of pre-eclampsia
2/4/2009 2/4/2009
and BELL's palsy duri
n has been received from a physician concerning Y a 21 year old female
21 ("who is a family friendY of the physicians") who was vaccinated with
n has been received from a physician Y concerning a patient was vaccinated with a dose of GARDASILU on an unspecified date. Subsequentl
n has been received from a physician concerning her newborn 3 month old baby who on an Yunspecified date was vaccinated orally with the
n has been received from a consumer Y concerning her 18 month old son "generally sensitiveNto different ingredients" and with no pertinent m
n has been received from a consumer concerning her son with no pertinent medical history and N penicillin allergy, who on an unspecified da
n has been received from a consumer Y concerning her 12 months old son who on 13-DEC-2004 N was vaccinated ###with one dose of MMR II al
n has been received from a consumer Y concerning her son who had been developmentally disabled N and who was vaccinated approximately
n has been received from a physician Y concerning Y a 57 year old female Y hospitalized patient who
N while hospitalized was vaccinated with PNE
n has been received from a physician concerning Y an 83 year old female who on 17-FEB-2009 N was vaccinated
2/17/2009with 3/10/2009
a dose of ZOSTAVAX (
ts of intussusception, eachY after given
Y rotateq vaccine,
Y the second episode
3 was 7 days afterYthe rotateq 3/13/2009
was administered.
3/20/2009 Was life flighted
ately 8 days after administration, the site of administration became sore, then burning and painful U sensations
3/13/2009
began3/21/2009
on day 11 following adm
ven varivax on 3/5/09. Within 10-15Ymins. of receiving vaccine pt. complains of flushed face,Ystinging at injection 3/5/2009 site 3/5/2009
and redness at site. P
area on right arm with a darker center surrounded by an erythematous area around it. It measures U 4cm3/13/2009
by 4cm. warm 3/14/2009
to touch. No fever.
linic on 03/24/2009 c/o severe painYat injection site. Unable to lift arm due to pain. Fever at injection
U site3/19/2009
and erythema 3/19/2009
noted at injection sit
t injection site, redness, swelling, hot to touch, tx w/ Y 3/19/2009 3/21/2009
pneumococcal vaccine trial, with severe COPD, Y was hospitalized for2 worsening interstitial cystisis.
Y Vaccination
7/28/2008 took place
3/3/2009 on 7/28/2008. Ac
RSE REACTIONS Y ### ###
d on the floor due to fainting. she stated
Y she was dizzy and the floor was spinning. She did not Y eat breakfast.
3/21/2009
Approx3/21/2009
1/2" in length and 1/4"
given on 3/12/09. She started having an erythemitous papular rash on 3/23/09. The rash began U on her3/12/2009
face and spread
3/23/2009 to her neck, ches
lder swollen & extremely sensitive with severe pain for approx. 3 weeks. called office was told U to ice area. 9/24/2008
went to other
9/25/2008
office was told som
veloped left-sided neck pain approximately
Y 48 hours after receiving varicella vaccination. The Y neck pain3/16/2009
was related 3/18/2009
to any head movemen
me to ER for 2nd injection of Hep B series on 3/10/09. The next am she noticed weakness in Y right hand3/10/2009
upon awakening.Patient
3/11/2009 was seen
ceived her first shot 5/24/07
Y - she had Y sorenessYin her arm and headaches
26 Y but tollerated them.
N On 10/1/2007 9/30/2008
patient
10/4/2008
was at basketball prac
e, vomiting, lack of appetite, extremeYfussiness N 3/20/2009 3/21/2009
er vaccine got vesicular rash on face. Y U 3/9/2009 3/13/2009
d, Swollen, hot to touch - Afebrile TX- warm compress to site three times/day recheck in 24hrs. U 3/18/2009 3/19/2009
hours entire upper arm was erythematous,
Y swollen and area around injection site was hard to Y palps - No3/12/2009
fever. By about
3/13/2009
36 hours erythem
d rash 8 days after receiving MMR and VARIVAX. Rash is diffuse on legs and trunk. There isYswelling of 2/27/2009 hands and feet.
3/7/2009
Dx'd with erythem
multiforme- Itchy red rash all over body.
Y Tx BENADRYL and cortisone ointment. U 3/10/2009 3/18/2009
rash on arms & forehead within 24 hrs of receiving TDaP vaccine recommended OTC BENADRYL Y & hydrocortisone
3/14/2009 3/15/2009
cream prn itching. No
crying for 3 Hour for no reason Y 2/25/2009 2/25/2009
igue, itching, hands hard to make a fist. Slight chest pressure insomnia anxiety anorexia. Y 3/10/2009 3/11/2009
ation with 2x2 redness in center with small bumps and tenderness. Y 3/16/2009 3/17/2009
of injection was red and swollen - very light & hot to the touch. Sun. - redness covered all ofYupper arm 3/13/2009 - down to the 3/14/2009
elbow, pulsating & ho
ure 104.2 within 12 hours of vaccine and stomach pains. U 3/16/2009 3/17/2009
was reported via a legal complaint, and described the occurrence of autism in a 4-year-old Y male
U subject11/2/2004
who was vaccinated with INFANR
continual ringing in left ear. Started Y 24-48 hours after receiving a .05 cc Tetanus/Diphtheria
Y booster
N injection. Still
###continual ###
ringing today. N
if he felt ok after I administered his Yshot and heY said yes, then said 2 he felt lightheaded and fainted.
Y I had3/18/2009
my tech call 3/18/2009
911 and I administere
s red, warm + swollen, painful T99.5. Doctor ordered Benadryl + Motrin. Area was cleared the Y next morning,3/13/2009
but returned
3/13/2009
that evening so re
dmin. 12/20/83, immediate adverse reaction, pt cried hysterically for next 6 months, Y dark black
N appeared under### eyes, learning
### special ED c
rts fever started 3/14/09. Rash startedY Sunday on chest & face. Itching. Swollen glands. Mucous N in throat.
3/6/2009
Seen 3/14/2009
at ER- Dx chick pox. S
3 days post VARIVAX. Seen by neurologist. Y 1/29/2008 2/11/2009
L given 3/17/2009. Patient got headache and vomiting on 3/19/2009 and 3/20/2009. Y 3/17/2009 3/19/2009
er arm completely swollen, warm but not tender, swelling was beyond elbow on 2/19/09. Recheck U if redness
2/18/2009
starts to
2/18/2009
extend rather than rec
after shots given, swelling size of grapefruit, red and hot. Treatment, BENADRYL, TYLENOLYand cold packs. 3/18/2009 3/19/2009
after second dose of VARIVAX vaccine (first dose on 1/27/97) developed swollen red arm at Yinjection site, 3/16/2009
fevers, and3/17/2009
severe myalgia. Also
redness and induration distal to vaccination
Y site with severe pain about 12 hrs after injection.YNext day redness 2/18/2009increased
2/19/2009
in size with fever
ed a 103 degrees fever for 2 days and Y cellulitis at the injection site. I also still have a lump inYmy arm. 3/5/2009 3/6/2009
dematous + erythematous at R upper arm surrounding injection site. BENADRYL, apply ice.Y 3/20/2009 3/20/2009
o itchy hives on Left deltoid appearing 5 days after injection. Y 2/16/2009 2/21/2009
post injection patient had large areaYof erythema >10 cm around point of injection. Y 3/9/2009 3/10/2009
se reaction reported - *Child mistakenly given Hep A 35 days prior to 1st Birthday. Y 2/10/2009
y care physician informed me on the use of GARDASIL and how it prevents cervical cancer.NAfter reading 10/1/2008
a small pamphlet
10/1/2008on the drug I a
in hives on arm where injection was given and chest. Relieved w/ 2 Benadryl. Y 3/13/2009 3/13/2009
3-09 Body aches, fever, left arm swelling, red & warm to the touch. Pt given BENEDRYL & Y on 3/16/09. 3/12/2009 3/13/2009
U
U
ceived TDAP & PNEUMOCOCCAL on 3-16-09. Presented to office on 3-19-09 with a 4 1/4 Y X 2 1/2" red,3/16/2009
raw, hard 3/18/2009
area, painful.
agnosed with chicken pox one month after receiving vaccine. U 1/19/2009
iving MENACTRA, in process of receiving GARDASIL, child became extremely pale and experienced Y LOC3/12/2009
x about 153/12/2009
seconds, slumping in
d arm rash lasting several days, treated Y with BENADRYL. Y 3/10/2009 3/11/2009
02/60; P 60 - R-12;- Pt feel lightheaded, skin tone change to pale. Saw spots, alteration in hearing Y (A:) Pt3/19/2009
given Kool 3/19/2009
Aid to drink Patient lay
ever 104.5, poor appetite, sleeping 21 Y hours/day. Fever controlled with TYLENOL and MOTRIN Y to 100-102 3/3/2009
degrees.3/10/2009
Afebrile 3/15/09, conti
Y Y 6/11/2002 3/20/2009
swelling (half dollar sized) at injection site of VARIVAX vaccine 24 hours prior. U 3/17/2009 3/18/2009
PENTACEL on 03/10/09. On 03/11/09 which mom was changing diaper she noted L upper thigh U at injection
3/10/2009
site was3/11/2009
swollen + red and see
and induration (L) deltoid at site of injection - blanching erythema - local allergic rxn vs cellulitis. Treated3/12/2009
for both (AUGMENTIN
3/14/2009 and CLARI
3/18/2009
L dose #3 1/27/09 2/17/09 - DysuriaY with Lower Abdominal Pain UA - Large Blood, small leuks, Y Prot > 300 1/27/2009
mg/DL cx-neg
2/17/2009
symptoms lasted
perienced a headache Tue evening of vaccine administration. Headache was "tolerable" and Y went away3/14/2009
by morning. 3/14/2009
given before age 1 no side effects reported. 3/16/2009
ported that injection site was red, itchy and sore since last night. Limited to round area around U injection site.
3/14/2009 3/16/2009
s were given, the patient was conversing Y with giver of immunization while drawing up 4th vaccine Y - Pt fell3/15/2009
out of chair,3/15/2009
hit head and was seiz
ng on legs. Slightly raised red rash on arms, legs, face, torso and back. 1 Temp 100.5. U 3/12/2009 3/13/2009
oke up the day after vaccinations with Y fever of 103 degrees. She was very fussy and had quarter- Y sized red3/12/2009
lumps on 3/13/2009
each thigh where vacc
day after vaccination. Y Y 3/9/2009 3/10/2009
ely after receiving HAV patient developed macular rash at site and upper back. Not hives, RxYwith BENADRYL. 3/16/2009 3/16/2009
s after injection - hive 3x4cm, (-) itching (-) shortness of breath --> ice pack, ZYRTEC PO, recheck Y 24 hours.
3/16/2009
3/17/09-
3/16/2009
still with redness / (-)
HEP A dose 2 in our office mom called 1 hr later & stated child's eye lids are swelling has callUinto MD. Child 3/17/2009
has seasonal
3/17/2009 allergies.
lled office 2 hrs after vaccinations were given. Child had hive- like rash on legs and abdomen. Y Instructed to 3/9/2009
give antihistamine.
3/9/2009
eared on neck 1 week after vaccineYpreceded by a headache and stiff neck. Rash is shingles-like. N Continued
2/25/2009
to spread 3/4/2009
down right arm, sho
out in full body rash consisting of small,
Y red, itchy dots 10 days after vaccine was administered. U Pt saw a3/13/2009
dermatologist3/23/2009
who told him he had
pprox. 11:15am shingles vaccine administered
Y to L arm SQ, tolerated well. Approx. 11:30 am Y client complained
3/17/2009 of nausea
3/17/2009 VS taken B/P 13
rmation was received on 26 November 2008 from Y a health care professional.
5 A female patientY received an 9/18/2008
injection 9/20/2008
of FLUZONE SV 2008-
n has been received from a physician who received a "health alert" from the state health departmentU concerning a 16 2/24/2009
week old patient who
n has been received from a registered nurse and a nurse practitioner, for GARDASIL, a Pregnancy Y Registry
1/20/2009
product,1/20/2009
concerning a 16 year
n has been received from a consumer, Y who was the guardian of the patient, for the Pregnancy Y Registry for 4/8/2008
GARDASIL, 4/8/2008
concerning a 14 ye
onset "bruising" dx: ITP.Y4-25-08 - GUILLAIN-BARRE Y Syndrome - 32
hospY 32 days. 4/1/09 MRY received for 11/8/2007
4 DOS- 11/27-29/07 ### with DX: Th
ausea, vomiting, fever + joint pain. 6/19/09
Y Pt reports she never sought medical tx. Took Benadryl.
N Case 3/17/2009
closed 3/17/2009
ced around 7:00 AM this morning that Y (R) upper arm was very red and very swollen. Redness N about 4 inches 2/25/2009
on diameter
2/26/2009 and arm is very s
-warm to touch-rash over entire upper Y arm- shoulder pain and swelling radiating down arm- Referred
Y to family
2/13/2009
doctor.
2/13/2009
Pt is 31, she got an M
vacc 110708; presented to ER 110808 Y with itchy red rash over entire body face, extrem. StartedY with neck, 11/7/2008
broke out 11/7/2008
with all over rash next
3/17/2009
) arm at inj site. redness, warmth, temp 100 deg. SEPTRA given for possible cellulitis. TYLENOL/MOTRIN
Y 2/16/2009
for discomfort,
2/18/2009 apply cool compr
3/16/2007
ination, patient collapsed to floor - fainting lasted 5 seconds or less. BP 118/80, no dizzness, Y nausea, headache.
3/18/2009 Left3/18/2009
with mother walked
nced vasovagal reaction within one minute following injection of HPV # 3. She was sitting on Y the exam table 3/24/2009
during3/24/2009
vaccine administration
ates client woke up from a nap around Y 4pm the same day of vaccination and his legs were stiff Y and he was 3/20/2009
screaming 3/20/2009
in pain. Mom states
ately 4:00PM 12/7/08 Symptom: Headache Y ThisY came on suddenly. 4Pain level was a 5. Described as aching 12/4/2008
pain on
12/7/2008
back (upper) head. W
presented to clinic 3/24/09 with c/o pins
Y and needles and tingling in right arm x ~ 3.5 weeks. U Onset was weeks 2/9/2009following
3/1/2009
02/09/2009 vaccin
pain/muscle locking approximately Y five days after vaccine administered at left shoulder and U left elbow, tingling ### in left11/3/2008
hand 2. Prolong
ccine administered in Lt Deltoid IM on 3/20/09. within 24 hiours patient reported left arm andYhand numb.3/20/2009 She experienced
3/21/2009 flu like symptom
male flyer w/ no significant past medical
Y historyY received smallpox vaccination
7 by scarification
U on 10MAR09. 3/10/2009
Pt then3/20/2009
deployed. On 20MAR
ted a red, hot raised area on the child's left upper arm 2 days after receiving the vaccines. ItYwas 3 in in 3/17/2009
diameter and 3/19/2009
had a white area in th
by Mother of client on 3/25/09 @ 08:30 Y a.m.): "Left leg is sore by her knee with swelling, redness
N (in a big
3/23/2009
red circle3/24/2009
where vaccine given)
administered Jan 27th, 2009. FeverYdevelopedYwithin 2-3 days of vaccine 10 administration, pt felt
Y bad, experienced
1/27/2009body 1/29/2009
aches and weaknes
Blood pressure, Face and eye swelling, Y shortness Y of breath and chest4 pain went to the emergency
N department
3/24/2009and 3/24/2009
is currently admited at M
red, swelling and itching, mom administered childrens benadryl ### ###
ess, tightness in chest. S/s started 10 Y days after vaccination. Pt was given naproxen 500mgUtwice daily and 3/12/2009
zantac 3/22/2009
150mg twice daily. Con
e reactions/symptoms. patient given extra dose of IPV (Polio) vaccine, FOC upset. 3/16/2009
ollen lump area. One lump to left deltoid 8.5x5.5mm. One lump to left arm sub-q 5 x 5mm. Lumps occurred 3/16/2009
one day 3/18/2009
after injection.
ous vessicles at injection site, pain and burning 3/13/2009 3/25/2009
ve first dose of Rotateq after 15 weeks of age on 3/20/09. Infant has had no untoward affectsYwhen nurse3/20/2009 checked with the parent the next
mitting this report per patient's primaryY care physician's request. Patient was hospitalized andUwas given Pneumovax 3/16/2009 3/18/2009
prior to discharge on 3/
rash broke out the night of the vaccination on elbows, moving the buttocks and then ankles. UFeet sweating profusely. ### Lasted
### about 3 week
erythema, plaque lesion; mild tenderness; no fevers, no chills, no airway compromise; treated Y with ALTABAX; 3/16/2009no other
3/18/2009
problems reported.
by pt to show nurse reaction. Pt told nurse that 8:30 A.M. 3/18/2009 - area became hot to touch N & itchy. 3/17/2009
1:30 P.M. -3/18/2009
Pt went to see school n
and swollen all around back of arm approximately 5 1/2 inches long. Pt. states site itches. Y 3/23/2009 3/24/2009
of throat with difficulty swallowing, fever,
Y weakness, red and swollen arms Y 2/13/2009 2/16/2009
Tdap left deltoid, 3-22-09: arm sore, fatigue, 3-23-09: pain in arm with movement swollen left axillary lymph 3/20/2009
node, tender
3/23/2009
to touch, 3-24-09:
aiting in line about 15 minutes after receiving iz and fainted, hitting head on wall and floor. Received
Y immediate medical attention. VSS. nl ne
on reported yet. Misadministration 2 hrs ago. 3/24/2009
d Acute L arm swelling + redness. Was Y seen on 3/18/09 + started on Keflex. Was seen againY on 3/20/093/16/2009 redness + 3/16/2009
swelling had improved.
Thurs. night Temp 105 Friday with HA Y dizziness Temp lasting till seen Tuesday - 100.1 in clinic.
Y 3/18/2009 3/19/2009
d a fever 103-104 F on Sat 3/21/09.YHe also C/O abdomen discomfort X vomited x1 and backache. U 3/19/2009 3/20/2009
ght after getting vaccines started with Y chills, low grade fever and headaches. I called doctors Noffice told it 3/23/2009
was normal. 3/23/2009
Today 3/25/2009 Son
n has been received from a physician Y concerning Y an approximately 12 month old (reported as Y "1 year") male who within the last few weeks
Y Ythrough the Merck pregnancy
6 registry concerning
Y a 17 year1/22/2008
old female
1/22/2008
who on 22-JAN-200
n has been received from a physician, for the Pregnancy Registry for GARDASIL, concerning Y a 23 year 1/26/2009
old female 3/16/2009
n has been received from a physician Y assistantYconcerning a 16 year old female Y with no allergies
Y who on3/12/2009
12-NOV-2008 3/13/2009
was vaccinated wit
n has been received from a physician for the pregnancy registry for GARDASIL, concerning Ya 24 year old 4/26/2008
female patient
4/26/2008
with no known dru
n has been received from a physician for the pregnancy registry for GARDASIL, concerning Ya 25 year old 6/30/2008
female patient
10/5/2008
with no known dru
n has been received from a physician Y concerning Y a children patient who
Y on an unspecified date Y was vaccinated with the third dose of ROT
n has been received from a physician Y concerning a child who on an unspecified date was vaccinated
Y with the third dose of ROTATEQ (Lot
was received via an author of a newspaper
Y article on 19 March 2009. It is part of a cluster involving
U one identified eight-year-old
1/1/2009 male pati
e, vomiting approximatelyY36 hrs after Y vaccine administration.
Y Admitted
6 Yto SICU on 3/21/09 for U observation 3/18/2009
and close3/19/2009
monitoring for Intraven
ain - whole body - muscles stiff - jawYmuscles sore sore throat - needed assistance Y dressing -Ngetting out of2/3/2009
bed - etc. 2/5/2009
Used wheel chair and
stered PENTACEL, PREVNAR and Y ROTATEQ Y3/16/09. Pt had 5 generalized
3 seizures on 3/17/09.
Y Temp3/16/2009
100.1 rectally.3/17/2009
4/2/09 MR receive
RA given left upper arm 3/18. Increased Y redness and swelling around site 3/20. 7"x7" warm, U firm with vesicular
3/18/2009 lesions
3/19/2009
in center, with crusti
U 2/27/2009 2/27/2009
e significant pain in arm at injection site.
Y Had some redness around site the next day as wellYas some joint 3/17/2009
discomfort 3/18/2009
in wrist/hand.
ttered papules -> Probable chickenpox Y *Child rec'd 2 doses of VARIVAX dose #1 age 12 mos. Y dose #2 age 9/26/2007
6 yr. 3/24/2009
n, red circle about 4" in diameter at injection site. Sore to touch. 2) Slight headache and same Y feeling I get
3/10/2009
if I eat food3/11/2009
with MSG, surprised
yr old immunizations on 3/18 noted swelling & redness on right arm 3/19. Also c/o fainting feeling Y with h/a 3/19 for several hrs that subside
Red rash size, 2 " in diameter started Sat. AM some soreness. 2 days later still bright red, rash Y itching. No 3/20/2009
swelling. 3/21/2009
Dx localized reaction. P
3/20/2009
cine given March 12 3:00 pm March 16 low grade fever, tired, March 18 broke out in hives. March Y 16 - 183/12/2009
low grade 3/16/2009
fever March 18 bad hiv
t injection site noted after administration of vaccine. 1 tsp BENADRYL given start: 2 doses ofY steroid for 3/19/2009
HS and next 3/19/2009
day AM.
izure-no treatment Y Y 3/16/2009 3/19/2009
old male subject presented to the Healthcare
Y Center for evaluation of a progressively disabling
Y fatigue-like 8/9/2004
syndrome that he believed was
ceived varicella vaccine at ages 19 months and 10 years -on 5/12/08-. The vaccine was administered in5/12/2008 the left arm2/23/2009
at 10 years of age, loc
er vaccine, he ran a fever of 100-102 Y degrees F on and off for 6 days. On the 7th day after vaccine,
Y he broke
3/5/2009
out in severe
3/9/2009 full-body hives
ox #2 given on 3/17/09 and came back on 3/19/09 with (R) arm posterior redness and swelling. Y Tx: Ice daily
3/17/2009
to affected
3/19/2009
area for 20 mins an
t injection site noted after administration of vaccine. 1 tsp BENADRYL given STAT 2 doses with Y steroids3/19/2009
for HS and3/19/2009
in AM.
immunization on 3/12/09. Parent of child noticed pain, swelling on 3/19/09 came into clinic on Y 3/20 with area
3/18/2009
of redness,
3/19/2009
swelling and pain
& swelling at injection site. Y Y 3/18/2009 3/19/2009
itching, swelling, fever at injection site
Y and rash extending from deltoid to elbow on (R) arm. U 3/25/2009 3/25/2009
itching, swelling and fever at injection
Y site and rash extending from deltoid to elbow on left arm. U 3/24/2009 3/24/2009
n has been received from a 22 year old white female consumer (medical assistant), for the pregnancy Y registry
4/11/2008 for GARDASIL,
3/1/2008 who on 11-A
n has been received through the Merck Y Pregnancy Registry via a physician concerning a 19Yyear old female 4/21/2008
with a 4/21/2008
history of tobacco abus
n has been received from through the Y Merck Pregnancy Registry via a nurse, concerning a 19 U year old female
9/7/2007 with a9/7/2007
history of asthma, and
ness, tingling, tightness right side ofYface, could hardly open mouth. given two 12.5 mg. childNBenadryl strips. 3/21/2009taken3/21/2009
to Goshen General Ho
ceived Tdap (Adacel) on 3-23-09 @Y3:20 pm. He awoke @ 8 am on 3-24-09 with joint aches, N chills (hot,3/23/2009
cold, sweats), 3/24/2009
malaise, weakness
N TO HAVE SEIZURES AN HOURYAFTER THE VACCINATIONS. I TOOK HIM TO THE EMERGENCY Y ROOM.
2/2/2008 WHERE
2/2/2008
THEY SAID THA
ceived vaccine and reports not feeling well a few hours later. Symptoms began as a headache Y and bodyaches,
3/25/2009 and3/25/2009
later progressed to swe
gan about 2 hours after receiving vaccine. No local, injection site reaction. She took a Benedryl Y and was 3/25/2009
clinically stable
3/25/2009when seen.
in for labs and for a Gardasil vaccination. She was vaccinated, and then while having labs drawn, Y she became### lightheaded ###and fainted. M
LASTING APPROX. 3 MINUTES TRANSPORTED Y BY EMS TO ER. Y 3/25/2009 3/25/2009
s post administration of Varicella vaccine, pt reports swelling at site. Upon inspection, erythema Y and swelling3/26/2009noted3/26/2009
to the site. Denies any
eived second dose of pre-exposure Y Rabies vaccine on 2/3/2009, and telephoned health department Y on 2/10/2009
2/3/2009with 2/9/2009
concerns over vacci
, very edematous, erythmatous, painful.
able crying for more than 3 hours. Tylenol did not help. Kept on crying in her sleep Y 1/19/2009 1/19/2009
iving vaccine patient became light-headed and dizzy. Pt. admits that this has happened before. Y She said 3/19/2009
she's not 3/19/2009
surpised that this happe
second dose in series of Hepatitis BYvaccine on 3/18/09. Reported that she started vomitingYon 3/19/09.3/18/2009 Was treated 3/19/2009
at an Urgent Care fa
RENCE WITH LIMB MOVEMENT LEFT LOWER EXTREMITY. REFERRAL: NEUROLOGY Y 3/11/2009 3/19/2009
ect of left arm at Varicella vaccination site has several clear filled vesicles. Arm warm, red and U swollen from3/24/2009
shoulder 3/25/2009
to elbow. 5 inch by 5 i
ceived his Tdap vaccine first. It took us 10 minutes after administration of the Tdap to determine N he also3/23/2009
needed MCV. 3/23/2009
This was administe
03, nausea, vomiting approx 8-10 hours Y after vaccination Y 1/5/2009 1/5/2009
e weakness, lethargic, muscule painYin all extremities. Continued to remain ill for Ymonths with N dizziness, stomach
9/2/2008pains, 9/2/2008
diahrea, numbness
ax was ordered and administered to a 2 month old patient. No adverse reaction has been reported. U 3/25/2009
was reported via medical records forwarded by a lawyer and described the occurrence of Lyme N disease in 6/4/1999
an adult female
6/4/1999 subject who wa
was reported by a lawyer and described the occurrence of stiff neck in a male subject Y of unspecified
N age 5/4/2000
&S inc. numbness/tingling in hands/feet.Y 12/3/08
Y ER for intense pain5 in
Y joints = Dilaudid. 12/5/08
N medical11/5/2008
center = constipation/MAALOX.
12/2/2008 1
er called 2 days after immunizations was given,Ywith c/o non-wt bearing 1 and swelling at site,Ybrought pt to 3/16/2009
office 3 days
3/18/2009
after with redness, s
min of getting the shot, pt had hives,Ychest pain,Y difficulty breathing, 1had called 911, pt admitted
Y to hosp. 3/24/2009
4/6/09 Received
3/24/2009 hospital medical
rts about 14 hours after shots, pt was seizing inY his bed. 911 was called
2 /ambulance son to hosp
U and pt 1/30/2009
taken to medical2/5/2009
center (then trans
ng today to report that on 3/25/09 bright red lump appeared on left leg where she received vaccines U at 1yr3/6/2009
wcc 3/6/09.3/25/2009
No warmth, dime siz
ebrile Seizure Y Y 3/25/2009 3/26/2009
ted local reaction. Y 3/24/2009 3/25/2009
with swelling to R deltoid. U 3/24/2009 2/25/2009
r, achy all over body and nauseated. Discussed possible reaction versus onset of viral illness. U To treat fever
3/24/2009
and push 3/25/2009
fluids. If not better by
ess. induration pain. Since he got the vaccine. 0 fever . given Cephalexin - Benadryl - cold compresses.
Y 3/23/2009 3/24/2009
hest 3 days after administration. Rash was clustered only in this area. Y 2/5/2009 2/8/2009
swelling and warm to touch. 10x8cm. Advised to ice and apply warm compresses, observe area U of erythema 3/24/2009
circle 3/26/2009
with marker, advised, m
elt woozy approx 5pm afternoon he received vaccine. Has had headache/nausea & vomiting. U Vomiting3/24/2009
occurred only3/24/2009
on 3/26/09.
r injection - Pt c/o rash, swelling, itching @ site. Y 3/17/2009 3/18/2009
delayed. Redness, warmth and swelling around injection site, 4x4cm. Given antihistamine and N hydrocortisone
3/19/2009
cream.3/24/2009
Local Rx started sam
swelling and pain after she received a MMR vaccine on 3/19/09 in Lt. upper arm. Y 3/19/2009 3/19/2009
was reconstituted with sterile water and was given as a injection to the Lt arm. Y 3/23/2009
d inflammatory reaction, right thigh fromY upper thigh almost to knee with warmth and tenderness. Y 10/6/2008 10/6/2008
he left upper arm 2cm/3cm red rash round noted left upper arm tender to touch. 3/25/2009 3/26/2009
+ minimal swelling @ site. Y 3/9/2009 3/10/2009
per right arm and neck and swelling upper right chest since flu injection 2/25/09. Notices pain U in upper right
2/25/2009
arm when he lifts things.
d Tdap + Typhoid 3/9/09 for pre-travel immunization. Within 10 min of receiving vaccine pt c/o Y pain + swelling
3/9/2009
L posterior
3/9/2009deltoid. Pt. denie
d 8x15cm local erythema, induration in thigh. 3/23/2009 3/23/2009
d up to ER 2/27/09 after receiving shot Y at Hospital with fever 39 + C + Febrile seizure. HIB inYFB #3 & PCV#3. 2/27/2009 2/27/2009
Y 3/24/2009 3/25/2009
ng all over started and headache 45 minutes after shot received, but able to still function. Took Y Tylenol 10003/25/2009
mg about
3/25/2009
3 hours later due to
n has been received from a Certified Nurse Midwife concerning a female with a penicillin allergy Y who on 01-FEB-2008
2/1/2008 3/1/2008 was vaccinated IM w
n has been received from an office manager and a physician, for the Pregnancy Registry forYGARDASIL, concerning ### a 23 year old female w
n has been received from Y a nurse practitioner
Y concerning a 16 year old female with history of Y mild reaction3/5/2009
(itching) to3/5/2009
orange who on 23-D
n has been received from a medicalYassistant concerning
Y a 15 year old female who in approximately
U March
10/1/2008
2008 and in October 2008, was
n has been received regarding a case in litigation concerning a 4 year old male who on 13-OCT-2000N was
4/25/2001
given a multi-vial (first) dose of R
ated that right arm was swelling, warm, Y red and firm to touch. States child c/o hurting and swelling
Y seemed 3/12/2009
to be increasing.
3/14/2009 Parent took chi
n has been received from a consumer concerning her son (a "6 year old" male) with history of U gastrointestinal
2/1/2004
dysbiosis and high yeast leve
n has been received from a reporter who mentioned that he heard of a boy in a family was vaccinated
N with one dose of MMR II on an unsp
n has been received from a reporter who mentioned that he heard of a boy in a family was vaccinated
N with one dose of MMR II on an unsp
as accidentally administered PEDIARIX (instead of PENTACEL) et Hepatitis B resulting in anUextra dose 3/19/2009 of Hepatitis B given. Patient was c
, fussiness and swollen glands. Y 3/12/2009 3/20/2009
sis and lightheadedness shortly after Tdap administration, resolved after 15 minutes. Fever 103 Y by history 3/20/2009
18 hours after
3/20/2009
injection, lasted 2 d
r pt. received vaccine she started c/o feeling tired. Pt had several weeks of fatigue symptoms Y that continued until###Feb.
11/5/2007
2008. Several differ
back, chest, abdomen with itching. Resolved OTC antihistamines. Y 3/16/2008 3/18/2009
after receiving immunization, injection site red, hot & larger in size. On exam: Right anteriorY thigh injection3/20/2009
site is firm,
3/22/2009
slightly warm, & ten
ng & redness at injection site 3-20-09 Tx. cephalexin 125 mg PO TID X 10 days. Y 3/19/2009 3/20/2009
ven Tripedia U2397BA instead of Td with pertussis. No adverse event reaction. Adverse reporting Y notified.
3/20/2009
Physician states that re-vaccina
ven Tripedia U2397BA instead of Td with pertussis. No adverse reaction. Adverse reporting notified. Y States
3/20/2009
that re-vaccination was not requ
se problem- Pt was given DTAP Tripedia U2397BA instead of Td with pertusis- was told revaccination not3/20/2009 needed.
om left thigh red, hot and swollen since Y vaccine given on 2/25/09. U 2/25/2009 2/25/2009
om left upper arm with erythema, hotYelevated rash 3"x 2 1/2 ". 2nd degree to vaccine area. U 3/18/2009 3/18/2009
d headache within 2-3 hours after TyphoidY vaccine. Within 24-30 hr joint paint in hips,shoulders,elbows
N and
2/23/2009
knees. Elevated
2/23/2009temp at 72 hou
LATTER PART OF FEBRUARY Y PATIENT
Y REPORTED
Y TO LOCAL60 EMERGENCY ROOM WITH U COMPLAINT 12/3/2008
OF WEAKNESS
3/1/2009 AND LEG P
SSIC LESIONS, BUT HAS RECIEVED 2 VARIRAX AND THE DISTRIBUTION AND ITCHINESS U ARE C/W 6/19/2007
CHICKENPOX.
3/25/2009
es and Fatigue increasing in first 6 months
Y after, leading up to dizzy and fainting spells, low blood
N pressure,
4/24/2008
and Migraines.
4/24/2008Still experiencin
n to have TB test read 3/13/09 1300. Rt deltoid where Tdap injection had been given "circle slightlyY larger3/11/2009
than a quarter
3/13/2009
is red, warm to tou
S ADMINISTERED IN AM ON 3/24/2009. T/C FROM MOC 3/27/09 AT 9:15 AM TO REPORT CHILD C/O 3/24/2009
HER LEFT 3/27/2009
ARM ITCHING. aRM
DM, HTN, HLD, BPH p/w weakness that started Y yesterday midmorning.
18 He firstYfelt weak during
N work, when ### he noticed ###that he could not
PAIN LEFT SHOULDER SINCE INJECTION- POSITIVE RASH N 2/25/2009 3/1/2009
ved vaccine on Fri. She did not experience
Y any adverse effects until waking up the next day.Y She was dizzy, 3/20/2009
had some
3/21/2009
episodes of rapid h
3rd 2009 my son recieved the Varicella vaccine along with the Hepatitis A and MMR vaccine. U Seven days3/3/2009
later he had
3/10/2009
a slight fever aroun
headache from day after vaccine 4YMarch 2009 to 12 March 2009. Accompanied by fever (101 Y deg), chills, 3/3/2009
burning 3/4/2009
eyes, cough, sore thro
ented to er on 3-20-09 with a full body rash andYfever of 105 F. Admitted 6 to hospital the nextYday. currently3/16/2009
the rash3/21/2009
has faded, no temp., l
e. After receiving Hepatitis A IM 0.5ml Y injection the nurse noted that the patient was not breathing
Y with his3/20/2009
eyes rolled 3/20/2009
back and body had be
nd shoulder very sore, swollen, difficult to move arm or shoulder. SiteYreddened, swollen raised, Y warm to3/24/2009
touch for several
3/25/2009days. 4/28/09 R
me red, inflamed, sore, patient developed fevers Y 3/5/2009 3/6/2009
inoculated with 6 separate vaccines at approximately 3:40 p.m. and after about 2 min., MomYnoticed that3/26/2009 child's face 3/26/2009
had broken out with h
t started at the site of the pentacel injection and then extended to the length of the leg, the other
Y leg, the3/26/2009
arms, the trunk,
3/26/2009
& the face; red/pin
shot was given, her legs started teitching.
Y TheYdoctor told me this 26
was normal. ItYkept up, gotN worse where 12/9/1999
she would turn### blue, eyes bulge
& induration on left arm measuring 3 1/2 X 5 1/2. Y 3/25/2009 3/26/2009
r, injection site pain, redness, swelling,
Y pain in eyes Instructed to see physician Y 3/24/2009 3/25/2009
ed the following from a consumer via the agency on 12 MAR 2009: A 58-year-old female patient, N was vaccinated with FLUVIRIN i.m. in Oc
d with 2 doses of 2 month immunizations < 28 days no adverse reaction reported @ 5 days.Y 3/23/2009
high and red area both size of a dime. No swelling of the leg. Applying cool pack and TYLENOL. N 3/24/2009 3/25/2009
d raised blister like lesions with erythema base at site of injection (clustered), then dried and Y became flesh 2/19/2007
colored. No 3/13/2009
fever, no other lesion
F at 11 PM, following immunizations Y (PEDIARIX, HIB, PREVNAR, ROTATEQ) in the morning. Y 4/7/09 Received
3/26/2009 ER3/26/2009
medical records of 3/2
wollen @ injection site with mild painYinduration measured @ 4 X 4, mom was told to apply cool U compress 3/24/2009
to site. Admin.
3/26/2009
BENADRYL 1 tsp
leg with large warm erythematous Y area tender small rash macular to same leg lateral side, twoU days after 3/24/2009
vaccine. 3/24/2009
Treated with KEFLEX 1
der joint pain with occasional low grade fever at night. N 2/27/2009 2/27/2009
and swelling at injection site pain through shoulder, arm, 50 mm x 50ml L deltoid. U 3/23/2009 3/24/2009
eived IMOVAX IM on 3/26/09 on L deltoid. Reports severe pain and knot at injection site andYlimited range 3/26/2009
of motion3/27/2009
L arm at 9am on 3/27/
a of swelling & redness in deltoid area of left arm. Y 3/17/2009 3/20/2009
ent BOOSTRIX instead of HAVRIX along with IPOL, MMR, VARIVAX and DTap. Y 3/24/2009
fter GARDASIL (#2) Pt developed acute respiratory problems. "Lack of breath" after thanksgiving Y dinner. ### ###
nausea, sweating - soon after injection - Pt put head between legs - pt felt better in 10-15 minutes.
Y Offered
3/27/2009
pt. cold3/27/2009
water - pt said she wa
ction - redness and induration on left deltoid. N 3/24/2009 3/26/2009
7/09 for "diffuse maculo - papular rash "from abdomen down -slight "scaly" feel to it - macular rash on bottom 3/26/2009
of feet.3/27/2009
MMR began screaming, writhing and Y complaining of arm pain (not at site of injection which Y was not inflammed)
3/25/2009 screamed
3/25/2009 x 3 hrs, had feve
ought patient in stated that his R leg was swollen. Pt was given injection on 3/18/09 on his RUleg was his 3/18/2009
IPV and DTP. 3/20/2009
Dr look at Pt and inf
tingly warm feeling in L fingers (1st and 2nd digits). U 3/27/2009 3/27/2009
at injection site, redness and swelling Y around elbow and an overall sick feeling. Y 2/25/2009 2/26/2009
Y Y 2/26/2009
02, irritable. S/S started pm 3/23/09. Redness, warm to touch right thigh edema. Left thigh edema Y and "knot"
3/23/2009
present 3/23/2009
treated with Tylenol.
d HPV (GARDASIL) #2 in L deltoid. Here for TI DM follow-up, not acutely ill. Within < 1 min, Y pt c/o pain, 3/26/2009
and erythema 3/26/2009
noted. I was called in
U 3/10/2009 3/21/2009
at injection site, redness and swelling Y around elbow and overall sick feeling. Y 2/26/2009 2/27/2009
s given but it was suppose to be a DTAP due to patients age. 3/19/2009
nausea, headache, slurred speech.Y 4/17/09 MR received from PCP from 3/25 to 3/27/2009. U Seen for PE 3/25/2009
and vax 3/26/2009
3/25/09. Seen 3/26/09 f
receipt of FLUSHIELD Lot #4998274 Y in 1999 to her left deltoid. The next day she noted fine Ypruritic red spots
10/8/1999
to bilateral
10/9/1999
cheeks progressin
nt reported receipt of IM influenza vaccination
Y at NMCP while working the ER in 2002 or 2003. Y He denied 12/7/2007
any illness 12/8/2007
(URI) prior to this vac
er injections, raised, red area around injection sites. Advised to apply cool compresses, and Yadministor 13/27/2009
tsp oral Benadryl
3/27/2009every 6 hours a
ZY AND LIGHTHEADED, FELT BETTER ONCE SHE LAID DOWN ON THE EXAM TABLE FOR Y ABOUT3/27/2009
20 MINS 3/27/2009
EPORTED TO PEDIATRICIAN Y ABOUT HIGH FEVER.Y TYLENOL NOT 53 Y WORKING. BY 2/28/09 U FEVER HIT 2/17/2009
103.7. TESTED
2/23/2009 POSITIVE FOR
Flu vaccine on 3/12/09. Had R leg pain starting on 3/18 and fever on 3/17. Seen in the office U on 3/19 and 3/12/2009
noted to3/18/2009
be walking slowly on to
cinated with MCV4 (MENACTRA) 3/24/09, Y returned 3 days later with swelling and pruritus ofYinjection site. 3/24/2009
She was3/25/2009
treated with Benadryl.
to severe hives, relieved by antihistamine; severe itching, redness and swelling at injection site Y for 24 hours.3/27/2009 3/27/2009
ves on ankles and lower leg, relieved by antihistamine. Itching at injection site for 24 hours. Y 3/27/2009 3/27/2009
fever-102, chills, body aches, mild headache. Soreness in arm. Symptoms lasted 48hrs, although N fever 8/26/2008
lowered to 8/27/2008
100 on 2nd day.11/08-p
ful, hot to the touch, egg sized knot @ injection site. Fever up to 100.8, chills, body aches,generalized
Y weakness
3/25/2009headache,nausea,
3/26/2009 loss of
ceived shots Dec. 29th, seizures
Y started
Y that weekend
Y following, progressed
6 into Y5-10 daily, N
mostly rt. sided jerking### turning
1/4/2009 blue and eyes g
03.5 at 0130 in the AM on the day after
Y the shot, that would not go down w/ Tylenol, Motrin U or tepid baths.3/23/2009
Fever stayed
3/24/2009
around for 3 days
ort received from a health care professional
Y on 13 March 2009. The reporter stated that two of N his patients "got ### the Flu"
3/5/2009
after receiving FLUZ
ort received on 19 March 2009 from Ya consumer who is the patient's parent. A male patient had received DTaP when he was an infant (man
ort received on 19 March 2009 from Ya consumer who is the patient's aunt. A female patient had received a DTP vaccine (manufacturer, lot
R upper arm injection site. Headache, nausea, myalgias, arm pain, itching. Prescription for hydrocodoneY 3/19/2009
and prednisone 3/20/2009
given.
high red and swollen over entire lateral thigh from knee to hip. Treatment per Dr. > ice and Y watch for further
3/25/2009
developments
3/26/2009 3-30-09 I spoke
d 3/9/09 - on 3/14/09 mother noted fine red rash on face, abdomen, neck trunk & upper legs,YNo treatment. 3/9/2009 3/14/2009
ought patient to the clinic on 3/23/09 to be evaluated by RN. Child was "covered" in pox. Some Y were still3/17/2009
in the vesicule
3/20/2009
stage, but most we
and swelling LUD. Warm to touch. Soreness X2days. Mother states applied ice and gave TYLENOL Y for 3/3/2009
low-grade fever
3/4/2009X1day.
& swelling on arm - right side. Y 3/23/2009 3/28/2009
2 degrees) multiple muscle aches, mild Y nausea was seen and released from ER 3/25/09 stillUhas muscle3/23/2009 aches & erythema
3/25/2009 around injection
lled 2 days after vaccine to say that vaccine site " reddened and raised" (erythema) starting Y about half dollar
3/18/2009
in size3/20/2009
and moving "to a much
on, large area of redness and swelling at site. (baseball size) + pain+ itch + fever 102-103 degrees, Y 5x within
2/23/2009
6 hours2/23/2009
of injection. Resolved
fter immunizations, child had red, swollen
Y left deltoid. Also c/o HA & burning throat & not feelingY well. Parent
3/18/2009took child
3/19/2009
to Dr. on Fri, 3-20-
rmation was received from a health Y care professional on 09 October 2008. A 35 year old pregnant female 9/22/2008
with no reported### obstetric history
was received on 23 March 2009 from a health Ycare professional. A 4 month old female patient received 2/11/2009 ACT-HIB lot2/12/2009
number UF516AA (Sa
n has been received from a consumer concerning his son, with no pertinent medical history N and no known2/1/1991
drug allergies, who in February 1
n has been received from a consumer Y concerning his 12 month old son with no pertinent medical U history and no drug reactions allergies wh
n has been received from a consumer concerning her son with no medical historyY or drug allergies U who was vaccinated with the booster do
n has been received from a registered nurse and the mother of a 9 month old male who on 10-DEC-2002, U 3/5/2003
05-MAR-2003 3/5/2003
and 10-JUN-2003
n has been received from a registered Y nurse and Y from a mother concerning
Y her approximately U 35 months old son with oesophageal acid re
n has been received from a physician for the pregnancy registry for GARDASIL concerning aY 14 year old 1/3/2008 female who1/3/2008
on 03-JAN-2008 was
n has been received from a nurse, for Y the Pregnancy Registry for GARDASIL, concerning a Y15 year old female 6/9/2008 with no
6/9/2008
relevant medical his
pain radiating from back to front 1 wk post vaccine. Denies rashes or other symptoms stateYwent to ER 2/25/2009 & was "ruled3/4/2009
out for heart problem
2mo shots on 3/9/09. Had seizure Y on 3/19/09. Febrile after seizure noted. Continued to beYfebrile X 2d. 3/9/2009 Fever broke,3/19/2009
developed full body
d with joint pain, & nausea vomited 1 time - joint pain worsened thru the day, difficulty walking. U Next day3/19/2009
less pain, still
3/20/2009
had nausea 3rd d. -
1st immunizations 3/13/09 - PEDIARIX left thigh, HIB left thigh and PCV7 right thigh and RV5 N orally. Developed
3/13/2009 subjective
3/13/2009 temp few hours
reports today that child is dizzy and has redness about size of a "fifty cent piece" some swelling U and warmth 3/3/2009
in area where
3/5/2009 TDAP was given
h and hair loss. Y U 2/24/2009 2/25/2009
ZOSTAVAX 2-2-09, then developed rash to both lower extremities (below knees) on 2-7-09 U - Only fine red 2/2/2009
rash, no blisters
2/7/2009 - Describes ras
with red patches and small white welts
Y on upper torso and itching; within 5 mins of receivingUimmunizations. BENADRYL ### ###
was given (1 1/2
ought child back to Health Dept due to redness, swelling and fever to right thigh. Client received Y immunization 3/16/2009to area
3/17/2009
3/16/09. Mother appl
received 3/16/09 5pm, Mother called Y Health Department 3/17/09 stated child broke out in hives Y on trunk,3/16/2009
back, "water 3/16/2009
blisters" under eyes.
d redness, swelling, pain and welts on Y left arm from shoulder to elbow. Saw MD on 2-5-09. Given Y Z-Pak, NAPROSYN,
2/4/2009 2/4/2009 steroid and steroid c
Y of arthralgias in a male subject of unspecified
U age
7/13/2000
ype rash on legs and arms, widespread and itchy. Y 3/25/2009 3/26/2009
Sore + tender - Hurt with movement 3-25-09 redness started on hours later but less tender 3-20-09 Y - still3/24/2009
red to arm,3/24/2009
warm to touch.
11.3 w. with redness, warm to touch, itchy to left upper arm. Instructed parent to apply BENADRYL Y oint. Cool
3/6/2009
compress 3/7/2009
2-3 times per day, T
as given a second dose of Hep A vaccineY and within seconds she fell backwards and hit her head. Her back 2/5/2009
remained2/5/2009
arched backward an
gling in jaw and lips, very mild. 3/12/09,
Y spasms in jaw and face itching. BENADRYL 25mg. U For one per day 3/6/2009
q6h prn 3/6/2009
itching. 3/18/09, office
nd numb feeling in legs, itch associated
Y with tingling. Also tight feeling in legs. U 3/25/2009 3/25/2009
s given a Tdap on 03/24/2009. When entering data on MCIR, imm clerk noted that Tdap wasYgiven per private 3/24/2009 provider
3/24/2009
on 11/08/2008. Th
AS GIVEN HIB AND PCV7 ON 3/24/09. Y PT HAS A HISTORY OF SEIZURES. PT WAS CLEARED Y TO GET 3/24/2009
IMMUNIZATIONS.
3/25/2009 CHILD'S MO
f injection site, low-grade temperature, muscle soreness, fatigue Y 3/27/2009 3/27/2009
clinic as walk-in with c/o non-productive
Y cough with shortness of breath x 2w after the evening U after he 3/11/2009
got his Pneumovax.
3/11/2009He states he i
and bruising noted at injection site on March 27, 2009. Noted discomfort on March 29 to injection Y site around
3/24/2009
10, awoke
3/27/2009
client up, discomfo
other call to Health Department on 03/30/09,
Y received 1st HPV 07/29/08 at Health department, U no adverse 9/30/2008
reactions10/7/2008
after this vaccine. Rec
AFTER RECEIVING THE ZOSTAVAX VACCINE THE PATIENT REPORTED PAINFUL RASH Y AT INJECTION3/24/2009 SITE
3/25/2009
BUT ALSO BILATER
swelling began left arm. 03/27/09 reddness and hot feeling occured with fever of 101.8. 03/28 N and 03/293/23/2009
swelling increased
3/26/2009with itching. De
on Thursday, March 26, 2009. Initial itching within minutes. Friday, March 27 area around injection U site was
3/26/2009
swollen,3/26/2009
red and hot. Evening F
and deep bone & body aches, site of shot swelling,(6 X5 inches) red and hot X 5 days so far. U Nausea X3/27/2009
4 days. Unable
3/28/2009to sit up longer th
Very fatigued, with severe swelling of arm from shoulder to elbow. Muscles in back of arm extremely Y tender.
3/24/2009
Ran fever
3/24/2009
alternating with ch
aims "huge" bruise near elbow and quarter size bruise at injection site. Red in between bruises. Y Not painful,
2/13/2009
but states
3/16/2009
that she was on che
pt of AVA # 1, TYPHOID, and SPV on 22 Jun 07, Y SM reported localized 5 soreness, low gradeY fever, muscle7/25/2007
twitching and insomnia.
### Insomn
h with significant swelling, urticaria 8x6cm area. Treated with BENADRYL 'X2 with improvement. Y 3/17/2009 3/18/2009
as given MMR and Varicella injection. Within 2 minutes of vaccine patient's legs swelled and Ya rash appeared. 3/30/2009
Was 3/30/2009
given 7.5 mg of BENAD
about 3 hours, didn't want to be touched. Soft spot on head was hard. U 3/24/2009 3/24/2009
ction 3/18/09 left deltoid, 3/19/09 wifeY noticed red ring around injection site. Pt. didn't sleep all Y night due 3/18/2009
to left arm &3/19/2009
pain up in left side of n
eaction at injection site 4 x 3 cm, + erythema + edema, TX BENADRYL, ice and CLARITAN.Y
l over forward while sitting on the floor
Y 4 hours after vaccination. Found to be breathing but blue Y lips and non-responsive.
3/9/2009 3/9/2009 Event lasted abou
was given Mon 3/23/09 about 12:45PM Y Pt started with nausea, + diarrhea that evening 4PM. YSeen in ER3/23/2009 on (Th) 3/26/09
3/23/2009
Given 1 liter of IV
d redness, swelling and pain at injection site on right arm. Y 3/28/2009
break - vaccinated 3/5/09. U 3/5/2009 3/28/2009
associated Varicella rash. Y ### 1/17/2009
ite reaction. Sore with in 12 hours, redness and increased pain by 24 hours mark, 2" x 3" redness, Y raised,
3/26/2009
warmth from
3/26/2009
the area. No fever.
n at 32 weeks and 10 days (too late for 3rd dose to be given). U 3/27/2009
h swollen, red, warm to touch - consistent
Y with cellulitis. Will treat with SEPTRA 1 1/2 tsp BIDUX 10 days 3/27/2009
and BACTROBAN3/29/2009 topical TID x 10
t shingles around 3 days after the vaccine (March 20th is when she started having symptoms). U Patient got better after medications were giv
ent received a pediatric dose of Hepatitis A, no adverse events, no treatments needed. Y 2/27/2009
n has been received from a nurse practitioner, for the Pregnancy Registry for GARDASIL, concerning Y a 24 year ###
old female ###
with a history of
n has been received from a physician Y concerningY a 70 year old male 0 patient whoYon 11-MAR-2009
N was 3/11/2009
vaccinated with a dose of ZOSTAV
n has been received from a consumer concerning Y his granddaughter 0 (a female patient of unknown
U age) who experienced paralysis after ge
n has been received from a physician Y concerningY a 15 year old female 2 Y patient with atypical seizure
N disorder
3/10/2009
(started3/13/2009
following an episode o
Y concerning a 25 year old female with no allergies Y who on 5/22/2007
22-MAY-2007 4/1/2008
was vaccinated IM w
n has been received from a physician Y concerningY an approximately 13 year old female, who on Y 29-JAN-2007 6/4/2007
was vaccinated
n has been received from a consumer Y concerningY her approximately0 20 month old son with N no pertinent 5/11/2006
medical history
5/11/2006
and no known drug
n has been received from a consumer concerning "three of her friend's sons" who were vaccinated U with MMR II (lot number, route and site
n has been received from a consumer concerning a stranger's granddaughter who was vaccinated U with MMR II (lot number, route and site
n has been received from a parent concerning her son via e-mail a male who was vaccinated U with MMR II and subsequently the child expe
n has been received from a consumer reported "she knows several children (exact number is U unknown) who experienced a high fever and
n has been received from the mother of her 12 year old son with a previous Pyloric StenosisUsurgery, who was vaccinated with a dose of M
n has been received from a consumer Y via the internet concerning her 16 month old son whoNin January 2005, 1/1/2005
was vaccinated
n has been received from a consumer via the internet reporting that she knew of toddlers who U on an unspecified dates were vaccinated wit
n has been received from a consumer concerning her daughter who on an unspecified date U was vaccinated with a dose of MERUVAX II. S
ort received on 17 March 2009 from Ya literature collection. " A previously healthy 17 month old N boy was inoculated with FLUZONE SV '2005
us case was received on 26 March Y 2009 from another manufacturer. The initial reporter wasUthe consumer's spouse. A male patient receive
states pain, erythema, and tendernessY developed Y at sites of vaccines 2 given 3 days prior to ERU admission 3/25/2009
at hospital.
3/25/2009
Erythema & warmth s
ruising and petechiae inYApril/May 2008.
Y Petechiae
Y on lower legs and 6 feet. 4/24/2009 MR received
N for DOS
1/30/2008
2/17-19/2009
4/1/2008 WITH D/c dx: Im
d chest pain, SOB and diaphoresis. YAdmitted toYclinic and diagnosed4 with MI. Troponins elevated, EKG normal, 1/30/2009 Cardiac
2/11/2009
cath primarily norm
d 13 1/2 x 12 cm reddened swollen and warm to touch. Rub area 2 Hrs. and apply ice pack for U 15 min. for 3/26/2009
24 Hrs - then warm compress.
reaction, red, warm to touch, raisedYarea 2 1/2 X 2 inches RT. Y 3/25/2009 3/26/2009
elling With mild erythema. Y Y 3/26/2009 3/27/2009
d a hot, red, swollen lump under skin where vaccine was given. Are marked with skin marker. U Patient advised
3/23/2009
to contact
3/26/2009
clinic if redness or
around injection site. Low grade fever. Cool compress and TYLENOL prn. Y 3/24/2009 3/25/2009
r injection I got very hot and dizzy. I could not stand up. Health Dept had to lay me down. MyYblood pressure 1/16/2009
was very1/16/2009
low, I was pale in col
d rash on Both anterior thighs within 24 hours after vaccine slightly pink maculopapules on both thighs. 3/23/2009 3/23/2009
pain, swelling radiating up to neck and down to fingers. N 2/19/2009 2/20/2009
3/18/2009
ately 48 hours after administration of Tdap + MCV4, Pt. had fever & didn't feel well. Could not Y pin point. 3/17/2009
16 hours later
3/19/2009
cried uncontrollably
se event, dose given 3 weeks to soon. 3/20/2009
d low grade fever, arthralgias and red swollen area at injection site. Y 3/19/2009 3/19/2009
swelling and hot touch. 3/20/2009 3/21/2009
d in ED 3/11/09 with possible seizure. Per parent history lasted several seconds, child's eyesYrolled up, became 2/24/2009
stiff 3/11/2009
and poorly responsive.
ction of pain, warmth, + erythema (7X 15cm) Y 3/18/2009 3/20/2009
arm red and swelling. Y U 3/17/2009 3/18/2009
len arm, bump, raised and hard. 3/24/2009
swelling of left arm. 48 hrs. after receiving Imm's. 0 temp. Y 3/25/2009 3/27/2009
Office visit - Dr. - Shingles on R forehead & scalp - mild - 2 wks. 12/23/08 - Office visit - Dr.Y- Pink eye 2/20/09
3/28/2007
- Office visit
###- Dr. - Shingles
:40p seen for erythema 3.5 cm X 3.5 Y cm & sore. Right Axilla tenderness. R upper arm started Y 3-17-09 with
3/16/2009
pain in 3/18/2009
Axilla & progressed to i
ale received DTAP, MMR, VAR, IPV, Y HEP A 3/27/09 no history of recent illness! h/o febrile seizures
Y 3/28/09:
3/27/2009
pt sleeping,
3/28/2009
woke up @ 1AM
hard knot. No fever or child. Did notYtreat with AX. Kept close eye on arm. Y 3/23/2009 3/25/2009
o left arm. Running temperature started Y evening after vaccine. Started on Ax on 3-20-09. Y 3/17/2009 3/17/2009
at injection site was warm to touch, red and very hard. Y 3/25/2009 3/25/2009
Y 3/12/2009 3/24/2009
l from mom got Imms (HIB and PVNR) Y 3-23-09. On 3-25 had a seizure in the car. He had been Y drinking 3/23/2009
a bottle, began
3/25/2009
shaking, and choki
ately 15 minutes after receiving vaccine she started feeling shaky, clammy, itchy, KP 3-25-09Nnauseous, 3/25/2009& became 3/25/2009
diaphoretic & light head
ccine administration on 3-23-09 @ approximately 1645. She stated she was fine until 2200 that U night. She 3/23/2009
noticed hives
3/23/2009
on arms, legs, & a
as given adult dosage of Hep A. 3/23/2009
le with generalized mildly pruritic maculopapulae
Y eruption of the arms, sides, flanks/ lower back,
Y legs, feet 2/18/2009
and hands3/5/2009
approx. 2 weeks after
Y 3/24/2009 3/24/2009
turned to office 3-23-09, after vaccine 3-20-09 with rash. Reviewed sx and hx with MD who U also saw patient.
3/20/2009
Diagnosed
3/21/2009
with viral EXANTH
ceived Pneumovax 23 vaccine IM to right deltoid Y on 03/24/09. On 03/25/09
1 he presented with
Y progressive 3/24/2009
painful swelling
3/24/2009 and erythema a
mth and induraton at vaccine site. Tender aillary nodes. U 3/28/2009 3/29/2009
POL on 3/27/09 and developed hives Y within 24 hrs Y 3/27/2009 3/28/2009
inistration of GPV, patiient expressed feeling weak and nausea. Provider was notified and patientY was taken3/3/2009
to tx room.3/3/2009
Initial BP was 104/6
ted to have a thigh mass one monthYafter administration of hib3 and flu vaccines. The massYcontinued to grow### and was removed
### on 12/23
CALL A DAY AFTER AND COMPLAINS Y OF DIFFICULTY IN BREATHING, HEAD PAINS, SWOLLEN Y TONGUE/THROAT,
3/24/2009 AND LEFT SID
9 Mom reports to IM clinic at 2nd shotY visit, thatYpatient developed projectile
1 vomiting & abd.Ypain about 24 hours ###after his ###1st set of shots.
rm after Tdap vaccine given on 3/16/09. Small amount of redness noted after injection. About Y 3/19/09 employee
3/16/2009 noted
3/19/2009
increase redness, sw
d a tactile fever for 3 days after the vaccine and then developed a blanching, macular rash on Y the face, torso,
3/24/2009
arms3/24/2009
5 days later.
eloped localized eythema of injection site approx. 4-8 mm per Mother of client via phone call.Area
U reported
3/23/2009
as triangular
3/23/2009
in shape with bruis
IA/HIVES- TREATMENT ATARAX 10 MG PER 5 ML-1 TEASPOON EVERY SIX HOURS. BAKING Y SODA OR### OATMEAL### BATHS.
wing was reported by the client: Vaccines
Y given on 03-09-2009 in the morning with complaintsUof soreness3/9/2009
at the injection
3/9/2009
site and a mild he
prox 5 min after vaccination received. Recovered quickly. Y 3/30/2009 3/30/2009
clinic and later seen on 3/30/09 forYan urgent visit for complaints of non-pruritic red rash onUleft side of trunk
3/24/2009
- Per PCP
3/27/2009
physical exam: ery
r for three days (T. Max 103.7f Y 3/28/2009 3/29/2009
1/31/2009 Y Y Y 9 Y N 1/15/2009 1/30/2009
s began the same evening I received Y the influenza vaccination given at work site. Fever, body
N aches, sore throat, ###weak, lightheaded,
### dizzin
g warmth, redness injection site 2. Left axilla pain -> tender enlarged isolated 2.5 cm lymph node
U 3. Non-tender,
3/26/2009 sl. irritated rash - both axill
erythema rash, primarily to trunk and bilateral legs. Y 3/26/2009 3/30/2009
barky cough, hard time breathing red Y welt on L arm. Y 3/30/2009 3/31/2009
dministered on 3-20-09 in AM. By afternoon tips of fingers hurt. Played basketball after school.Y Noticed3/20/2009
tips of fingers
3/20/2009
had blisters. Some
o body ache, weakness, pain in left arm, behind shoulder and left upper chest. Pain and discomfortN with ROM.
thigh: No tx. Telephone advice given. Right thigh. Y 3/24/2009 3/26/2009
ger than a bean) tenderness, slight redness and warmth near L shoulder. U 3/27/2009
Y U 3/30/2009 3/31/2009
round mouth with swelling spreading Y over both cheeks over period of several days. Applied steroid
Y cream3/19/2009
which helped 3/19/2009
-> course last 5 da
hrs after receiving 6mo vaccine hadYvomiting with associated limp/pale episode. No seizure activity.
Y Returned
3/16/2009 to baseline
3/16/2009
within 60-90 min.
ns on labia - lidocaine jelly, ACYCLOVIR 200 mg/ 2tsp TID 5cc TID. 2. Fever 100.2. 3. Coughing U for 3 days. 2/27/2009
4. Colitis 3/3/2009
x 3+ days. 5. Pharyng
ve nodule. No sign of infection. U 3/18/2009 3/28/2009
minutes after administering HPV vaccine, patient fainted. No history of fainting in the past. Y 3/31/2009 3/31/2009
ought her daughter in @ 1630, with a nodule on left leg about the size of a quarter. I referredUher to PCM5/21/2008
as W/I. Patient5/21/2008
didn't seem to hav
spot, raised area, Lt upper arm where varicella was administered. Dr checked area on 3/31/09. Y 3/30/2009 3/31/2009
ic reaction, This case was reported by a healthcare professional via a sales representative and U described 3/12/2009
the occurrence3/12/2009of nonspecific rea
ction, My daughter immediately put her head back and said I don't feel very good. I feel like I'mY going to faint.
3/31/2009The nurse3/31/2009
was standing behin
n has been received from a pediatric Y medical records and a physician concerning a 15 weekNold bottle fed female ### with
1/19/2009
no known drug aller
n has been received from a registered nurse concerning her 1 year old son with milk Y allergy N and no other medical history who was vaccinat
n has been received from a consumer concerning her 42 month old son with "gene mutations" N who "when 12/1/2006
he was 15 month old" in approxi
n has been received from a consumer Y via the internet concerning her now 5 year old son who N on an unspecified date was vaccinated with
n and follow up has been received from a physician for the Pregnancy Registry for GARDASIL Y concerning1/9/2008
a 18 year 1/9/2008
old female with sulfon
n has been received from a nurse for Y GARDASIL, a Pregnancy Registry product, concerningUa 21 year old 1/15/2009
female with 1/15/2009
no medical history o
n has been received from a medicalYassistant concerning a 16-year-old female with no medical Y history or3/25/2009
on 25-MAR-2009 w
n has been received from a licensed practical nurse (L.P.N.) who was told by a patient's mother U that she heard from someone concerning 2
n has been received from a physician concerning a 19 year old female who was vaccinated U with unknown how many doses of GARDASIL.
aving severe stabbing ache in shoulder & upper arm approximately 2-3 days afterYvaccine. Began N having, numbness ### & tingling.### Discolorat
Cm red, raised, hot area c/o itching Yat the site starting the next day. TX: Ice, Benadryl and Hydrocortisone
U 3/25/2009
cream. 3/26/2009
ceived PNEUMOVAX vaccine on 3/11/09. contacted outpatient primary care clinic on 3/30/09 N with the following
3/11/2009 - c/o-3/30/2009
non-productive cough
eloped ROTAVIRUS infection after receiving vaccination. Y 1/7/2009 1/13/2009
d to clinic the day after receiving vaccine.
Y Per her report approximately 30 min after receivingY vaccine her 3/24/2009
arm started 3/24/2009
swelling, she felt feve
possible mixed with IPV form submitted per CDC recommendations No Reaction per client's parent. 3/30/2009
Mom states light rash on face yesterday prior to vaccines (not mentioned or noticed prior to injection) this 3/31/2009
morning (4-1-09) 4/1/2009
child has fine ras
heavily speckled line or band going up his arm from the injection site. U 3/12/2009 3/13/2009
ame dizzy after vaccination Y 3/30/2009 3/30/2009
vers a day, bad headaches with fever, sore throat, stopped up nose or runny, weak, upset stomach U and vomiting,
2/3/2009pale 2/9/2009
skin, cried because
as given flu shot and pneumonia vaccineY right before discharge. Patient reports that when he U got home 3/15/2009
he began experience
3/15/2009 generalized p
d one-sided facial palsy with a significant
Y droop that affected the eye early in February of 2009.
Y Went to 1/13/2009
ER. Significant 2/10/2009
change in sensatio
eloped fever and had febrile seizureYat home Temperature 102. Child is fine today. Fever was Y treated in3/23/2009
ER 3/31/2009
ular rash over chest, abdomen, and back within 15 minutes of injections. No treatment administered.
U Still
3/31/2009
present early 3/31/2009
AM the following da
LOST CONSCIOUSNESS AFTER RECEIVING THE LAST OF 5 VACCINES. CLIENT WASYSITTING IN3/31/2009 CHAIR AND 3/31/2009
HEAD FELL BACK.
post-vaccine: egg-shaped area of rash on arm below shot site; @ 30 hrs post-vaccine: sudden Y onset of moderately
3/28/2009 3/29/2009severe muscle/joint pai
ver vaccination given on 3/27/2009 @ 10:20 a.m. Student returned to Clinic at 11:35 a.m. forYswelling of3/27/2009
lower lip, left 3/27/2009
lower lip to middle of
ECAME DIZZY AFTER RECEVING THE LAST OF 3 VACCINES. CLIENT REMAINED IN CHAIR, Y FEET3/31/2009
ELEVATED. 3/31/2009
DIZZINESS ABATED
after varicella vaccine #2 developedYredness and swelling at injection site. 48 hrs post vaccine Y developed 3/29/2009
increased3/30/2009
redness, swelling and
E - REDDNESS AND ERYTHEMA LEFT Y ARM DISTAL TO THE INJECTION SITE AREA - C/O HEADACHE 3/30/2009
AND MUSCLE3/31/2009 ACHES - SAYS
emp up to 103 - today 102.6 - left arm hurts and slightly swollen - left hand pain "tingles" - fatique
U - today3/31/2009
slight cough 3/31/2009
- eyes watery - no ap
s:Shortness of Breath, Racing Heart, Y Anxiety, some Dizzyness, These symptoms got progressivelyN worse3/7/2009
over the course3/8/2009of 2 weeks. The
iarix instead of DTaP. No adverse Symptoms and do not expect any. Y 3/24/2009 3/24/2009
to clinic one day after receiving vaccinations with Right upper arm reddened, swollen and warm U to touch.3/30/2009
Patient stated3/31/2009
tenderness; denied
lts under skin, muscle feels very tight even after constant massage. Also high fever of 102.9 Udegrees. High 3/31/2009
pain in legs 4/1/2009
- enough to prevent
ceived Influenza vaccine (adult dose) instead of Hepatitis B vaccine. He is now 12 weeks of U age. To date, we have ### not experienced
### an adv
ported redness for a few days. This progressed into pain and tingling in arm, like "ants crawlingU on my arms".2/11/2009 Still itching,
2/12/2009
but was told my M
hot was given. Pain starting in arm of injection site, quickly moved to shoulders and neck. Within
U two days
3/26/2009
it included 3/27/2009
the entire back and h
spontaneous report of seizure, influenza, wheezing
Y and fever was received from a physician Y concerning a 27-month-old
### 11/2/2008 female subsequen
ven GARDASIL vaccine was informed would have to wait 20 minutes to be observed, pt wasYsitting on exam 3/27/2009
table after
3/27/2009
injection passed out
become fussy, crying - had to console approx 2 hrs- 3 vaccines were given crying lasted forYapprox 9 hours- 3/18/2009Mom had 3/18/2009
to hold Pt constantl
Y 3/17/2009 3/22/2009
Y N 3/31/2009 4/1/2009
rea @ injection site. Y 3/23/2009 3/24/2009
etting a rash of small red bumps on my face on Friday 3-27-09. Saturday rash had spread to Yneck and chest. 3/13/2009
By Sunday it had spread to ar
woke up the morning after the injection with "puffy face and L side of neck" which turned into U a rash. States
3/16/2009
also had
3/17/2009
some rash on stomac
ain, induration warmth at injection site with redness at site and extending distal to injection site
U to elbow. 3/25/2009 3/25/2009
accines 10:30 am, began with vomiting, uncontrollable crying and apnea 45 min-1 hr later. Heard Y pt on phone
3/19/2009- screaming,
3/19/2009 high pitched cry
immunization patient shaking, teeth chattering / cold - felt frozen under 3 blankets. Doesn't Y believe he had a fever.
### Achy. ### Fatigued X 12 ho
after VARIVAX developed varicella lesions on arms, legs, mouth. Y 3/23/2009 3/25/2009
n has been received from a physician Y concerning a 16 year old female patient who completed Y GARDASIL series. The patient was HPV pos
n has been received from a registered nurse, for GARDASIL, a Pregnancy Registry product,Uconcerning a 20 year old female patient with n
n has been received from a consumer regarding a case in litigation concerning his child whoUwas diagnosed with autism shortly after receiv
n has been received from a parent concerning his 6 year old son who was vaccinated with MMR U II (Lot# not reported). The patient was on
us case was received on 26 March Y 2009 from a consumer (patient's parent). A 23 year old maleN patient with seasonal allergies received AD
74yo, Male, came to ER with - Had flu Y shot yesterday, this am developed rash right thigh, now U diffusely spread
12/3/2008to both
12/4/2008
legs, chest arm. Eyes
loss of control - 9-13-08. Hospitalized five days.
Y Diagnosed virus syndrome.
4 Home doctor saidU had Guillain10/2/2008
Barre syndrome.
10/3/2008 4/8/09 Receiv
seminated encephalomyelitisY about Y1 week afterY shot. Fever started.
27Extreme irritability and screaming.
Y Altered
12/2/2008 state of consciousness
### 12 d
ed rash over trunk, face & extremities Y with classic pox like vessels with erythematous bases. Y 3/20/2009 3/26/2009
m erythema and induration. Y
veloped fever up to 103.2 F rectally on 3/26/2009 - and an erythematous papular rash - descendant - started 3/17/2009
on face on 3/27/09. Fever res
12 hours later. Headache, couldn't move
Y arms and legs. Y 3/26/2009 3/27/2009
ent needle was in right deltoid, pt started to waver w/eyes rolling back. Pt began to wobble to N a fro. I helped
2/9/2009
him to his
2/9/2009
seat. Water was giv
about 15:40. Approximately 17:30 becameY dizzy light headed, face tingled and broke out in aYsweat. Lasted3/24/2009
about 303/24/2009
min. Later arms and le
a of redness and induration on L upper arm approximately 12x10 cm. 3/18/2009
f PREVNAR were administered on the same day. Patient's Dr. notified @ 11:30am 3-25-09. Y 3/25/2009
adache, neck soreness, vomiting, nausea,
Y dizziness and fatigue N 3/24/2009 3/25/2009
poor appetite, nausea/vomiting, left arm pain and soreness. Unable to attend school since 3-30-09.N Out of3/30/2009
character 3/30/2009
for this child. Arm pain
ine hives for 15 min. Then resolved. Clear lung. Y 3/26/2009 3/26/2009
01 degrees, rubbing @ head, increased Y fussiness There is a question of secondary viral illness Y 3/31/2009 4/1/2009
n 3/18/2009 pt. awoke with temperature
Y of 105.4 degrees @ 11 AM after waking up c/o entire Y body twitching,
3/17/2009and increased
3/18/2009crankiness. 3
TDAP vaccine 3/19/09. Developed Y sore arm within 24 hrs became indurated, red, hot in injection area around
3/19/200948hrs,
3/21/2009
felt flu like (tired, achy
ceived Tdap on 3/23/09. Came into office today 3/30/09 arm slightly red, small lump at site. Patient
N states
3/23/2009
"it is much3/24/2009
better than it was. Arm
gan to develop around the injection site and spread to my chest, neck and back. Rash began approx. 4 days 3/8/2009
ago and
3/18/2009
has steadily worsene
t B/P 106/60 Temp 98.4 Pulse 72 Resp. 20 - c/fired, dizzy. c/o feeling hot and sweating on & off. 1245 T3/27/2009
malise 1245 3/27/2009
T.C. to mother child ta
breakthrough. Had 2 doses of VARIVAX (3-2-04 & 3-4-08). Diagnosed with varicella in our office U on 3-28-09.
3/4/2008
Had 303/24/2009
vesicles. No fever.
rned pale a minute after receiving all 4 vaccines, then her lips turned blue 1/2 minute later, sheY had a seizure,
3/13/2009
with her
3/13/2009
eyes flipping upward
eloped diarrhea evening of 3/6/09. Fever
Y Sat-Mon & Tues. which mo. kept controlled with Tylenol & Advil. 3/5/2009
Caught runny 3/6/2009
nose developed ov
TdaP 3/16/09 Developed symptoms 3-17-09. State fever 104.0 F orally, chills, muscle aches, Y arm deltoid 3/16/2009
red. Taking3/17/2009
Tylenol. given (Rt) ar
ed tightness in throat 30 min. after receiving vaccines - Took BENADRYL and felt better after Y 1 1/2 hours.
tates he was in this office yesterday, received pneumonia vaccine in rt arm. Report this was Y he second pneumonia
3/25/2009 vaccine.
3/26/2009 States approx
-103.8 and diarrhea. Y Y 3/31/2009 4/1/2009
ates he felt some numbness and tingling in my 3rd and 4th digits in lower left arm along ulnaUnerve. States 3/12/2009
he is experiencing
3/12/2009 mononeuritis
U
sy (R). Pt states a few hours after vaccine
Y she noticed
Y drooping on right
4 side of face - hospitalized.
N Referral
3/23/2009
to neurologist.
3/23/2009Not resolved at v
al swelling @ site of KINRIX Y 3/30/2009 3/30/2009
diameter nodule, palpable. Y U 3/31/2009 4/2/2009
tal body itching for 1 1/2 months after
Y the injections. Flushing of skin, resolved in ER, MD and Y allergy visits. ### ###
erythematous rash and small vesicles around vaccine injection with out any treatment rash cleared Y in 3 days
3/25/2009
with out3/28/2009
any signs.
er arm swollen, warm to touch, sore, mildly red. Treating with cool compresses and IBUPROFEN Y as needed.
3/13/2009 4/2/2009
TETANUS shot a week ago, then started having pain in the area of the injection, but then in the N last couple 3/23/2009
days or so
3/24/2009
has had pain, swellin
2/24/09 Fever by report from mom.Y2/27/09 Patient
Y began experiencing
4 ankle pain. 2/28/09YAnkle began 2/20/2009
to swell with
2/22/2009
redness. 3/1/09 Pa
RECEIVED 7 VACCINES ON THE 26 OF MARCH. CLIENT HAD POSITIVE PREGNANCY TEST U TODAY3/26/2009
IN OUR ADULT 4/2/2009
HEALTH CLINIC
and erythema (~4 inches red ring in diameter) appeared on 03/06/09, 2 days after receivingYthe vaccine. 3/4/2009 Patient also complained of swelllin
in office for a 6 month physical on 9/09/08. Prior to adminsitering vaccinations black dots were U noticed on7/8/2008
the child's left thigh. It was noted
ening of the shots, she developed low grade temp that increased the following day to 104F. U She also developed
3/31/2009 emesis
3/31/2009
(NBNB) x 3 with la
ll on 4/2/09 stating that on Monday March 30 she received the Shingles vaccine. She did not U have any problems
3/30/2009for3/31/2009
greater than 24 hours
gluteal pain starting four days after vaccination and lasting for four days. Pain relieved with anti-inflammatories.
Y 2/25/2009 No other
3/1/2009
symptoms. Decli
d a vaccination from an expired vial of Hep B. (exp date was 2-2-09). Parents were advised to revaccinate 3/12/2009
the child. No adverse reactions
oral typhoid capsule as directed and within several hours had vomiting, diarrhea, fever and fatigue. Y Symptoms
3/6/2009resolved
3/6/2009
by next day. Advis
d full blown Shingles approximately Y 4 days following vaccination. Prescribed ACYCLOVIR, 800MG, ONE TABLET 3/5/2009 5 TIMES
3/9/2009A DAY FOR 10
ived subcutaneous injections of MMR and Varivax on right and left thighs respectively usingUVanishPoint synringes. ### Black### dots noticed on b
H PEDIARIX U ### ###
ND ERYTHEMA TO RIGHT DELTOID Y 16.25 CM x 16.25 CM. ADVISED PARENT ON APPLICATION U OF3/31/2009
COLD COMPRESSES,
4/2/2009 MED W\
arted to notice hives on the back of her neck, between legs and on wrist about 5 hours after U administration 3/31/2009
of the vaccine.
3/31/2009Patient has been
al reaction at the left deltoid - mild erythema, tenderness and edema. U 3/31/2009 4/2/2009
d about 5 hrs. after being vaccinated Y and still continues. He became very unresponsive at times. U He ended 3/26/2009
up getting
3/26/2009
dehydrated which ca
U 3/18/2009
r of 106F, wheezing, upper right quadrant Y pain Yand lower right quadrant
1 pain. It lasted for 8 months.
Y Treatments
8/29/2007 were
9/19/2007
antibioctics. 5/26/09
was reported by a consumer and described the occurrence of possible acute hepatitis in a female U subject of unspecified age who was vacc
was reported by a pharmacist and described
Y the occurrence of injection site soreness
Y in a 29-year-old
N female
2/11/2009
subject
2/11/2009
who was vaccinated
was reported by a lawyer and described the occurrence of joint pain in a male subject of unspecified U age 6/1/1999
who was vaccinated
5/1/2000 with LYMER
nding graduate school, this 40 year old member Y reported receipt of 7hepatitis A #1, influenza, and typhoid 8/5/1997
vaccinations11/8/1997
on 11/7/1997. Medic
d orange size lump/ swelling/ redness - sore to touch first 24h - used ice - advised use allergyYcrm & ice for4/1/2009 sx 4/1/2009
Y 3/26/2009
/2 inches red area with swelling, mild Y induration. U 3/26/2009 3/27/2009
ed ball under skin @ injection site that Y is painful DX: Cellulitis Y 3/31/2009 3/31/2009
5 min after GARDASIL Dizziness 30 min after vaccine still c/o dizziness, now on 4/2 , got vaccine Y on 3/31/09
3/31/2009 3/31/2009
izure. Temp. 105. TYLENOL. 4/30/09 Y scheduled for f/u MRI. Y 3/26/2009 3/27/2009
er gave child TYLENOL 0.4ml but did not take temp. 1pm Mom woke child for feeding. Mother Y stated he 3/26/2009
was upset, 3/26/2009
he could not decide if
in joints, muscles - constant. Periodic nausea, periodic chest pain. N 3/20/2009 3/20/2009
bumps at injection site going down into underarm & side of back started date of injection & Y still present 3/19/2009
on 4-2-09 3/19/2009
itching at injection site right delt. PtYstates "feels like sunburn" U 3/28/2009 3/30/2009
redness and swelling of Rt triceps afterY DTAP. Moderately tender. This is a minor side effectU 3/31/2009 4/2/2009
right upper arm below injection site extending to medial arm. Warm to touch. Pt reported itching Y started3/31/2009
several hours
3/31/2009
later. Warmth note
:00 PM - began experiencing rt. eyeYitching, burning, watery raw @ rt. corner of eye, later in N day blister appeared
3/25/2009corner
3/27/2009
of rt. eye went to D
ection site, malaise, nausea, photosensitivity, headache, diarrhea and trouble sleeping. U 3/31/2009 4/1/2009
n has been received from a physician Y concerning Y a 72 year old male 0 patient with heart condition
U who in August
8/1/2007 2007,2/1/2009
was vaccinated with
n has been received from a consumer concerning her 4 year old son with no pertinent medical N history or drug9/1/1995
reactions or allergies who in
n has been received from a medicalYassistant concerning her 16 year old daughter who on 11-FEB-2008 Y 2/12/2008
the third dose of w
n has been received from a physician Y concerning Y a 12 year old female6 with allergies to Augmentin
N who on9/17/2008
10-OCT-2007,
3/27/2009
17-JAN-2008 and
n problems, dizziness, near Y fainting,Y rapid heart Y beat, broke out in rash
Y all immediately.
Y Now:N MS, Graves 6/23/2008
Disease, 6/23/2008
Fibromyalgia, daily mig
litis, pain, fever, tachycardia. Redness/pain at site Y w/ worse progression.
3 Vanc and Zosyn given Y upon presentation
3/16/2009 to 3/18/2009
ER. D/C home with p
V on 3/6/09 and AVA on 3/11/09. On 3/17/09 pt Y describes feeling fatigued,
1 he had non positional
U left sided
3/6/2009
chest pain
3/17/2009
(1-2/10), cp worse w
rash on (L) arm, neck and face; rash Y appearedY3/27/09. No fever. Patient's
2 daughter received Y live attenuated
2/23/2009
varicella
3/27/2009
vaccine 3-4 weeks p
3 degrees), headache, body aches, dizziness, fatigue. U 3/26/2009 3/26/2009
lu shot experienced headache, dizziness + flu like symptoms. Y
m pink area around where PNEUMOVAX given. Y 4/1/2009 4/3/2009
nted for a few seconds after that patient had major headache, in addition patient pain on upper Y right arm. 3/19/2009 3/19/2009
began 1 hr after injection. Today Right inner and anterior thigh- diffuse swelling from 1 1/2 above U knee to 3/16/2009
groin crease.
3/16/2009
er the vaccines, patient c/o feeling "bad".
Y Had anorexia and nausea, was very pale. The nextYday also extremely 2/25/2009 pale,
2/25/2009
weak, couldn't eat, na
Y 4/1/2009
er administration, nickel size redness. Y On 5th day after; hive looking rash appears. On 6th day Y after administered
3/18/2009vaccine
3/23/2009
entire deltoid red
me in 3/31/09 stated that the day heY got vaccines 3/23/09 his legs both got swollen and purple. Y They took 3/23/2009
to urgent3/23/2009
care, advised them jus
feel nauseous, vomited x 3 in spaceYof 2 hours. Saw ER physician for meds which stopped emesis. Y 3/10/2009 3/10/2009
htheadedness within 15 minutes of ZOSTAVAX administration. Paramedic took vital signs +Ublood sugar3/27/2009 (all WNL). 3/27/2009
Pt refused work up at h
sized swelling at site of VARIVAX reported by mom. 1-2 days after immunizations. Later pt developed Y vomiting /diarrhea illness, 2 d after i
broke out in small blisters on abdomen 2 days after receiving varicella immunization. StatedYblisters itched 2/16/2009
but no fever
2/18/2009
noted. Today in clin
+ erythema + pruritis of Rt upper arm. U 3/24/2009 3/27/2009
ome: (Location) bilateral arm. Pt. mother
Y describes it as painful. Relieving factors include: BENADRYL.
Y Associated
3/27/2009 3/29/2009
symptoms include: pain
ceived 6 wks immunization of 5 wks. Y 3/10/2009
ts today 4/1/09 with red area (about baseball - sized) + sl. raised + mild pain on right deltoid U - site of MENACTRA
3/31/2009I.M. 4/1/2009
injection given on 3/3
al reaction 9X6 cm local ice and Benadryl. Y 3/27/2009 3/28/2009
dministered to left thigh but bruisingYto left shin. Parents stated leg was swollen with bruisingYwent to ER.3/30/2009 3/31/2009
of Rt thigh area after vaccine. SwellingY started morning after vaccine. Area also has some erythema.
Y 4/2/2009 4/3/2009
soreness, swelling. Y 3/19/2009
veloped redness around back of arm about 5-6 inches long and also skin felt hot to touch and Y very itchy.3/30/2009 3/30/2009
9 Received Hep A at approx 2pm. Developed
Y hives approx 8p. Took BENADRYL. 3-31-09 noYhives visible. 3/30/2009
C/O itching
3/30/2009
all over. SOLUMEDR
s given at 9 months. 3/25/2009
ap/Hib/IPV and HebB/Hib- no sx 4/2/2009
SIZE DARK PINK RAISED AREA AT INJECTION SITE NO PAIN NO TREATMENT Y 4/2/2009 4/2/2009
oke out in shingles 6 days after vaccination
Y was administered. Pat She is being treated by her N primary care
3/24/2009
physician3/30/2009
accordingly.
r, strong crying, for many hours, fine the next day. Y 4/2/2009 4/2/2009
ized knot on right arm. Red & warmYto touch. ER MD gave steriod dose pk. & Icc pack U 3/24/2009 3/29/2009
e adn hives were around shot area and on both thighs adn stomach, the areas were itching. YSo mom gave 3/27/2009
benedryl3/27/2009
and repeated it at 9 a.m
n left deltoid where Tdap was given. Area hot, red. swollen. Smaller area of redness with heat on right deltoid4/1/2009where 4/2/2009
Menactra was given.
adverse reaction. Patient received Dtap vaccine instead of the recommended Tdap vaccine.YPatient received 4/1/2009
adequate protection with Dtap
d bilateral kidney area pain, increased thirst, increased urination approximately 20 hours after U Hep B #2 was
3/19/2009
given. 3/20/2009
No problems with vacc
MOTHER PRESENTED TO HEALTH DEPARTMENT FOR CHILD'S VACCINES. MOTHERYREPORTED 7/17/2008
THAT CHILD 7/17/2008
HAD SWOLLEN RE
o weeks after my daughter Y got the 1st
Y Gardisil vaccine shot she started having seizures, sheNhas no family 9/3/2008
history of9/18/2008
seizures and has alwa
d a vaccination from an expired vial of Hep B. (exp date 2-2-09). Parents were advised to revaccinate
Y the
3/13/2009
child. No adverse reactions have
d a vaccination from an expired vial of Hep B. (exp date 2-2-09). Parents were advised to revaccinate
Y the
3/19/2009
child. No adverse reactions have
ter developed a large red knot at injection
Y site, was raised, size of a half dollar, warm and very
Y tender. She3/26/2009
also had a4/1/2009
severe runny nose. A
0 minutes of patient receiving TdaPYand gardasil, pt had a 30 second episode of stiffening and Y blank staring.
4/3/2009
Since that
4/3/2009
time she has had
disease (rash, fever). U 3/23/2009 4/2/2009
TDaP and PNEUMOVAX L deltoid 3/31/09. Reaction of swelling, redness and immobility began U within 24 3/31/2009
hours of injection.
3/31/2009Slow resolution
d by Clinic today to report that she developed L lateral arm pain, some numbness/tingling from Y shoulder 3/20/2009
-> fingertips,
3/21/2009
quite significant at tim
ring rash in groin and hip area. U 3/27/2009 3/31/2009
x 100.5; redness, induration 2 cm x 2 cm. Y 3/30/2009 3/30/2009
-> redness + swelling at the site of injection - measures 4.5 inches + 4.5 inches. U 3/30/2009 3/31/2009
ea of redness on L thigh ice packs andY Benadryl. Y 3/30/2009 4/1/2009
ea of redness, warmth and in duration Y on L thigh. Treated with ice packs and Benadryl. U 4/1/2009 4/2/2009
arthralgias / HA (L) shoulder pain with
Y t ROM-->Bursitis Rx CALEBREX/NORCO/ROM exercises N 3/29/2009
ed varicella rash (Sib with same despite 2 VARIVAX immunizations). Y 1/21/2008 3/30/2009
ed Varicella rash (Sib with same despite 2 VARIVAX immunizations). Y 4/21/2008 4/2/2009
ort received on 20 January 2009 from a consumer, who is the patient's parent. A 5 month oldY male patient, 4/30/2008
with a history
4/30/2008
of environmental a
ort received on 13 March 2008 from Yanother manufacturer, (a report number was not identified). N The initial reporter
### to this ###manufacturer had
ort received from a manufacturer on 23 January 2009. The other manufacturer had received the original report from a health care professio
ort received on 22 January 2009 from Y a health care professional. A seven-month-old femaleNpatient with no 1/6/2009
past medical
1/6/2009
history, had receiv
rmation was received on 19 August Y 2008 from a consumer (patient's mother). A two and a half Y month old 8/11/2008
female patient
8/11/2008
with no reported m
ort received on 08 August 2008 fromYa physician. A healthy 2-year-old male patient, had received on 04 August 8/4/200820088/4/2008
a fourth intramuscula
was received from a health care professional on 09 June 2008. A five-year-old male patient with a history 6/17/2004
of asthma,5/1/2008
chronic ear infections
was received from a health professional on 03 June 2008. A 36-year-old female patient wasY accidentally6/3/2008 exposed to6/3/2008
ACTHIB (lot number
NG AFTER WAKING, CRANKY, LETHARGIC AND GROGGY X 2 WEEKS AFTER ADMINISTRATION. Y 3/11/2009
LEGS SWOLLEN
3/12/2009 UP TO 4 DAYS
s- He had extremely sore legs and Y arms even though vaccines were given only in arms. HeYwas achey 2/19/2009and felt flu 2/19/2009
like. Then had low grad
ceive.5cc pneumo-vac on 5/3/07 in their
Y Right deltoid. On 5/29/07, pt had reported c/o rash on Y face, upper chest, and forerms. Pt was given
Fever ~ 101 F, Malaise, Moderate Diarrhea, chills in evening, body aches, 4/3/2009 4/4/2009
08, pt was in clinic and C/O welts onY thigh; Shoulder reaction to flu shot; cough and sore throat.Y ONSET OF SYMPTOMS: ### ###
Ongoing since fl
as given scheduled vaccination doses Y of: Typhoid, Influenza, and Anthrax on 3/14/09. After about U a week3/14/2009
and a half3/24/2009
later, the patient notice
, 4/3/09, I received two vaccines, a Y
tdap in the left arm and a pneumococal polysaccharide vaccine N in the 4/3/2009
right arm. Within
4/3/2009 a few hours, I st
ter hives around vaccination site later
Y and to this date muscle aches, joint pain and skin hypersensitivity.
N 3/8/2009 3/10/2009
A and Hep B shots on 4/4/09. Felt sickY and nauseated at the time. Returned on 4/5/09 c/o inability U to remove4/4/2009
R arm and 4/4/2009
nausea and vomiti
Y Y 0 N
serious case was received on 24 February
Y 2009 from a health care professional. A nine yearUold patient received ###the2/24/2009
INFLUENZA vaccine (
n has been received from Y a medicalYassistant concerning
Y a 49 year 1old female with diabetes,
Y chronic obstructive
3/24/2009pulmonary
3/24/2009disease, coron
n has been received from a consumer concerning her son with no medical history or drug allergy N who was vaccinated with a dose of MMR
n has been received from a consumer concerning a male who, on an unknown date, was vaccinated U with MMR II (lot # not reported). There
n has been received from a consumer concerning her 7 year old son who on unspecified date U was vaccinated with MMR II. The patient dev
n has been received from a consumer reporting that her nephew now 30 month old male who N in approximately 2006 was vaccinated with M
n has been received from a consumer, Y concerning her 17 year old son with a penicillin and CECLOR Y allergy, sulfonamide allergy, drug hyp
n has been received from a physician Y concerning a patient who in approximately 2008 "about Y a year ago" was vaccinated 9/1/2008 subcutaneously
d fever 3/26/09/ER visit for febrile seizure
Y / URI. U 3/25/2009 3/27/2009
ter receiving DTAP, PREVNAR, ROTAVIRUS
Y & HIB vaccines child experienced right facial droop involving 2/20/2009
eye, lower 2/20/2009
face & mouth. Symp
hought to be febrile seizure, 2 days Y after receiving MMR. Was seen in ER. No labs or test were Y done. Ran 3/24/2009
fever x's 3/26/2009
24hrs. When fever subs
5 minutes after HPV (GARDASIL) vaccineY lasted about 1 minute with L arm jerking X 3 sec paleY looking 3/23/2009
referred to ER. 3/23/2009
BP 100/80, HR 78,
ped erythematous rash, urticarial type with angiodema which began on 1/29/09 and persistedY throughout1/29/2009 2/13/09-see 1/29/2009
picture. There was s
ient said arm slightly sore evening of immunization but next day fine. Patient was given TdapY by mistake since 4/1/2009 it is only recommended at a
d hives within 15 minutes of receiving vaccinations. Gave 0.1 epinephrine IM in office. Y 3/27/2009
alized reaction started day after. Increase to redness, swelling. Spreading down R arm hot toUtouch. 3/5/2009 3/6/2009
ma around injection site, non tender induration of muscle about 7cm - L thigh. U 3/31/2009 3/31/2009
KINRIX (DTaP/IPV) Rt thigh on 4/1/09, red, sore, itchy indurated warm spreading rash developed. Y 14x10cm 4/1/2009
likely allergic,
4/3/2009 but AUGMENTI
VARIVAX 3/26/09 mom noted a red area on L arm at injection site. Tender to touch, but notYsore with movement. 3/26/2009 73/27/2009
cm by 5 cm warm reac
a USAFR female service member, and was on military status on 29 March 2009, when she received N a TDaP
3/29/2009
vaccination
3/29/2009(0.5 mL, IM, L upp
given 3-20-09 AM. Seen in office 3/23/09
Y with 3"x31/2" erythematous, swollen, warm induration U @ site of3/20/2009
Td injection. 3/22/2009
very painful every time I move it. U 2/25/2009
allergic reaction U 4/1/2009 4/2/2009
ak, muscle soreness for 3-4 days two weeks after administration of Hep A and Hep B vaccines. Y Advised3/12/2009
to see his healthcare
3/26/2009 provider.
d an expired dose of Hep B. Parents were advised to revaccinate patient. No adverse reactions Y have been 3/20/2009
reported. 3/20/2009
reported. 3/20/2009
reported. 3/17/2009
reported. 3/19/2009
reported. 3/19/2009
clinic, c/o redness and blotching of the
Y left upper arm with swelling. Area was warm to touchUand swollen 4/1/2009 from shoulder 4/3/2009
to the elbow. Pt als
lled on 4-6-09 stating that patient had a fever of 103.6 for 48 hours. No other symptoms noted. Y 3/26/2009 3/28/2009
ed out as aching 1 hour after vaccination. Client states pain (Left Arm) was at it's worst 1 week U after vaccine
3/27/2009
(04-03-09)3/27/2009
when she experien
9 the employee went to the ER around Y 10 pm due to swelling in neck, change in voice and difficutly
Y speaking.
3/24/2009 States3/27/2009
he did not have diffic
ain of both knees. 4/13/09 MR and Y vax info received from PCP. In for 14 yr WCC with normal U exam 11/11/08. ### Vax given. ### Returned 12/22/
ately 24 hours after the vaccine was received the patient had severe chest pain. The chest pain Y began evening### and lasted### for over an hour
ticed on 4/5/08 at 2:00AM, soreness, itching and a knot on left arm where Zostavax was administered.
Y Patient
4/3/2009 applied 4/5/2009
alcohol to help with
9am- phone call from parent. Parent reports child right upper arm is red, swollen, & hot to the U touch. Symptoms
3/31/2009 began 4/1/2009
on 4/01/09 and is wo
alized papules. No bullae or blisters around site of injection (left upper thigh) Possible folliculitis
U but possible 4/3/2009
local varicella
4/4/2009 from vaccine.
given 3/31/09 approx. 10:30am. Pt. Y noticed it was tender an swollen 4/01/09 approx. 6:30 pm. U 4/02/09 area3/31/2009
red, raised, 4/1/2009
hot to touch & incre
otavirus) vaccine given vinitial dose at 19 weeeks of age, after the recommended start age of Y 15 weeks,3/20/2009
by mistake.3/20/2009
No physical reaction to
ived IPV and DTAP in Right thigh on 4/3/2009. Now has pink/red and hot area to site measuring U 3.5 x 4 inches.
4/3/2009 Painful
4/6/2009
to palpation. Place
r shot pt had swollen, painful area at site, 1" redY circle at site with rash
4 around it. Syncopal episode
Y on 4/1.
3/31/2009
Transported 4/1/2009
to hospital by ambu
ven Pneumovax vaccine as ordered.YLeft deltoid injection site wiped down with alcohol swab,Yand vaccine 3/2/2009 given. Site 3/3/2009
dabbed w/ cotton ball,
ed sudden and severe hair loss resulting
Y in many visits to dermatologists over the last year and
N a half. This 7/20/2007
has resulted
9/17/2007
in meds prescribe
Clinic on 4-6-09 to report that she had experienced painful, red blotchy raised rash on left upper Y arm which4/1/2009presented4/5/2009
on 4-5-09 at approxim
-Hyporesponsive Episode, onset was about 2 hours after receiving DTaP vaccine, lasted approximatelyY 3/14/2009
4 hours 3/14/2009
A TDAP SHOT ON FRIDAY(04-03-09) AND SAT. HE HAD BODY PAIN & CHILLS.LEFT ARM Y WARM AND 4/3/2009
TENDER 4/4/2009
TO THE TOUCH. TOD
en, feverish arm where shot was administered. Headache, neck ache, weakness, general feeling Y of tiredness.
4/3/2009 4/5/2009
ome numbness and tingling across the upper back and neck and extending down into his arms Y bilaterally. 4/1/2009
This was resolving
4/1/2009when seen on
Y the occurrence of feels like having a heart attackY in a 60-year-old
10/1/2008female
10/1/2008
9, pt presented w/ aboutY14 hr hx ofYfever, headacheY and vomiting and
7 20 min of purpuric rash.
Y Pt directed 3/20/2009
to ER then
3/30/2009
Peds ICU. CSF incre
dmother and mother report that this Y 6-month-oldYinfant has been a bit3 fussy and out of sorts since
Y he received
3/17/2009
immunizations
3/19/2009two days ago
ve Diarrhea, Vomiting, Back Pain, Body Y Aches,YHA. From 033009 --> 1 033109 To ER Admitted Y Observation. 3/30/2009
Discharged
3/30/2009
040109. To Scho
a reddish purplish area on leg not acting sick otherwise. Recommended she watch it for a fewUdays and if3/24/2009 not better to4/6/2009
be seen.
at injection site "burning" to left arm, both arms, now legs and eyes. No rash, no swelling and U no fever, VSS. 4/2/2009
Advise;4/4/2009
Monitor.
e: onset: 3/10/09-present. OTC MOTRIN Y taken for symptoms. Lower back pain: onset:3/10/09 N x 1day. Fever: 3/9/2009
onset:3/10/09
3/10/2009 x 1day Reported
and swelling L leg. Started the day after lZ. Worsened x 24 hours then improved, used ice only. Y 4/3/2009 4/4/2009
9 - School nurse phoned HD and stated Y that student's L upper arm was somewhat red with some U swelling.
3/31/2009
Client c/o4/1/2009
nausea and L arm pai
with long periods of crying and inconsolability. Fever 101.8 rectal. Vomiting x 1. decreased oral Y intake. 4/2/2009 4/3/2009
red and swollen. Cellulitis - given antibiotics.
Y Went to urgent care - Then follow up and officeU6/23/08. 6/20/2008 6/21/2008
n has been received from Y a Nurse Practitioner
Y Yfor the Pregnancy Registry for GARDASIL concerning
Y an6/18/2008
18 year old female patient with no
n has been received from a concerning Y a 50 year old nurse female who was alsoYa nurse was Y vaccinated with a dose of ZOSTAVAX (Oka/
n has been received from a physician Y concerning a patient with milk allergy who was vaccinated U with ROTATEQ vaccine. Upon return for a
week after vaccinations - resolved Y after two days.
Y Lethargic, irritable22 Y2-3 weeks Y
later for about
N two weeks. One### month after ###
immunizations,
en thigh left - side left day #2 after vaccination.
Y ER on 4-5-09 No tx. Y 4/2/2009 4/4/2009
o site with induration x 3-4 days. Left arm. Y 3/26/2009 3/28/2009
shingle shot. Asked nurse if it would hurt, no just like flu shot. It did hurt and burned. 03-19-09 4 AM Difficulties
3/18/2009 Breathing for 1 Hr. Noticed
d petechial rash on inner thighs, abdomen, behind knees 5 days after vaccine give. No itch -YNo vesicles.3/17/2009 No rash at3/23/2009
injection site. Platelet c
n so had ADACEL vaccine (administered off -site) 10 days later, presented to me with myalgias, arthralgias, headache, 3/7/2009
malaise. Ok to conta
DISIL vaccine administered 7/8/08 pt report hives all over body within hours of injection lasting Y 3-4 days. 7/8/2008
Tx with BENADRYL.
7/8/2008
swelling & erythema of entire thigh > 72 hrs Discomfort & ambulation > 48 hrs. Y 11/1/2005 11/1/2005
cm red wheal appeared after 9 month immunizations given. No discomfort/problems noted, but N wheal has2/6/2009
persisted since
2/6/2009shots (on right th
ction right thigh with erythema and induration
Y developed nine days after immunizations. AlsoUwith low grade 3/24/2008
temp. (99.9)
4/2/2009
d rash L side neck in dermatomal pattern consistent with VZV. 3/18/2009 3/25/2009
iven 3/19/09, fever developed 3/27/09. Y Rash erythematous macular papule with palms/soles & buccal urticaria 3/19/2009 developed
3/29/2009 3/29. Looks like
Y ### ###
ed 6 mo. well baby checkup on 2/23/09. Vaccines listed below given. Pt. came in to see MDYon 2/28/09.2/23/2009 Vomiting 2/25/2009
began on 2/25 with Dia
lled, c/o erythema (L) upper arm at injection site, Sl. raised "welt" in appearance, "larger than Y half dollar"3/25/2009
in size. No3/26/2009
c/o discomfort, and dec
se events recorded 8/2/2006
d to the office on 3/31/09 with c/o rash Y all over body since Sunday 3/29/09. Spreading rash not U itchy. No 3/19/2009
fever. Non vesicular,
3/29/2009maculopapula
KINRIX 3/24/09 (R) deltoid. Seen 3/26/09
Y with swelling, erythema, warm to touch no tendernessY no induration.
3/24/2009 Negative
3/25/2009
node. Ab after vac
d headache 5/26/09 Received PCPYmedical records of 12/3/08-5/18/2009. FINAL DX:migraine Y HA; probable 12/3/2008
psychiatric
2/21/2009
illness Records rev
maculo papular rash to face, neck, Yarms, chest, abdomen, back and groin blanching and non U vesicular. 3/17/2009
Not itchy, afebrile,
3/27/2009 No V, No D. Po
ceived KINRIX as part of 4y.o. physical, in (L) deltoid 4/3/09 at approximately 9:AM; went to schoolY after appt,
4/3/2009
picked 4/3/2009
up from school at 5PM
ec. Yellow Fever Vaccine - woke upYwith itching mild noc, slight headache - In AM 3/31/09 noted Y rash (hives)
3/30/2009
chest,3/30/2009
neck, arms and legs. D
ely following injection pt. became stiff,Y eyes rolled in back of head, bluish + orange around mouth,Y + pt. was
3/31/2009
having jerking
3/31/2009motions of entire
ed of itchy throat 40 minutes after receiving multiple vaccines (TYPHIM VI, HAVRIX and yellow Y fever YF-VAX).
3/25/2009 Administered
3/25/2009BENADYL 50
ness, swelling and firmness Rt 'upperarm' 3"x2 1/2". No fever or chills. Denies cp or SOB. NoYpruritus. ROCEPHIN 3/30/2009 gram3/31/2009
+ IM, KEFLEX 500
m notices red spots on back of neck Y and a lot on stomach. 1-16-09 8AM when woke up this AM, Y red spots 1/6/2009
were all over
1/15/2009
face, back, neck and
o pneumonia vaccine given in the left arm (deltoid). Mild pain, redness and streaking from injection
U site. 4/6/2009 4/6/2009
Hep B vaccines were given to 70 newborns because the GSK products requires 10 mcg dosage, but MERCK product 2/17/2009
required only 5 mcg f
tates he was in his office yesterday, received Pneumonia vaccine in rt arm. Report this was he second pneumonia 3/26/2009 vaccine.
3/26/2009 States approx 3
tion given on 3/27/09 3 hours after going to bed woke up screaming for 5-10 min. did settle some Y fussy till
3/27/2009
TYLENOL 3/27/2009
kicked in temp 103 de
d redness around upper arm 2 d after vaccine given-Itchy c/o nausea- Rx BENADRYL, MOTRIN Y -Lasted2/10/2009
3-4 days. 2/11/2009
an two days after shot was given (103F)Y mother gave Tylenol. Child taken to ER with c/o seizure. 3/18/2009 3/20/2009
tion site reaction with mild cellulitis Y 3/31/2009 4/2/2009
X 24 hr, injection site rash, urticaria Y Y 4/1/2009
heat, swelling left deltoid area. Hard in center of redness, approx. ping- pong ball sized Y 3/21/2009 3/23/2009
D with throat itching within 5 min of shot.
Y Requiring BENADRYL 25 mg PO + Albuterol Nebulizer Y treatments
3/30/2009
X 2 given
3/30/2009
over 2 hours.
ld with spots on body, started 3 days ago along with diarrhea; cough x 4 days temp 98 R 148-38 Y Stuffy 3/10/2009
nose, yellowish
3/23/2009
nasal drainage. A
ain, left sided facial flushing, fevers up to 100.8 degrees orally after vaccine given. Also noted Y left supra3/18/2009
- clavicular3/18/2009
lymphadenopathy. Fu
and swelling to left upper arm. Y U 4/1/2009 4/2/2009
noticed itching at site of vaccination. Mild tenderness, seen at clinic 3/27. 6X5 cm warm pinkYarea surrounding 3/25/2009
2.5 cm3/26/2009
area darker pink + mi
5 cm X 5 cm; Swelling + Pallor 8X8 cm; tenderness. U 3/31/2009
Y 4/2/2009 4/2/2009
stomach,head hurt, feet felt prickly Y 3/28/2009 3/28/2009
d with ACAM2000 during pregnancy. Pregnancy resulted in full term healthy delivery. 4/10/2008 4/21/2008
3rd dose of Gardasil on 3/31/09 On 4/2/09 she had an episode where she became very angry Y and agitated3/31/2009
and had 4/2/2009
behavior not like her n
as given Adacel instead of Infanrix. I have told my superviser and his parents. Y 4/7/2009
sed appt for Well Child Clinic and coordinator
Y MaryBeth Hayes RN called to remind parents. Y She spoke with2/24/2009
dad and 3/1/2009
he said that child had
Optic Neuropathy leading to severe loss Y of vision right eye. Treated with high dose Y IV steroids
N with no benefit. ### 5/4/09
11/4/2008
Received Optho Clini
INTED.ASSESSED MY MD Y 4/7/2009 4/7/2009
owing vaccination, pt. developed generalized
Y itching and painful sores on her back. She went U to her doctor
3/30/2009
on the 3rd4/1/2009
day post-vaccination
fic myocarditis. This case was identified
Y as part of the H-406-005 Enhanced Surveillance Study (5000005). 2/2/2009 2/18/2009
ardial infarction (410.7), unspecifiedYsite (410.9). This case was identified as part of a study.U 1/30/2009 2/17/2009
Kinrix innoculations given on 3-17-09, on 3-28-09 (11 days post inocculations) Pt spiked a 102F U temperature,
3/17/2009which3/28/2009
subsided over the nex
ought child in today for assessment of oval shaped 3 inch by 6 inch reddened area on left posterior U lateral4/6/2009
upper arm,4/6/2009
site of VZV sc injectio
s after her vaccine was given the following
Y symptoms
Y were noted: weakness
1 of mouth muscles
Y with drooling 2/4/2009
and liquids
2/22/2009
running out of mou
d with ACAM2000 during pregnancy. Pregnancy resulted in spontaneous abortion. 1/14/2009 2/2/2009
ates he got his second injection on Friday and that his rash came back over the weekend and Y stating this3/5/2009
time the rash3/9/2009
is worse. +Pruritis,
d to toe. Not sleeping or eating. - Maculopapular
Y rash, condense together in big patches, notUsick, no cough,
3/26/2009
no URI3/27/2009
c/o, measles-like rash.
rash with blisters) on lower L back. Y U 3/25/2009 4/5/2009
1/13/2009
erythema L thigh day after immunizations. Continued to increase spread of erythema. MotherUhad given Benadryl 4/3/2009et had4/4/2009
applied ice to site.
009@09-43 from pt. States he was in this office yesterday, received pneumonia vaccine in rt arm. Report3/25/2009 this was he 3/26/2009
second pneumonia va
n has been received from a nurse for the pregnancy registry for HPV concerning a female with Y a history of2/4/2008
vulvar condyloma
2/4/2008with Trichloroa
n has been received via an internet blog from a consumer concerning her daughter who wasUvaccinated with a dose of GARDASIL. In the m
n has been received from via the physician of aYpatient whose mother 6 found the current case U online. The5/30/2007
current case concerns a female p
d focal deficits temporallyY associated Y to receipt Yof the spv. See attached.
20 Diagnosis:
Y CEREBELLARN ATAXIA/menigoencephalitis.
1/5/2009 1/20/2009 Symptom
n has been received from a physician concerning a 17 year old female who was vaccinated N with her second dose of GARDASIL, 0.5 mL, IM
orts pain & burning sensation to right Y upper arm since flu vaccination. Severe pain started approximately11/4/2008
2 wks after administration.
### She re
oid (arm) red and swollen, mother of patient stated that kid had a low grade temp. of 99.4 theYday after vaccine administered.
ma & swelling of uvula. Y Y ### ###
d swollen warm to touch. Are measures Y 8x6 cm. no pain. Temp 99. Y 3/30/2009 4/1/2009
shingle shot. Asked nurse if it would hurt. No, just like flu shot, it did hurt and burned. 03-19-09 4 AM difficulties
3/18/2009 breathing
3/18/2009for 1 hr. Noticed
ghtly raised, warm to touch pink area @ injec. site post getting VARICELLA vaccine on 3/30/09 U 14.5 cm3/30/2009
X 7cm. Reported
3/31/2009 by guardian on 4
area of blanching erythema around Yinjection site at L upper arm. Started a few hours after injection-
U zero 4/1/2009
treatment included
4/2/2009with systemic
n has been received from a nurse practitioner,
Y for the Pregnancy Registry for GARDASIL, concerning
Y a 15 year ###old female
3/1/2008 with iron deficie
n has been received from a physician Y assistant concerning a 24 year old pregnant female with Y a history 2/12/2008
of penicillin2/12/2008
allergy who on 12-FEB
on arm. Not sure if it was vaccine reaction
Y or early cellulitis. U 7/11/2007 7/13/2007
d syncopal episode, shortness of breath,
Y headache, throat felt "fuzzy" Injection site swollen,Ured, achy. 8/8/2007 8/9/2007
n has been received from a case in litigation via Litigation Reports concerning a 15 month old N male patient3/14/2000
who on 14-MAR-2000
3/30/2000 was vacc
was received from a health professional
Y on 26 March 2009, via another manufacturer (document number 45215838). A patient received Fl
Y Y 2/6/2009 2/9/2009
eveloped. Got in waiting area she began to break out with a pruritic rash and had difficulty breathing.
Y 62.53/4/2009
Solumedrol3/4/2009
IM given, 0.2 Epinep
ASIL 1-30-09 - At 2nd appt for GARDASIL 4-2-09 pt. described symptoms from first IZ admin. Y stated had 1/30/2009
severe headache
1/30/2009 with vomiting a
induration at left thigh elevated white
Y blood cell count to 13.7 K Fever to 100.5 U 4/6/2009 4/7/2009
redness, itching and swelling of the upper arm for a week followed by a general feeling of tiredness,
Y headaches### and general ###achiness lastin
Y 4/2/2009 4/6/2009
lled stating that left arm is red, swollen, warm to touch, has a red splotchy rash and is the sizeU of a "grapefruit".
4/6/2009 Patient
4/7/2009
denies any pain, bu
rned red and slightly raised the evening of the day the shot was given. Y 4/6/2009 4/6/2009
the tongue and throat. No acute respiratory distress. complained of mild itching around eyesYand forehead. 4/8/2009
No erythema 4/8/2009
or rash noted in th
EAMED ALL DAY RIGHT AFTER SHE RECIEVED THE IMZ. RUN 103 TEMP THE FIRST DAY Y AND 1014/2/2009 TEMP THE4/2/2009 NEXT TWO DAYS. C
nt received Tdap vaccine (Adacel) and experienced muscle aches, chills, general malaise, nausea Y and axillary
3/19/2009lymphadenopathy.
3/19/2009 Symptom
U 4/1/2009 4/1/2009
nt received Tdap and experienced nausea, vomiting, chills, low grade temp and a rash beginning Y immediately
3/19/2009
after injection.
3/19/2009Symtoms subs
s a Methicillin Sensitive Y Staph Aureus
Y left septic
Y hip and left abscess5Y on ankle with presumedU osteomyelitis3/16/2009
of femur. 3/20/2009
Patient's prenatal cou
ite blanched and cool to touch, after the blanching, the injection site had a bluish-tinged appearance.
Y Ice
3/30/2009
pack applied3/30/2009
to injection site, mo
nt received Tdap and experienced fever, bodyache and headaches. Symptoms subsided in 4Ydays. 3/19/2009 3/19/2009
nt received the Tdap vaccine and experienced nausea/vomiting, axillary lymphadenopathy, blotches, Y beginning
3/19/1968 8 hours
3/19/1968
after vaccine admin
nt received Tdap and experienced chills, diarrhea and vomiting 1-2 hours after injection. TheYsymptoms subsided 3/19/2009in 3/19/2009
2 to 3 days.
HPV vaccine Gardisil on March 31, 2009. Y The next day I was feeling soar and tired, but did not
N think anything
3/31/2009
about 4/1/2009
it. By Friday evening (
Hep B shot 3-31-09 VLL. On 4-02-09, mom notice it was reddened, hot and hives were appearing Y as well
3/31/2009
as swelling 4/2/2009
on the upper left thig
red DTAP instead of Tdap to 11 yr old, administrative error, no adverse event 3/23/2009
9@ 11:05AM, Injection site is red, swollen,
Y warm to the touch, and pain in elbow.03/16/2009@ U 3:05Pm, No 3/9/2009
pain, no3/14/2009
warmth, but still swolle
ately 48 hours after immunizations her Y left leg at injection site began swelling and turned reddish
N purple, swelling
4/3/2009continued4/5/2009 and covered he
a 62 year old African American male Y and recieved
Y the flu vaccine on 11 1/12/09. He reported a Uhistory of Diabetes.
1/12/2009 He2/24/2009
was recovering from a
ons were received on 04/06/09 (received DTaP, MMR, VZV). On 04/08/09 developed swelling, U itching, redness
4/6/2009 in left 4/8/2009
arm at site just below
had a rash on neck and chest. LipsYwere swollen. Itching at rash sites. Also complained of itching
Y throat. 4/1/2009
Went to ER4/7/2009administered Benedr
d the months up to March Y there was no local orYsystemic reaction 21 to any
Y of the Immunizations N given on 12/19/08. ###On 2/28/2009
March 3 patient came
8HRS DEVELOPED LOCALIZED REDNESS AND SWELLING IN RIGHT ARM, FEVER, MALAISE, U MYALGIAS.
4/6/2009REACTION 4/7/2009 OCCURED A
minutes of receiving theYvaccines, patient
Y developed
Y hives on his head
3 and then experienced U shortness of 4/2/2009
breath, wheezing
4/2/2009and his lips tu
er), child went to ER 2-13-09 with LLQ Y pain hadY CT- Showed ovarian 2 cyst was told by ER physician-
Y was8/25/2008
result of HPV2/13/2009
immunizations. Lap
d immunizations (FLUMIST, HepA/B, Meningococcal, Y MMR, Pneumococcal)
15 on 2/18/09. PerUthe pt he received
2/18/2009 these3/4/2009
vaccinations on 2/19
high-redness, 14x17 cm swelling and discomfort from upper thigh to knee area. Involved thigh Y 2.5cm larger 4/6/2009
in circumference
4/7/2009 - secondary e
oday that he had a reaction to RECOMBIVAX HB #2 in October 20008. Y 10/1/2008 10/1/2008
d rash around belly button and on thighs- chicken pox looking rash with temp received varicella Y 2/26/09. 2/26/2009 4/6/2009
redness, 12 cmx8cm. Noticed 4/8/09 @ 0630. Vaccine 4/7/09 2130. Y 4/7/2009 4/8/2009
e began about 3 days after ZOSTAVAX injection. N 3/24/2009 3/27/2009
ticed red welt on site of injection theYfollowing day. In the afternoon around 3 pm. she experienced
Y slight3/26/2009
itch on left3/27/2009
arm. The red welt on ri
d red itchy mark ant injection site. U 4/7/2009 4/8/2009
ncopal episode after GARDASIL. Did not fall, guided to chair by me & aroused with ammonia Y & cold wet cloth.
4/8/2009 No seizure
4/8/2009 act. Pulse alwa
n has been received from a healthcare Y worker concerning a 78 year old female who was vaccinatedY with8/30/2006
a dose of 1/26/2009
ZOSTAVAX (Merck). F
Y concerning a 77 year old female with SULFONAMIDEN allergy
3/1/2007
and no 1/22/2009
known medical history
n has been received from a 74 year old female with no known medical history and drug allergies, N who two 1/12/2009
weeks ago 1/23/2009
was vaccinated with
n has been received from a registered Y nurse concerning a 77 year old female patient with noNknown allergies 9/27/2007
and no pertinent medical hist
n has been received from a registered Y nurse (also reported as certified medical assistant) concerning
N a 71
1/20/2009
year old female patient with hiat
n has been received from a licensed practical nurse concerning a 55 year old female paraeducator Y (weight1/2/2009
242 pounds, 1/2/2009
height unknown) w
n has been received from a physician Y concerning a female patient who on 23-JAN-2009 wasYvaccinated1/23/2009 with a 0.651/23/2009
ml dose of ZOSTER va
n has been received from a Master Yof Science in Dentistry and a Physician concerning herself, Y a 61 year 1/9/2009
old female1/24/2009
patient with pre-osteop
n has been received from a registered Y pharmacist concerning an 87 year old female patient U with recurrent1/9/2009
shingles (about every two month
n has been received from a registered Y nurse concerning a 63 year old male patient with no pertinent
U medical
1/12/2009
history1/15/2009
and no known drug all
n has been received from a physicianY concerning a 65 year old male patient who on 21-JAN-2009 N was vaccinated
1/21/2009 with 1/23/2009
ZOSTAVAX. On 23
n has been received from a physicianY concerning a 73 year old female patient with reflux, osteopenia
Y and high### cholesterol
1/14/2009 who on 31-DEC
n has been received from a physicianY concerning a 68 year old female patient who on 21-JAN-2009 U was1/21/2009
vaccinated with 0.65 ml of a dose
Y pharmacist concerning a 69 year old female patient with N herpes simplex
3/5/2008 and1/26/2009
penicillin allergy who o
n has been received from a 74 year old male physician with prostate cancer that was treatedUwith radiation 12/1/2007
who in approximately
1/1/2009 Decembe
n has been received from a pharmacy Y student concerning an over 65 year old female who on U 28-JAN-20091/28/2009
was vaccinated
1/29/2009 with a dose of
Y assistant concerning a roughly 60 year old female who U on 20-JAN-2009
1/20/2009 was1/20/2009
vaccinated with a dos
Y assistant concerning a 59 year old female with no drug N reactions or 1/2/2008
allergies 1/2/2008
and a history of breas
n has been received from a physician concerning a 79 year old male who on 6-JAN-2009 was N vaccinated1/6/2009
injection with
1/20/2009
ZOSTAVAX (LOT #
n has been received from a nurse concerning a 3 year old patient who on 19-JAN-2009 wasUvaccinated 1/19/2009 with a dose1/19/2009
of ZOSTAVAX instead
n has been received from a pharmacist concerning a 67 year old female patient with an allergy N to something
1/22/2009
the dentist
1/22/2009
gave her (not furth
n has been received from a pharmacy Y student concerning a 65 year old female patient with N hypertension,1/8/2009
hypercholesterolaemia,
1/16/2009 osteopor
n has been received from a pharmacist concerning a 80 year old female patient with no known N allergies 1/19/2009
who on 19-JAN-2009
n has been received from a physicianY concerning a female patient who was over 65 year old, N who beginning
11/1/2008
November
12/1/2008
2008, was vaccina
n has been received from a physician concerning a female in her 70's who on an unknown date U was vaccinated with ZOSTER vaccine, 0.6
Y burse concerning a 71 year old male who on 16-JAN-2009 Y was vaccinated
1/16/2009 with 1/21/2009
a dose of ZOSTAVA
n has been received from a physician concerning a 67 year old female who was vaccinated Y with ZOSTER vaccine live (Oka/Merck), lot # n
n has been received from a 63 year old male patient with headaches caused from some food N products (unspecified)
9/1/2008 and no known drug all
n has been received from a 62 yearYold male patient who on 2-JAN-2009 was vaccinated with N a dose of ZOSTAVAX
1/2/2009 1/4/2009
(No Lot # provided) 0.
n has been received from a nurse concerning a 4 year old female who on 23-JAN-2009 wasUvaccinated 1/23/2009 with ZOSTAVAX 1/23/2009
SQ, 0.65ml (lot #
n has been received from a physicianY concerning a female patient with diabetes who in February N 2007, was2/5/2007
vaccinated1/1/2009
with a 0.65 ml dose
n has been received from a 62 yearYold female registered nurse with no known drug allergy N and hypercholesterolaemia 1/13/2009
who on 13-JAN-20
n has been received form a consumer Y concerning his son in law who on unspecified date was U vaccinated with a dose of ZOSTAVAX. Five
n has been received from a pharmacist concerning a 70 year old female who on 23-DEC-2008 U was vaccinated### with1/17/2009
a 0.65 ml dose of ZOS
n has been received from a licensed Y visiting nurse concerning a 67 year old female with drug N hypersensitivity
1/14/2009to codeine,
1/17/2009
PPD and ZYBAN
n has been received from a doctor of pharmacy concerning a 60 year old male with cholesterol N and hypertension
1/8/2009who 1/18/2009
on 8-JAN-2009 was
n was received from a 80 year old male
Y patient with allergies to tetracycline; CIPRO; penicillin;
N clindamycin;
11/5/2008
erythromycin;### tramadol; metop
n has been received from a physicianY concerning a 74 year old female patient with a historyUof splenectomy 1/6/2009
who on1/20/2009
approximately 6-JAN-2
Y 35 years old female pharmacist who reported that she N thought her1/14/2009
right eye could
1/14/2009
had inadvertently
n has been received from a PhysicianY Assistant concerning an 81 year old female patient with N hypertension, hyperlipidaemia,
1/15/2009 osteoporosis
n has been received form a female patient who was vaccinated with ZOSTAVAX (Lot # not reported). U Patient called because she wanted to
n has been received from a consumer concerning her 60 year old husband with no pertinentNmedical history 1/19/2009
and no1/19/2009
drug reactions or allerg
n has been received from a physicianY concerning a female patient who had an outbreak of shinglesU in July
12/1/2008
2008 and 1/15/2009
in December 2008 wa
n has been received from a pharmacist concerning a female patient in her 60's who on 2-JAN-2009 U was vaccinated
1/2/2009 with a dose of ZOSTAV
n has been received from a medical assistant concerning a 12 month old male patient who on U 13-JAN-20081/13/2008
was vaccinated
1/13/2009subcutaneous
n has been received from a pharmacy tech concerning a female patient in her late 60s who U on approximately 01-JAN-2009, "approximately
n has been received from a physicianY concerning a male patient who was vaccinated with a Udose of ZOSTAVAX (Oka/Merck) (lot # not pro
n has been received from a licensed Y practical nurse concerning a 76 years old male patient N with cardiovascular
8/1/2008 disorder, hypertension and
n has been received from a licensed Y practical nurse concerning an 87 year old male patient N with kidney 1/15/2009
stone, coronary1/16/2009
artery disease, dem
n has been received from a physicianY concerning a "young child" who was vaccinated with aYdose of PROQUAD ###(Merck).###Subsequently, w
n has been received from an 81 year old female with diabetes and a history of nervous breakdown, N and 1/22/2009
no drug reactions
1/28/2009who on 22-JAN-
n has been received from a physician concerning a 77 year old female who on 05-JUN-2008Ywas vaccinated 6/5/2008
with 0.65
1/20/2009
ml dose of ZOSTER
n has been received from a medicalYassistant concerning a 62 year old female patient with no Y known drug1/7/2009
allergies1/16/2009
and VARICELLA as a c
n has been received from a registered nurse concerning a 62 year old patient who on 20-JAN-2009 N was1/20/2009
vaccinated1/21/2009
with ZOSTER vaccine
n has been received from a certifiedYmedical assistant concerning a 62 year old male patientUwith no known 1/20/2009
drug reactions/allergies with ga
Y and a medical assistant concerning an 81 year old female N who on12/8/2008
08-DEC-20081/25/2009
was vaccinated su
n has been received from a nurse practitioner concerning a 68 year old female with hypertension, U arthritis
1/16/2009
and a history
1/27/2009
of genital herpes. T
n has been received from a physician concerning a patient who was vaccinated with ZOSTER N vaccine live
3/10/2008
(Oka/Merck) 1/9/2009
0.65ml (lot number
n has been received from a pharmacist concerning a 62 year old female with allergic reaction N to TETRACYCLINE
1/30/2009 and 1/31/2009
PHENOBARBITAL w
n has been received from a licensed Y practical nurse concerning a 78 year old female with hypertension,
N 2/25/2008
hyperlipidaemia
1/26/2009
and a history of pa
n has been received from a physicianY concerning a 67 year old male with colitis ulcerative, goutN and metabolic syndrome 1/26/2009
whose wife was v
n has been received from a certified medical assistant concerning a 76 year old male with hypertension
U 1/26/2009
and coronary2/3/2009
artery disease who o
n has been received from a pharmacist concerning a 66 year old female with allergic reaction Y to antibiotics
1/29/2009
who at "some
2/1/2009
time last week" w
n has been received from a female who on 23-JAN-2009 was vaccinated with ZOSTER vaccine N live (Oka/Merck)
1/23/2009(lot 1/31/2009
number, route and sit
n has been received from a 64 yearYold female with no medical history and no drug allergiesNwho on 29-JAN-2009
1/29/2009 was 1/31/2009
vaccinated with a 0
n has been received from a physicianY concerning a 60 year old female with hypothyroidism, N hyperlipidaemia,
1/15/2009
sciatica
1/30/2009
and back problems w
n has been received from a registered nurse (R.N.) concerning a 14 month old female with no U relevant medical
2/3/2009
history
2/3/2009
or past drug history
n has been received from a pharmacist concerning a patient who on an unspecified date was U vaccinated with a dose of ZOSTAVAX (Oka/M
n has been received from a 66 yearYold female patient with penicillin allergy, no pertinent medical
N history,
1/23/2009
who on 23-JAN-2009
n has been received from a 70 yearYold female patient with blood pressure high, no drug reactions
N / allergies,
1/13/2009
who on 1/30/2009
13-JAN-2009 was va
n has been received from a 66 yearYold female consumer with no known drug reactions/allergiesN and breast
5/11/2008
cancer since
8/1/2008January 2007, wh
n has been received from a medicalYassistant concerning a 63 year old male with diabetes and N no drug allergies ###who1/30/2009
on 15-NOV-2008 was
n has been received from a medical assistant concerning a 14 month old patient who was vaccinated
U inadvertently
2/5/2009 with a dose of ZOSTAV
n has been received from a physician concerning a male who was vaccinated SQ with a 0.65 U ml dose of ZOSTAVAX (Oka/Merck) at a pha
n has been received from a physician concerning a patient who was vaccinated with ZOSTAVAX U (Oka/Merck) 0.65ml (lot number, route an
n has been received from a certifiedYmedical assistant concerning a 66 year old female patient with no known
1/29/2009
drug 1/31/2009
reactions/allergies and
Y pharmacist concerning a 74 year old male patient with Y no drug reactions/allergies,
2/4/2009 2/5/2009 who on 04-FEB-2
n has been received from a registered nurse concerning a female patient who on an unspecifiedU date was vaccinated with one dose of ZOS
Y pharmacist concerning a over 60 year old male with atrial
N fibrillation and### a history of###chickenpox and
Y nurse concerning a 63 year old female who on 25-JUN-2008
N was6/25/2008
vaccinated6/25/2008
SQ with a 0.65ml dose
n has been received from a pharmacist concerning a 72 year old female with penicillin allergyN who on 19-JAN-2009
1/19/2009 was 2/2/2009
vaccinated with ZO
n has been received from a medical assistant concerning a 77 year old female who on 03-FEB-2009
U was2/3/2009
vaccinated2/7/2009
with ZOSTAVAX (Oka
n has been received from a physician concerning himself, a 70 year old male patient, with no pertinent medical history and no known drug
Y student concerning a female who on 3-APR-2008 was U vaccinated4/3/2008
with ZOSTAVAX### (Oka/Merck) (lo
n has been received from a physician concerning his father who on an unknown date, was vaccinated
U with ZOSTAVAX (Oka/Merck) (lot #
n has been received from a physician concerning a female who was vaccinated with a dose Uof ZOSTAVAX (Oka/Merck) (lot number, route
n has been received from a physician concerning a patient who on an unknown date, was vaccinated
U with ZOSTAVAX (Oka/Merck) SQ (lo
n has been received from a physicianY and a nurse. It was reported that a 62 year old femaleNwith type II diabetes,
2/5/2009 hypertension,
2/8/2009 congenita
n has been received from a physicianY concerning a male physician who was vaccinated withYa dose of ZOSTAVAX (Oka/Merck) (no lot # p
n has been received from a physician concerning a patient who was vaccinated with ZOSTAVAX U (Oka/Merck) 0.65ml subcutaneously. Sub
n has been received from a physician concerning a 62 year old female with several autoimmune U diseases, 1/1/2009
who about1/1/2009
a month ago approxi
n has been received from a physician concerning a patient who on an unspecified date was U vaccinated with a 0.65mL dose of ZOSTAVAX
n has been received from a physicianY concerning a patient who on 10-FEB-2009 was vaccinated with a 2/10/2009
dose of ZOSTAVAX
2/12/2009(Oka/Merck).
n has been received from a licensed practical nurse concerning a 79 year old female who onN29-DEC-2008 was ###
vaccinated
1/8/2009 with ZOSTAVA
Y concerning an 89 year old male with allergies to GUAIFENESIN,
N 4/14/2008
PENICILLIN 2/13/2009
and SUDAFED, and
n has been received from a medicalYassistant concerning an 80 year old female with diastolic N dysfunction,2/10/2009
hypertension, systolic murmur, c
n has been received from a 59 yearYold female with allergic PENICILLIN, SULFONAMIDE and N ERYTHROMYCIN, 1/7/2009 and 1/7/2009
no pertinent medica
n has been received from a physicianY concerning a 77 year old female who on 12-FEB-2009Nwas vaccinated 2/12/2009
SQ with2/13/2009
ZOSTAVAX (Oka/Me
n has been received from a physician concerning a patient who was vaccinated with ZOSTAVAX U (Oka/Merck) 0.65ml subcutaneously. Sub
n has been received from a physicianY assistant concerning a male with hypertension, osteoarthritis
Y and no drug allergies
2/9/2009
whose wife in Dec
n has been received from a 61 year old female with iodine (IVP dye) allergy and a history of Nheadaches 1/19/2009
while on therapy
1/20/2009
with DEMEROL a
n has been received from a 67 yearYold female with allergic reaction to ERYTHROMYCIN, KEFLEX,N sulfa, FLAGYL,
### BUTALBITAL,
### aspirin
n has been received from a physician concerning a patient who on an unspecified date was Yvaccinated with a dose of ZOSTAVAX (Merck)
n has been received from a pharmacy technician concerning a 60 year old female patient who N on 17-FEB-2009
2/17/2009 was2/17/2009
vaccinated with a dose
Y concerning a 78 year old male patient with a previous N cause of shingles
2/16/2009 in October
2/18/2009 2008, who on 1
Y concerning an adult female patient who was vaccinated Y with a dose of ZOSTAVAX 1/18/2009 (Oka/Merck) 0.5
Y concerning a 70 year old female with allergies to alendronate
N sodium
2/16/2009
(MSD)2/18/2009
WAES # 0902USA044
n has been received from a pharmacist concerning an 81 year old female patient with a historyN of shingles1/8/2009
on her trunk
2/8/2009
and no known drug
n has been received from a physician concerning an over 65 year old patient who on approximately
U 20-DEC-2008,### 2/20/2009
two months ago, was va
n has been received from a physician concerning a male who was vaccinated with ZOSTAVAX U (Oka/Merck) 0.65ml2/18/2009(lot # not reported). Aft
n has been received from a nurse practitioner concerning an approximately 70 year old patientU with cardiac failure who was vaccinated SQ
n has been received from a pharmacist concerning a female patient with sulfa allergy who on N 18-FEB-2009 2/18/2009
was vaccinated
2/19/2009 with ZOSTAVA
Y nurse concerning herself with a history of osteoporosis N and borderline 8/4/2008
elevated9/1/2008
LDL who on 04-AUG
staff in physician office concerning a 63 year old female Y patient with a history of Fibro Myalgia who was
Y concerning a 73 year old female with osteoporosisN and hypertension
2/17/2009 2/19/2009
and no known drug alle
n has been received from a 67 yearYold female with penicillin allergy and high blood pressure N who on 1-JUN-2007
6/1/2007 was 2/14/2009
vaccinated with a do
n has been received from a consumerY of 77 year old female with a history of high blood pressureN and drug2/20/2009
reaction2/21/2009
to niacin and stent put
n has been received from a physician concerning a 73 year old female who was vaccinated N with a dose 1/23/2009
of ZOSTAVAX (Oka/Merck) approx
Y concerning a patient who on 23-FEB-2009 was vaccinated N intradermally
2/23/2009 with
2/23/2009
a dose of ZOSTAVAX
Y and a licensed practical nurse concerning an 86 year N old female patient ### with hypertension,
2/3/2009 coronary
Y concerning himself, a 61 year old male patient with a history
N of pain
2/16/2009
and vaccine 2/18/2009
reaction and no kno
n has been received from a licensedY practical nurse concerning a 61 year old male patient who U on 5-FEB-2009 2/5/2009 at 13:25
2/5/2009
was vaccinated wi
n has been provided from a physician concerning a female patient who on 13-FEB-2009 was Y vaccinated2/13/2009
with a dose 2/23/2009
of ZOSTAVAX vaccin
Y concerning an 83 year old female patient with osteoarthritis,
N elevated
4/22/2008
cholesterol,
2/14/2009
degenerative joint
n has been received from a nurse practitioner concerning a 72 year old female homemaker N with no history 2/1/2008
of HSV I or 2/1/2008
II and allergy to aspi
Y nurse concerning an 79 year old male with type 2 diabetes N mellitus,
11/8/2007
coronary 2/5/2009
artery disease and pro
n has been received from a 71 year old female with allergic reaction to FLAGYL who on 20-FEB-2009
U was
2/20/2009
with a dose of ZOST
Y concerning a patient who was vaccinated with a singleYdose of ZOSTAVAX 2/1/2008 (Oka/Merck).
1/12/2009 It was repo
n has been received from a physician concerning a female in her 70s who "about a year ago" Y was vaccinated with ZOSTAVAX (Oka/Merck
n has been received from a pharmacist concerning a 65 year old female who on 29-JAN-2009 U was vaccinated
1/29/2009 with 1/29/2009
a dose of ZOSTAVAX (
n has been received from a nurse practitioner concerning a male patient who at the "beginning Y of December 12/1/2008
2008" 12/1/2008
was vaccinated with ZO
n has been received from a 72 yearYold female with diabetes, sulfonamide and a history of tetanus
N who about one and 2/8/2009
a half to two years a
n has been received from a 71 year old female patient with a history of shingles before receiving
N the vaccine
10/2/2008
and blisters
10/9/2008
around her lips si
n has been received from physician concerning a patient who was vaccinated with ZOSTAVAX U (Oka/Merck) on an unspecified date. Subse
n has been received from a physician concerning a 61 year old female with diabetes who in N February 2008, 2/1/2008
was vaccinated
5/1/2008with ZOSTAVA
n has been received from a pharmacist concerning a 65 year old female who on 21-FEB-2009 Y was vaccinated
2/21/2009 with 2/23/2009
one dose of ZOSTAVA
n has been received from a female consumer who was vaccinated with ZOSTAVAX (Oka/Merck). Y The consumer reported my physician did
n has been received from a medicalYassistant and a nurse practitioner (N.P.) concerning an N 81 year old female
2/9/2009patient
2/11/2009
with hyperlipidaemia
n has been received from a physician's assistant concerning a girl who on an unspecified date U was vaccinated
2/12/2009 with 2/12/2009
a first dose of VARIVAX
n has been received from a 65 year old female with blood pressure and thyroid problem whoYwas vaccinated with a12/1/2008 dose of ZOSTAVAX (O
n has been received from a 60 year old female with sulfonamide, morphine, DEMEROL andNCELEBREX 1/2/2009 allergy who1/3/2009
on 02-JAN-2009 was
n has been received from a pharmacist concerning a 65 year old male who on 05-Jan-2009 N was vaccinated 1/5/2009
with ZOSTAVAX,
1/10/2009 subcutaneou
n has been received from a 60 year old female receptionist who in December 2008, was vaccinated Y with12/1/2008
a dose of ZOSTAVAX
12/1/2008 (Oka/Merck
Y concerning a 66 year old female patient with no known N drug allergies,
1/12/2009who on1/14/2009
12-JAN-2009 was va
n has been received from a pharmacy tech concerning a female patient in her late 60's who U on approximately 1/1/2009
01-Jan-2009,
1/1/2009"approximately
Y concerning a 60 year old male patient with a history
N of Human 1/2/2009
immunodeficiency virus expos
n has been received from a physician concerning a male patient who on an unspecified dateYwas vaccinated 6/30/2008
with a dose of ###
ZOSTAVAX (O
Y pharmacist concerning a 22 year old female employee Y who handles the intact1/1/2009ZOSTAVAX vaccine (
n has been received from a 65 yearYold female registered nurse, who is the consumer, with Y hypersensitivity and ###
allergic reaction
### to antibiot
n has been received from a registered pharmacist concerning an 80 year old female with arthritisY and sulfa 1/2/2009
allergy who1/2/2009
on 02-JAN-2009 wa
Y a 76 or 77 year old female patient who in MaryY 2008, was vaccinated
3/1/2008 12/1/2008
with ZOSTAVAX (Oka/
n has been received from a pharmacy student concerning a patient who about 1 month ago,Nwas vaccinated 12/1/2008
with a 12/1/2008
dose of ZOSTAVAX (O
manager concerning a 72 year old male who on 06-JAN-2009 Y was vaccinated
1/6/2009 with 1/6/2009
a dose of ZOSTAVA
n has been received from a registered pharmacist concerning a 72 year old female patient who Y on an unspecified date was vaccinated with
Y concerning a male patient who in December 2008, N was vaccinated
12/1/2008with 1/5/2009
a dose of ZOSTAVA
rmation has been received from a pharmacist concerning a 77 year old male who on 30-DEC-2008 N was vaccinated ### with
1/9/2009
ZOSTAVAX (Oka/M
n has been received from a 68 yearYold female patient with sulfonamide allergy and a historyNof blood pressure high who in ###
approximately 2
manager concerning a 62 year old female who on 08-JAN-2009 Y was vaccinated
1/8/2009 with 1/8/2009
a dose of ZOSTAV
manager concerning a 66 year old female who on 08-Jan-2009 Y was vaccinated
1/8/2009 with 1/8/2009
a dose of ZOSTAV
n has been received from a 68 yearYold female patient with breast cancer, atrial fibrillation, cardiac
N valve11/1/2007
leak, neuropathy
11/1/2007peripheral, sulfon
n has been received from a medical assistant concerning a 69 year old female who was vaccinated U with a dose of ZOSTAVAX (Oka/Merck
Y concerning a 91 year old female who on 12-DEC-2008 U was vaccinated### with a dose ###
of ZOSTAVAX
n has been received from a 74 year old female with Crohn's disease, penicillin and Keflex allergy
N who on 1/8/2009
08-Jan-2009 1/8/2009
was vaccinated with
n has been received from a 62 yearYold female nurse with penicillin and PREDNISONE allergy, N hypercholesterolaemia
1/7/2009 1/8/2009 and osteopenia and
Y concerning a patient who on approximately 1-JAN-2009 U "last week" 1/1/2009
was vaccinated
1/1/2009with ZOSTAVA
n has been received from a healthcare student concerning a male patient who on 07-JAN-2009 U was vaccinated1/7/2009 with 1/7/2009
ZOSTAVAX (Oka/Mer
n has been received from a pharmacist concerning a 62 year old female with PENICILLIN allergy N who on 1/5/2009
05-JAN-2009 1/5/2009
was vaccinated with
Y concerning a 65 year old female who on 06-JAN-2009 U was vaccinated1/6/2009
with ZOSTAVAX
1/6/2009 (Oka/Merc
n has been received from a nurse concerning a male who on an unknown date, was vaccinated N with ZOSTAVAX (Oka/Merck) (lot# not pro
n has been received from an 82 yearY old female patient with no known drug reactions-allergiesN and medical history,### who on ###16-DEC-2008
n has been received from a 75 year old female with allergic to sulfa who was vaccinated withNa 0.65 ml dose of### ZOSTAVAX
1/2/2009(Oka/Merck) (lo
n has been received from an office manager concerning a female nurse with a history of shingles
U who on 31-DEC-2008
### was
###reconstituting
n has been received from a physician concerning a patient who on approximately 24-DEC-2008 U was vaccinated ###with ZOSTAVAX (Oka/Me
n has been received from a 60 year old nurse practitioner with no pertinent medical history reported
Y and12/3/2008
no drug reaction/allergies,
### reportin
n has been received from a registered nurse concerning a patient who was vaccinated with Y a dose of ZOSTAVAX ### (lot # not ###reported) by th
n has been received from a 63 yearYold female consumer with penicillin allergy who reportedNthat she received 4/1/2008
a single
11/1/2008
dose of ZOSTAVAX
n has been received from a nurse practitioner concerning a 66 year old female patient with no N known drug reactions/allergies
### ### and asthma w
Y nurse concerning a female who on 19-DEC-2009 wasUvaccinated with "one ### dose" of ###
ZOSTAVAX (O
Y a 68 year old female patient with hypertensionYwho on 08-FEB-2008
2/8/2008 12/9/2008
was vaccinated in her le
n has been received from a 61 year old female with an allergy to penicillin and no pertinent medical
N history who ###on 19-DEC-2008
### was vacc
Y concerning a 63 year old female patient, with no pertinent
N medical history###and no known### drug react
n has been received from a registered pharmacist concerning a patient who was vaccinatedUwith ZOSTAVAX 12/1/2008
(Oka/Merck)
12/1/2008 about two week
n has been received from an 81 year old female who in October 2008 was vaccinated with ZOSTAVAX
U (Oka/Merck),
10/1/2008 10/1/2008
0.65ml/once, SC Sub
n has been received from a pharmacist concerning a 74 year old male with a history of cold U sores, who one year ###ago was### diagnosed with N
n has been received from a 62 year old male who "about 8 weeks ago" was vaccinated withUsingle dose of series ###of ZOSTAVAX ### (Oka/Merc
n has been received from a male with a history of herpes simplex who was vaccinated with aNsingle dose of ZOSTAVAX ### (Oka/Merck)
### (lot #
n has been received from a physician concerning a 15 year old female patient, who on an unspecified
U date, was### vaccinated ###with ZOSTAVA
n has been received from a registered pharmacist concerning a patient who was vaccinatedUwith single dose 6/1/2008
of ZOSTAVAX
6/1/2008about 6 month
n has been received from a 62 year old female with "numerous reactions to other unspecified U medication" who### on 17-DEC-2008### was vacci
n has been received from a 85 year old female patient, with codeine and sulfonamide allergy, N who on 15-DEC-2008 ### was vaccinated
### with a
n has been received from a 61 yearYold female patient with allergic reactions to antibiotics (had
N a reaction once to ERYTHROMYCIN), who
n has been received from an 86 yearY old female with blood pressure and a history of shingles N in April 2006,
12/7/2007
who on 07-DEC-2007### was vac
n has been received from a 71 yearYold female patient with hypertension and no known drugNreaction or allergies, ### who on### 20-NOV-2008, w
n has been received from a doctor of pharmacy concerning a patient who on an unspecifiedUdate was vaccinated with a dose of ZOSTAVA
n has been received from a doctor of pharmacy concerning a patient on an unspecified dateUwas vaccinated with a dose of ZOSTAVAX (O
n has been received from a doctor of pharmacy concerning a patient who on an unspecifiedUdate was vaccinated with a dose of ZOSTAVA
n has been received from a registered pharmacist concerning a 77 year old female patient who Y on 12-DEC-2008 ###was vaccinated
### subcutan
n has been received from a registered pharmacist concerning an unknown number of patients U who were12/1/2008
vaccinated12/2/2008
with a dose of ZOSTA
rmation has been received from an office
Y coordinator and follow up information has been received
N from a10/9/2007
physician 10/9/2007
concerning a 59 year ol
n has been received from a registered nurse who on unspecified date developed shingles like U blisters from giving ZOSTAVAX to patients. S
Y pharmacist concerning a 75 year old female patient who N on 23-JAN-2008
1/23/2008was 12/9/2008
vaccinated with a dos
n has been received from a physician concerning a 71 year old male who on 09-DEC-2008 was U vaccinated 12/9/2008
with a 0.65 mL### dose of ZOSTA
n has been received from a 56 year old male patient with dialysis and allergy to tetracycline Nwho on 11-DEC-2008 ### was vaccinated
### in the ar
n has been received from a nurse practitioner concerning a 65 year old female patient with hypertension
N and osteoporosis,
### ###
who on 15-DEC
n has been received from a medicalYassistant concerning a 60 year old female patient with drugN hypersensitivity
12/9/2008 to DEMEROL
12/9/2008 and no perti
n has been received from a doctor of pharmacy concerning a 66 year old patient who on 16-Dec-2008
N was vaccinated
### with
###
a dose of ZOST
n has been received from a female who on an unknown date, was vaccinated with ZOSTAVAX U (Oka/Merck) (lot# not reported). Subsequen
n has been received from a consumerY concerning her 73 year old male husband with a pacemaker U and a1/2/2008
defibrillator,
11/1/2008
and a history of both
n has been received from a female patient who on 26-Nov-2008 was vaccinated subcutaneously N with a dose of### ZOSTAVAX ###(Oka/Merck). O
n has been received from a pharmacist concerning a 62 year old female patient with no drugNreactions/allergies, ### who on 12-DEC-2008
### was
n has been received from a nurse concerning a 75 year old male patient with a history of largeY cell lymphoma
11/2/2007
who on12/5/2008
21-NOV-2007 was va
Y from 62 year old female pharmacist prone to fever Y blister who on12/5/2008
05-DEC-200812/5/2008
at 10:00 was vacc
n has been received from a female physician who on 10-DEC-2008 was vaccinated with a dose N of ZOSTAVAX### (Oka/Merck). ###The physician
n has been received from a 65 yearYold female with diabetes who in July or August 2008, was N vaccinated7/1/2008
with a dose12/1/2008
of ZOSTAVAX (Oka/
n has been received from a physician Y concerning a 78 year old male patient with hypertension,N artery coronary
1/5/2007 disease
10/2/2008
and diabetes and a
n has been received from a pharmacist concerning a patient who two to three days ago wasNvaccinated 12/8/2008 with a dose of ZOSTAVAX vaccine
n has been received from a health professional concerning a 67 year old female with an allergy N to latex, who on ###10-DEC-2008 was vaccina
n has been received from a registered Y nurse concerning a 61 year old male with hypercholesterolemia
Y who on### 10-DEC-2008 ### was subcutan
Y concerning a 13 month old female who inadvertently
U on 09-DEC-2008
12/9/2008 12/9/2008
was vaccinated SQ w
n has been received from a medicalYassistant concerning a 74 year old female patient who had U an episode 5/1/2008
of shingles prior to receiving ZO
Y concerning an 87 year old female patient withNhypertension, 12/1/2007
hyperlipidaemia
12/7/2008 and hypothyroid
n has been received from a store manager concerning a female patient who on 12-NOV-2008 U was vaccinated ### with a dose of ZOSTAVAX (
n has been received from a physician Y concerning a 66 year old female patient with codeine N allergy, hypertension
10/1/2008and 10/1/2008
hypothyroidism who 2
n has been received from a female patient who on an unspecified date was vaccinated with U a dose of ZOSTAVAX (Oka/Merck). Subseque
n has been received from a female consumer who on 25-NOV-2008 was vaccinated with a dose U of ZOSTAVAX ###(Oka/Merck).
### On 28-NOV-2
n has been received from a 46 year old male patient with history of drug hypersensitivity to penicillin
N and12/3/2008
shellfish based
12/3/2008
medications such
n has been received from a consumer concerning her sister, a female patient who accordingUto the consumer she had already had a very b
n has been received from a physician concerning a 1 year old patient who on 24-NOV-2008Uwas vaccinated with ###a dose of### ZOSTAVAX (Ok
Y concerning a 67 year old male patient with sleep
N apnoea and 9/12/2008
a history
9/12/2008
of head injury recover
n has been received from a 64 year old male with high blood pressure and shingles with post U herpetic neuralgia
10/1/2007 (PHN) and ###
a history of sten
n has been received from a physician concerning a 60 year old female who, "in last week", on U approximately 24-Nov-2008
### was vaccinated
n has been received from a female patient, who in February 2008, was vaccinated with a dose Y of ZOSTAVAX 1/1/2008
vaccine
12/1/2008
(Oka/Merck) (Lot. #
n has been received from a 73 yearYold male patient with history of prostatic disorder and noNknown drug11/1/2008reactions/allergies,
11/3/2008who on appro
n has been received from a physician Y concerning a 77 year old female patient who in February N 2007, was2/1/2007
vaccinated with### a dose of ZOST
n has been received from a pharmacist concerning a patient who about a year ago was vaccinated N with a dose of ZOSTAVAX (Oka/Merck
n has been received from an 88 year Y old female consumer with a blood pressure condition and N no pertinent medical ### history, ###who on 18-No
n has been received from a registered Y nurse (R.N.) concerning her father, an 83 year old male N with a history2/1/2008
of macular
11/1/2008
degeneration and "
n has been received from a physician concerning a 74 year old male with hypertension, dyslipidaemia
Y and penicillin
### allergy ###
and a history of
n has been received from a consumer Y concerning her 75 year old mother with leukemia, memory N loss and a history
### of two strokes, and "all
n has been received from a registered pharmacists concerning a patient who was vaccinated U with a dose of ZOSTAVAX (Oka/Merck) (Lot
n has been received from a registered pharmacists concerning a patient who was vaccinated U with a dose of ZOSTAVAX (Merck) (Lot not re
n has been received from a 54 yearYold female with a history of shingles in right eye in Feb 1998
N and no drug allergies
### who###
was vaccinated
n has been received from an 88 year old male with no pertinent medical history who on 15-DEC-2008
N was vaccinated
### 1/6/2009
subcutaneously with
n has been received from a 61 yearYold female with sulfonamide allergy and no pertinent medical U history who
1/5/2009
on 05-Jan-2009
n has been received from a 74 year old female with sulfa allergy and allergic to an antibioticsU(unspecified) 1/6/2009
who on 6-JAN-2009
1/8/2009 was vaccin
n has been received from a registered pharmacist concerning a patient who was vaccinatedYwith a dose of ZOSTAVAX (Merck) (Lot not re
n has been received from a 66 year old male patient with high cholesterol and a history of quadruple
N vessel
1/5/2009
bypass graft
1/6/2009
in 1990, shingles
n has been received from pharmacist concerning a 73 year old female who on 03-JAN-2009Nwas vaccinated 1/3/2009
with a dose
1/3/2009
of ZOSTAVAX va
follow-up information has been received from a registered pharmacist concerning a 75 year N old male patient1/4/2009
with no 1/4/2009
known drug reaction/a
n has been received from a physician Y concerning a female patient who on 05-DEC-2008 was U vaccinated12/5/2008
with a 0.65ml dose ###of ZOSTAVAX
n has been received from a female Y Registered Nurse, who "5-6 weeks ago", was vaccinatedNwith ZOSTAVAX ### vaccine
12/8/2008
(Oka/Merck) subcuta
n has been received from a 70 year old male with sulfonamide allergy who on 24-DEC-2008Ywas vaccinated with ###a 0.65 ml ###
dose of ZOSTA
n has been received from a pharmacist Y concerning a 67 year old female patient with hypothyroidism,
N arthritis, diverticulitis
### ###
and interstitial cy
N
Y concerning
Y an approximately 030 months old female who Y received 3 doses of PEDVAXHIB
5/1/2008 (lot# not re
n has been received from a Doctor Y of pharmacyY concerning a 79 year
0 Yold male inpatient for N
decompensate 4/2/2009
diabetes 4/2/2009
with hypertension, dia
n has been received from a registered nurse, for VARIVAX vaccine (MERCK), a Pregnancy U Registry product3/4/2009
concerning
3/4/2009
a 17 year old preg
n has been received from a registered pharmacist concerning a now 66 year old female whoYin approximately 2003 "about 4 to 6 years ago
rib cracked went to doctor.
Y She prescribed pain pills, week later it went popped again. YearsNwent by without 10/1/2003
problems, breast cancer show
a 16-year-old female who presents today with mother.
Y The patient states
1 she was with her momY earlier getting
3/12/2009her prom
3/13/2009
dress fitted when s
vaccines on 3-16-09. The evening of vaccine she got a fever + slept poorly. In the morningYafter the vaccine 3/16/2009
was disoriented
3/16/2009 + needed he
h swollen, red with blisters. Looks like
Y a 2nd degree burn. Almost entire thigh swollen. Very tender
U to touch.
4/1/2009
Swollen area
4/1/2009
very hard. Receiv
dizziness, vomiting low grade fever resolved spontaneously. U 4/1/2009 4/1/2009
d bilateral pulmonary embolisms
Y and Y moderateYto severe right ventrical
4 heart dysfunction. Misdiagnosed
Y originally
### as "walking
### pneumonia",
pain and swelling in arm. HeadacheYand temperature 100.2 degrees 24 hours after vaccine.Y5 cm swelling 3/27/2009
and erythema.
3/28/2009
e course on the vaccines, patient has Y developed debilitating abdominal pain. 4/15/09 MR receivedU 5/5/08
6/13/2008
to 4/13/09.8/1/2008
15 yr WCC 6/13/08 w
at 10:45 am 3/26/09, shaking. PoorYsleep night of 3/25/09. Y 3/25/2009 3/26/2009
PE complete immunization given (DTAP Y IPV MMR Varicella) 415P child started cough. 4:20pm Y wheeze A-P 4/6/2009
lungs. Benadryl
4/6/2009 12.5mg / 5ml S
ction lasting 4 days. Y Y 3/30/2009 3/30/2009
d PREVNAR vaccine @ thigh on 4/12/09 at 1021 AM. Awoke from nap approx 3PM & criedYas if in pain. 4/2/2009 Mom noticed 4/2/2009
R leg (thigh->toes)
edness and swelling of left upper thigh, plus erythema approximately 12cm. U 4/1/2009 4/1/2009
ceived the Zoster vaccine at the clinic 2/5/09. At his f/u visit 3/3/09 he reported he'd developed a shingles 2/5/2009
rash approx 2/15/2009
10 days after the vac
njection of ZOSTAVAX on 03/25/2009 about six days later developed red spots on my right leg U on the inside
3/25/2009
between 3/30/2009
ankle and knee. The
ped rash after vaccines were given. I'm sure of due to Varivax n MMR. 3/24/2009
me to pick up a sticker and she looked pale, lips were white. She said she was tired and laidYdown on the4/8/2009 floor. I picked
4/8/2009
up patient and carr
eral scattered vesicles. Some already crusting over. Y 3/10/2009 4/4/2009
roke out on left thigh as soon as theY MMR was pushed. Patient was given BENADRYL 12/5mg Y and thigh 4/9/2009
was observed 4/9/2009
for 15 minutes. Th
of redness to the right deltoid, muscle
Y aches in right arm patient unable to lift arm above hisNright shoulder.4/4/2009
Patient states
4/6/2009
" I just do not fee
lled 4/9/09 AM to notify us approximately two hrs after vacc. She felt "weak and with headache"; U this morning
4/8/2009
after 154/8/2009
min run she c/o swea
LA vaccine (along with TDAP & HEP A, and MENATRA) given 3/31/09 (1388 IM VERIVAX lot) onset (acute) 3/31/2009
Bell Palsy4/4/2009
VII on 4/4/09.
U 4/6/2009
iatric/adolescent dose of Hepatitis A instead of adult dose. Dr notified at 16:04, 3/31/09. Y 3/31/2009
as inadvertently given DTap instead of Tdap. Patient contacted today and has had no adverse Y events. 4/3/2009
elling - Pt reported fever to 101 x 2 days after 2 days on 4/3/09 redness- swelling inner L armY5"X3" - No fever 3/3/2009
- Tx BENADRYL
3/3/2009 and KEFLE
Y
3/31/2009 3/31/2009
old female presents with fever startingY 4 days after
Y vaccination. Patient 2 continued to fever for
Y 6 days with3/9/2009
102-104.7t 3/12/2009
with no other sympto
he dept and left message. Pt was contacted at 2:15pm of 04/07/2009, stated"03/26/2009 gotYinjection in3/26/2009clinic, started3/27/2009
to act out on Friday
munized with Varivax vaccine on 3/4/09. Over the next 48 hours, she developed redness and Y warmth at 3/3/2009
injection site, 3/3/2009
and surrounding are
1/30/2009 N 4/17/2008 1/30/2009
ar sized redness and warm to touch at administration site. Y 4/8/2009 4/9/2009
elt "woozy,dizzy" when got home. approx Y 1 1/2 hr later had some difficulty breathing along withY burning sensation
3/18/2009of3/18/2009
face and eyes. did not
2/18/1998 Y Y Y 1 N 1/9/1998 1/19/1998
ent at 10:15am, pt. called 9:15pm complaining of right arm pain, not red, no fever, vomiting and Y stomach3/26/2009
ache; ate out. 3/26/2009
d Herpes Zoster (C5 distribution) 03/21/2009 Y 9/2/2008 3/21/2009
s a softball sized area at the site of administration. Area is painful, red, swollen, and warm toUtouch. Patient
4/8/2009
does not4/9/2009
have a fever or other
ver 6 hours after injection. Tylenol given.Fussy. Appetite down and remains down. Awoke whimpering Y with
4/7/2009
high fever 4/7/2009
(10 pm) Temp Recta
ceived #2 VZV, #1 HPV, and #1 Tdap (had 5 previous DTP vaccines) 4-1-09 at the HC. At the Y OV on 4-1-09
4/1/2009
patient also
4/4/2009
had a viral gastroe
4/9/2009 N 4/8/2009 4/9/2009
week field exercise, patient was administered anthrax and smallpox vaccine, 05MAR09. Patient Y did follow-up
3/5/2009
note on 3/23/2009
12MAR09 with no pro
eved shots at health department-
Y behind
Y schedule.Received 6 vaccines. Around 8 hours later, Y dad found3/16/2009
child having 3/16/2009
seizure, limp, blue, dr
came cranky cried her developed rash on her lower extrimities.Rash lasted for 1 hour patientY consolable 1 n 20 minutes after the administr
hours after TD was given pt started Yto run a low grade temp and had swelling of the injection site along with 4/6/2009
a hive. Mom4/7/2009
was told to use co
ceived Kinrix (DTaP,IPV, MMR & Varicella 04/07/09. He was seen in the office this date dueYto pain, itching 4/7/2009
and swelling4/8/2009
in left arm for 2 da
o 102.5, rhinorrhea, and erythematous rash that began on cheeks and spread to neck, trunkNthen extremities. 3/26/2009 Further
3/28/2009
details can be obtain
3/12/2009 N 3/11/2009 3/11/2009
was reported by a physician (also the father of the subject) and described the occurrence ofUvaccine underdose 3/5/2009 in a 3/5/2009
31-year-old pregnant f
ped acute abdominal pain - 2 hrs after injectionYof (1) GARDASIL; (2) 1 MENACTRA, (3) TDAP. Y Pt was evaluated
3/25/2009 in ER
3/25/2009
- diagnosis acute UT
remic swelling on Rt upper arm at injection site 1"/1'/2" Y 3/19/2009 3/19/2009
9 at 1030 the pt received the TDAP and IPV in her right arm. The pt woke at about 2230 with the sensation 3/25/2009
that her3/25/2009
throat was swelling. T
and rash reaction with angioedema. 4/1/2009 4/4/2009
ew minutes client turned pale, stiffened body, arched back, arms curled to chest, eyes rolled Yback, head jerked 4/8/2009 back and
4/8/2009
forth. Lowered clie
weakness BP prior to event 114/62, S/P 96/58 pulse 60 normal breath sounds. Blood sugarY = 82. 4/2/2009 4/2/2009
s after receiving vaccine started to "hum"
Y fell over backwards hit head on floor, unconsciousUapprox 10 seconds
4/8/2009 -> head
4/8/2009
twitching
as in office to have meningococcal but was given a HIB injection instead. 3/30/2009
vaccination on 3/31/09: TDAP and TYPHOID right arm, FLUMIST and AVA #4 left arm. On 1 April 09 pt3/31/2009 noted a 3" 4/1/2009
circle of redness and s
ates she started having cold symptoms and a sore throat starting the day after the immunization. Y 2/21/2009 2/22/2009
ately 2 weeks after immunization, he states his muscles felt tight, and he states he felt more Y fatigued than 2/27/2009
normal. This 3/13/2009
lasted about 5 days
mplaining of intermittent sharp mid to low back pain since last night. Pain occurs when getting up from laying down position and forceful ex
er vaccine administered had swelling, redness, tender. To RTR- 2" by 2" - raised red & swelling Y to L deltoid-4/7/2009
15mm by 4/9/2009
15mm diffuse red.
me to our clinic on 4/9/09 at 10:05 accompanied by mother. Patient complains of body aces,Unausea no vomiting, 4/7/2009soreness4/8/2009 in bilat. arms an
rmation was received on 21 November 2008 from a health care professional. A cluster of approximately
Y 20 cases of slight bleeding at the s
ort was received on 08 December 2008 Y from a consumer (patient's mother). A 4-month-old male U with a history
10/7/2008of being
10/7/2008
33 weeks premature
Y for GARDASIL, a Pregnancy Registry product, Y concerning 3/20/2008
a female3/20/2008
who became pregnant
n has been received from a registered Y nurse for Y the pregnancy registry
0 for GARDASIL concerningY a 17 years
6/1/2008
old female
6/16/2008
patient with no pe
n has been received from a consumer Y concerning Y his 18 year old daughter
10 with no pertinentNmedical history
8/28/2008
or no known9/8/2008
drug allergies, wh
n has been received from a licensed practical nurse (L.P.N.) who was told by a patient's mother U that she heard from a school staff member
n has been received from a consumer concerning her now 11 year old nephew who on an unspecified U date was vaccinated with a dose of
n has been received from a consumer concerning her now 12 year old nephew who on an unspecified U date was vaccinated with a dose of
n has been received from a physician concerning Y a male who on 04-APR-2008
0Y was vaccinated
N with a dose 4/4/2008
of ZOSTAVAX3/1/2009 (Oka/Merck). In
ort was received from another manufacturer
Y (document number 45216582), who received theYreport from a health care professional, who is
n has been received from an 82 year old female patient with no drug reaction/allergies, who Non 23-JAN-2009 1/23/2009
at about
1/24/2009
12:00, was vaccinate
reporting disturbed sleep at night secondary to pain at injection site. She is reporting that she
U experiences 4/3/2009
some numbness
4/4/2009from shoulder
about 4-6 cm left deltoid. warm to touch. Y 4/1/2009 4/2/2009
d rash. She went to the doctor andYit was diagnosed as shingles. She had a fever and flu like U symptoms 3/20/2009
preceding the rash. The rash wa
on all my neck for two days, I had fever yesterday, it last only one day and I still have the swelling
N of glands
3/30/2009
starting 4/7/2009
yesterday. I haven't vi
after receiving the shingles vaccine on April 3, 2009 I had flu like smyptoms. Headache, sleepless
Y nights,
4/3/2009
chills, achy4/6/2009
all over,very weak, f
Dtap given, 04/01/09 Pt. had axillary temp of 103, 04/02/09 Pt. had 2-3cm redness at injection U site 3/31/2009 4/1/2009
ction to Dtap (given on 03/30/09), right
Y arm swollen and red (4cm). Pt. came back to office onU04/01/09. 3/30/2009 3/31/2009
mins of injections, pain, stiffness, extreme
Y fatigue, lethargic . Then experienced cont.
Y pain and N soreness,3/23/2009
stiffness on3/23/2009
and off for next week
X2 4/29/09 Received Hospital medical Y records Y for 2/8-2/9/2009 & 4/5-4/7/2009.
5 FINAL DX: newY onset seizures
2/4/2009 Records2/8/2009
reveal patient expe
d area, size of half-dollar, left arm.Swelling
Y arm/neck/shoulder. MD diagnosed cellulitis. U 8/18/2008 8/20/2008
ainful red swollen 4 X 3 1/2" area on left arm after vaccination Y 4/25/2008 4/26/2008
mm red raised area at site of injection generic benadryl given Y 4/8/2009 4/9/2009
te, fever, seizure Y N ### ###
abdomen/chest/lumbar Y Y ### ###
nt shooting pains in right arm, soreness at injection site, no redness or swelling at site U 11/5/2007 11/6/2007
red Tdap and Gardisil, pt.'s head dropped, was unresponsive, arms and legs drew up in seizure-likeY activity,
8/17/2007
pt. was8/17/2007
incontinent of urine, pt
redness, warm to touch, itches Y U 8/3/2007 8/4/2007
and high pitched screaming two hours after vaccines given, lasted for 2 hours Y 5/16/2007 5/16/2007
inistration of all 4 vaccines, upon departure and standing, client reported feeling dizzy. Assisted
Y client back 4/9/2009
to chair. 4/9/2009
Client fainted. Incohe
er MMR vaccination our daughter developed
Y a 101 degree fever. The the 6th day our daughterU had a febrile
3/30/2009
seizure due4/3/2009
to a 104 fever. Sh
d vomiting, dehydration and abdominal Y pains. 4/14/09
Y Received hospital
4 medical records of U4/9-4/12/2009.3/30/2009
FINAL DX: 4/2/2009
cyclic vomiting; abdo
n 02-25-09. States she had pain, swelling and itching lasted 2 weeks after injection (given 11/3/08).
Y She11/3/2008
didn't do anything then and about
ped a rash on right arm shortly after vaccine administration N 3/9/2009 3/14/2009
redness, very hot, doubled in size on Y the evening of 04/06/09. Mother gave Benadryl and theYnext morning 4/6/2009
pt. woke up 4/6/2009
screaming of pain. M
rea of induration over R deltoid with 13x10 cm of erythema, non-tender, no expressible d/c. Received
U DAPTACEL
4/9/20094/9/094/10/2009
R deltoid
20, 2009 - developed severe headache.
Y Seen by PMD on March 23, who diagnosed shingles. Y 3 lesions4/10/2008
on scalp - 3/20/2009
(L) side of head - culture
h large erythematous edematous puritic
Y patch around site of DTaP & varicella injections -> 5" wide x 4" long;
4/8/2009
To ER 4/8/2009
+ office.
hing, blinking, facial grimace beginning on day of administration of vaccine and has been ongoing. U Frequency
4/6/2009
about 4x/10
4/6/2009
minutes.
itis day 13 after MMR. Y 3/26/2009 4/6/2009
tous discoloration with slight induration approximately 9-10 cm, no c/o pain. Y 4/7/2009 4/9/2009
rythema 15x16cm left thigh, not tender, + warmth and itch. Continue TYLENOL and IBUPROFEN; U BENADRYL4/8/2009 for itching.
4/9/2009
after the shots, became pale around 5 sec no treatment needed. Y 4/7/2009 4/7/2009
e and pain in all of them, incontinence urinary, memory loss. N 2/10/2003
s and dizziness especially upon standing. Hot feeling in face and head - sweating on face and U head. Fasting
4/10/2009
blood 4/11/2009
sugar 131 (diabetic). Oc
ven vaccine IV push instead of subcutaneously pt HR 130's but anxious and getting respiratory Y treatment. 4/11/2009
HR in 70's in 15 min.
as extremely exciteable when his cousin that he hadn't seen in over a year came to visit us, his U grandparents.
3/30/2009
The boys
4/9/2009
love each other, bu
is red, no swelling noted, arm is warm, but so is other, painful to touch. Patient was advisedUto put ice on 1/14/2009
arm and alternate
1/16/2009with warm com
left upper arm Y U ### 1/26/2009
augh,weak, breathing problems Y Y ### 11/6/2008
us case was received on 01 April 2009 from a health care professional. An approximately 3 week Y old patient (gender
### 6/7/2008
not specified) receive
ort received 01 April 2009 from a health Y care professional, who is also the patient. AccordingUto the reporter, they developed the "flu" an uns
us case was received on 01 April 2009 from a healthY care professional.
0 A 5 month old male U patient received
4/1/2009
PENTACEL4/1/2009
(lot number C318
n has been received from a physician Y concerning a 24 year old female with allergies to tomatoes
N and pollen, migraine,
### rhinitis
### seasonal, de
Y concerning a 24 year old female who Y on 18-FEB-2009
N was2/18/2009
vaccinated2/18/2009
with her second dose
n has been received from a physician Y concerning a patient who was vaccinated with ROTATEQ Y (lot number not reported) oral. Subsequen
n has been received from a physician Y concerning
Y a 2-3 year old patient Y who was vaccinatedUwith ROTATEQ (lot number not reported) oral
Full clonic/tonic 1 hr 45 minutes after receiving Y routine immunizations 2 - Family describes today's
Y episode the 4/3/2009
same as4/3/2009
in the past (same sei
ays after vaccine. Hospitalized 1 week Y after with
Y erythema multiforme. 3 2 weeks after in ER with
N transient3/17/2009
synovitis and fever. Hospital recor
multiforme major possible KAWASAKI's Disease. Y 4/27/09 MR received 5 for DOS 3/24-28/2009
Y with D/C 3/16/2009
DX: Erythema3/18/2009
multiforme major s/
pasms started on the 3rd day after vaccinations
Y Yand progressed. Diagnosed
3 in January 2009,
U being treated
10/1/2008
with medications
10/4/2008(TOPAMAX, B
welling, induration + erythema at injection site - induration 4X5cm; erythema 12 X 8 1/2 cm with N some bruising
4/3/2009
onset at
4/4/2009
approximately 3hrs a
swelling, redness and pain at site 9 hrs after shot. Also vomiting. Patient called MD on 3/25/09Y regarding 3/20/2009
above instructed
3/20/2009 to take Ibuprofe
rs of vaccination, Pt developed "big knot" at the injection site, and the site turned blue. Heart Y rate became2/2/2009
elevated. 2/2/2009
She had bad headach
27-09 with c/o dizziness, pain, racing heartbeat & fever. (did not know how high). Too dizzy Yto stand up.3/26/2009
Person suggested
3/27/2009they go to urge
nto clinic after shots for immigration.Y She was given a Tdap and an MMR in left arm. Six days Y later she 3/20/2009
came back 3/26/2009
to clinic with a bruised a
a swelling and rash at site of VARIVAX. Y Y 4/7/2009 4/7/2009
eceived PC from Pt states LA started Y itching and swelling this weekend. Tdap was given on Y 1-28-09 states
1/28/2009
applied 3/14/2009
soaks to LA area. On 3/
w/ redness & warmth x 40 hours: then pain in arm radiating to shoulder/neck & elbow -> referred Y to physical
2/6/2009
therapy2/8/2009
on 4-3-09.
after receiving vaccine felt itchy, dry mouth, felt generally "bad" - low grade temp 99.1 - Following
Y day temp
2/10/2009
is PM 102
2/10/2009
degrees - TYLENOL
ed child had a tem up to 102 degrees within 24 hrs (off and on). Soreness, redness, and slight Y swelling to3/31/2009
area where4/1/2009
shot was given (L) Va
runcal pruritis (primarily B/L breasts). Sx occurred 24-48 hours s/p vaccine (GARDASIL) # TYand lasted9/23/2008
approx. 4 wks.
9/24/2008
Denies rash/ fever
ite - swollen, red, soreness, fever (at the injection site) left leg where DTAP + Polio were given.
U 3/16/2009 3/17/2009
ceived ANTRAX and Typhoid on 12 Mar 09. Smallpox on 19 Mar 2009. Patient found out thisY month that3/12/2009 she was pregnant when she recei
d with shingles along L4 - L5 distribution today. U 9/10/2008 3/31/2009
eddened, "hst to touch", swollen - takenY to Urgent care by Mom - 4-1-09 - Placed on KEFLEX Y po tid - arm
3/30/2009
resolved 4-30-09
4/1/2009
ight sweats 3/12/09 + 3/13/09. Y 3/12/2009 3/12/2009

h was red & swollen with some oozing coming from area between both shots. Redness wasYapprox. 14-16 3/27/2009
cm X 143/28/2009
cm. Child given BENA
erythema, swelling, heat, hardness possible cord. No vesicles. U 3/30/2009 4/1/2009
f 04-1-09 : "Restussness" Morning of 4-2-09: Hives U 4/1/2009 4/2/2009
d injection and by next morning felt Ypain/soreness to area of injection. 48 hours after injection
U Pt. noticed3/20/2009
a swelling3/21/2009
an redness starting two
advertently received BOOSTRIX instead of KINRIX. No adverse events were noted. MotherYwas notified 4/2/2009 of error
ately 5 minutes post injection, Pt experienced syncopal episode lasting 10 seconds. BP 90/62 Y at episode. 4/6/2009
After orientation
4/6/2009
X 3 was re- esta
d, hard area with streaking - Pt. dx. in
Y ER with cellulitis - Parent reported (L) deltoid Y 4/6/2009 4/7/2009
ht shoulder and right deltoid, red, swollen, hard and warm to touch. Denies pain or fever at thisU time. Began4/10/2009
4/11/094/11/2009
and continues today 4
X6 inch area of redness 2 days after Y VARIVAX. Augmentin 875 mg -125mg - 1 tab Q 12 X 10d. U 4/8/2009 4/10/2009
ped hives at the IPV site. Y U 4/7/2009 4/7/2009
veloped erythema & puritis of left upper
Y arm within hours of receiving injection there (10 inchYX 10 inch area
4/25/2008
of erythema
4/25/2008
& slight induration
action left shoulder - Swelling, pain, redness, fatigue started day after ADACEL administration - Tx MEDROL, 4/6/2009
Ibuprofen
4/7/2009
d, warm to touch, swollen size of tennis ball. Y 4/6/2009 4/7/2009
Pt received Td & Hep B on both L Delt. Pt. states she has marble size knot under skin @ site. Y 3/11/2009 3/17/2009
erythema R upper arm with vesicles. U 3/18/2009 3/31/2009
red w swelling. Ice packs (treatment). U
t itch, redness + swelling at vaccine site starting approximately 8 hours after administration associated
Y with
3/30/2009
moderate3/30/2009
headache persisting a
tarted with rash neck + chest 3/20 face, arm leg c/o itching - approx 45 U 3/3/2009 3/19/2009
al body aches, nausea, fatigue, elevated B/P and tachycardia, epistaxis; Serum sickness. Y 4/2/2007 4/2/2009
ter rec vaccine, welts developed onYRt neck, between breasts + underneath breasts, Rt + LtYouter arm proximal 4/11/2009 to elbows.
4/11/2009 C/o headache, r
s- erythema on right right arm with calor. There was no induration nor tenderness. Y 4/6/2009 4/6/2009
ash on face day following administration of GARDASIL. Also a cough. Y 3/20/2009 3/21/2009
eruptions treated with BENADRYL / CALAMINE Y 3/27/2009 4/5/2009
was reported by a healthcare professional and described the occurrence of vomiting in a 3-month-old
U (almost
3/4/2009
4 month 3/4/2009
old) female subject
was reported by a physician via a sales
Y representative and described the occurrence of rashNin a 4-month-old 4/1/2009
male subject
4/1/2009 who was vaccin
09 with small induration and some redness. Advised to put cold compress + should resolve in U a few day by 4/7/2009
doctor. 4/8/2009
h with erythema and swelling 8cmx4cm Y are of pinpoint induration for 2 days. U 4/7/2009 4/8/2009
ped 8cm X 4.5 cm warm, erythematous raised lesion on upper arm 2 days after receiving VARIVAX. Y Itchy.4/6/2009
No fever. 4/8/2009
ports a rash - itching - developed 2 days after vaccine given 3/18/2009 - Reports used Neosporin with success 3/18/2009
- Referred
3/20/2009to PMD or clinic f
acting different, restless, low grade fever, crying,
Y screaming with sucking,
2 poor appetite, restless
Y x 2 days.
3/30/2009
Onset 4/2/09.
4/2/2009Assessment: Pall
U age
4/1/1999
was reported by a lawyer and described the occurrence of arthralgias in a male subject of unspecified
U age
5/5/2000
99019267-1 describes joint and muscle pain inYa 58 year-old female0who received LYMERIX. N The vaccinee 6/1/1999
has no known allergies or med
ability 8 days after vaccination. Fever lasted 3 days and ranged from 100.3 to 104.2 1 episode U of vommitting 4/4/2009
on day 4/10/2009
3. Treated fever with
d 12 days ago with MMR. Had some arm soreness which has resolved. Then on Saturday Y 8 days after vaccine
3/5/2009 - he
3/15/2009
developed subjective
after receiving the 1st MMR vaccination
Y our daughter developed a fever (highest recorded was 101.3), had 4/3/2009
minor vomiting
4/12/2009 (4 episodes tota
CALLED COMPLAINING OF HEADACHE WHEICH STARTED APPROXIMATELY TWO DAYS AFTER RECEIVEING 4/6/2009 4/8/2009 ZOSTAVAX. tHE P
eported that son's developed arm blister, redness.local reaction 11 April 2009. Dr. made aware Y and advised 4/10/2009
pt to apply
4/11/2009
cold ice pack,and i
ollen area 1" to 2" wide per mom. Y 4/7/2009 4/8/2009
an oval shaped, bright red rash on Saturday morning. As of Monday morning it was resolving. Y Denied pain 4/1/2009
at site or 4/4/2009
itching.
ported child was not acting herself atYpreschool that morning, as reported by her teachers. Parent Y reported4/7/2009
paying special
4/8/2009attention for a po
icidal ideation, ever since vaccination was administered. This has continued to worsen. Before N being vaccinated,
3/25/2009 mental
3/26/2009 health was at the
VER FACE AND NECK APPROX HOURS AFTER VACCINATION WITH 1ST OF PRE-EXPOSURE Y SERIES
4/7/2009
RABIES 4/7/2009
PCEC VACCINE
d 4/8/09, The following day in the afternoon
Y the client came to office w/his father and an examination
Y of the
4/8/2009
arm was 4/9/2009
made. Red circular ar
s in fingers/hands/feet approximately 3 weeks post Y flu shot. Diagnosed30 with GBS. 4/27/09 Received
U hospital medical
### records
### of 11/24-12/1
tion given on 3/31/2009. Child had Y tactile fever for one day on 4/9/2009 with onset of generalized body rash 3/31/2009
which is4/9/2009
still present at time of
eved four vaccines on 4/2/09. The client
Y parentYrequested all vaccine4 be given in the same extremity
Y due 4/2/2009
to a previous4/4/2009
injury in the other ar
ES HE REC'D PNEUMOVAX ON 4/7/09 AND THAT EVENING HE HAD FEVER FOR TWO DAYS Y AND SEVERE
4/7/2009BODY 4/7/2009
ACHES. PT STAT
ld child received Hepatitis A # 1 at 6 months instead of 12 months, per standard, in error. In Y follow up with 3/16/2009
the parent, child has had no adv
ticed Saturday night 4/11/2009 a red, Y raised area on left deltoid. seen today 4/13/2009 PM Y in office with4/10/2009
4X4cm area 4/11/2009
with redness and mil
ry & Physical. This patient received a Pneumococcal Y vaccine probably
5 on 3-25-09 and we doY not know where. 3/25/2009
Patient
3/28/2009
came to agency on 3
ately 2" induration and redness of upper left arm where VARIVAX was given. Mom contactedYoffice and was 4/7/2009
given instructions
4/8/2009 to give BENA
on arm at shot site. It's there a month. Almost gone away. Y 3/13/2009 3/13/2009
perienced a short, 5 second seizure Ylike episode five minutes after receiving the following vaccines
Y (Meningococcal
4/6/2009 (Menactra)
4/6/2009 lot#, and PP
ceived vaccination on 4-8-09 & called Y pharmacy on 4-11-09 to report that the site of injectionYhad a egg shaped 4/8/2009 lump4/11/2009
that was red & itchy.
the site of injection; next day after immunization, Mupirocin oint TID x 7 days. U 4/7/2009 4/8/2009
given L arm on 4/9/09, Pt returns on 4/11 with Lt arm about 50 cents size red area with some U bruising on4/9/2009
upper aspect4/10/2009
at injection site, to f
ain and edema localized at injection site. Unable to lift arm, unable to touch arm or put pressure Y on arm or 3/27/2009
sleep on left
3/27/2009
side x 72hrs. Gener
09 employee came in to clinic reporting right arm where tdap was adminstired for the last week Y was red, swollen,and
4/1/2009 4/1/2009
painful at site of inject
ped erythrematous local swelling at injection site. Y 3/12/2009 3/13/2009
N 4/3/2009 4/12/2009
atigue for one week after vaccine administration. Seen in clinic on 04/14/09. Afebrile, WT 150#, Y BP 130/67. 4/9/2009
HEENT-negative,
4/10/2009 abdomen sof
ness, swelling around injection site. U 3/10/2007 3/16/2007
Y Y 3/30/2009 4/7/2009
sodes on day after receiving
Y vaccines
Y requiringYtransport to PEDS ICU. 7 05/04/09 - Hospital Umedical records3/16/2007
for 03/17/2007
3/17/2007 to 03/23/2007.
tarted after 12 weeks. 3/6/2007
Pt. developed red rash all over;itching;14x10 cm red macular rash at injection site on left leg;large
U erythemous
3/23/2007
patches
3/28/2007
on chest, back and
and hives at injection site within 30 minutes of vaccine administration. Y 6/6/2007 6/6/2007
09 pt. presented to the office with aYrash for 1 day.Exam reveiled approx. 100 vesicular lesions Y scattered6/19/2007
about, primarily
4/6/2009on the torso. Mild
ed, dizzy, especially when standing up, started within 30 min. of vaccination, lasted about 5 days Y 4/3/2009 4/3/2009
signs/symptoms approximately one hour following Tdap immunization. Patient experienced visual Y disturbances,
4/10/2009 including
4/10/2009blurry vision, Eup
D MD VISIT.2 DAYS S/P VACCINE ADMIN OF TDAP, PT SEEN FOR REDNESS/TENDERNESS, U GIVEN 4/8/2009
KEFLEX4/11/2009
RX.
call from mom @ 1:29 stating "my son got shots at Southside yesterday now he has a rash all over his body 4/13/2009
and a fever."
4/14/2009 Mom asked wha
re varicella (RA-SQ) became very reddened,Y tender and swollen to the size of a silver dollar.UParent was 4/2/2009
going to take
4/13/2009
child to MD for evalu
episode about 5-10 minutes after receiving Menactra and Gardasil in L arm and TDaP in R. Y 4/14/2009 4/14/2009
L OVER THE BODY 2 HOURS AFTER Y VACCINE ADMINISTRATION. U 3/19/2009 3/19/2009
NED PREGNANCY Y 3/20/2009 3/25/2009
C URTICARIAL RASH A FEW HOURS Y AFTER PREVNAR AND PEDIARIX VACCINES. U 3/20/2009 3/20/2009
ndurated area on left deltoid at site of Administration approx 4 X 4 inches. Associated pruritis Y 4/13/2009 4/14/2009
REFERS HAVING A RASH ALL OVER Y THE BODY AND A RED EYE. Y ### 12/2/2008
ation site reaction. 2 inch raised welt, red, warm to the touch, painful. Began 12-18 hours after Y vaccination,
3/13/2009
slowly resolved
3/14/2009 on its own over
d nausea and vomiting after leaving clinic. Resolved day following injection. Reported soreness Y at injection
12/3/2008
site. Red12/3/2008
skin discoloration 4 x
able crying for several hours continuously. Y 2/13/2009 2/13/2009
veloped Guillan Bare syndrome, 4 days after the Y vaccination. 4/22/09
20 Y MR received for DOSU10/29-11/17/2008### with D/C DX: ### Guillain-Barre
perienced 5-6 bouts of diarrhea within 10 months of vaccination. After she was about 18 moUthe bouts of diarrhea ### seemed ###
to stop. She wa
clinical trial report of allergic reaction with bronchospasm
Y has been received
2 from an investigator
Y concerning
3/24/2009
a 39-year-old
3/26/2009 male, (subject n
was reported by a physician via a sales representative and described the occurrence of hepatitis U A antibody negative3/1/2009
in an adult male subj
ness and swelling at the injection site. Took BENADRYL and used ice packs. Y 4/9/2009 4/10/2009
U 4/9/2009
iven in Left deltoid. Redness, swelling, warm to touch. Y 3/4/2009 3/4/2009
redness/swelling/tender 4 hours after Y injection. TYLENOL/BENADRYL/cool compress resolved in a hour 4/10/2009
after TYLENOL/BENADRYL
4/10/2009
@ 11:10 A on 4-13-09 and reports. " I think I have shingles" describes as dime size water blisters U to R arm
3/30/2009
and under4/9/2009
R arm, painful. C/O a
t, tender, swollen area right shoulder Y and fever. Seen 4/9 (2 days after) not on pain/fever meds.Y Pt returned 4/7/2009
for PPD reading so its not clea
recurrent area on face, Y 9/15/2006 4/10/2009
4-9-09 04-11-09 2/3 of upper thigh Yaround injection site - was red, swollen and child refusedYto walk. Was4/9/2009 not itchy.4/11/2009
Was given BENDARY
ash and slight numbness, no swelling of lips or tongues. Y 4/8/2009 4/9/2009
ed reaction on L thigh with warmth (no Y tenderness). Y 4/13/2009 4/14/2009
jection site (large lumps) itchiness all Y over body, headaches, could not lift arms, aches. U 4/9/2009 4/10/2009
rash & VARICELLA appearing rash. Y Y 4/8/2009 4/11/2009
h after receiving Rotavirus vaccine then went away and no distress. Y 4/8/2009 4/8/2009
lled 8 days after DTap was given in right thigh to c/o swollen, hot to touch area at site - unrelieved
Y by TYLENOL
4/7/2009 for age
4/7/2009
referred to PCP.
ter is 13 yrs old and has received the gardasil vaccine during which before receiving the 3rd vaccine I was notified that 4/1/2009
there would be som
dose, there was a very sharp, deep pain at injection site. When I went to leave office I felt dizzy, N nauseous, 2/18/2009
and vision
2/18/2009
started blurring and
tion at 2:33 pm on the date above, Rainbow began to experience, dizziness, fever, sore throat, N severe arm pain. Today, 4/10/2009
the next morning,
N 2/1/2008
N
4/3/2009 Y N 3/31/2009 3/31/2009
n has been received from a medical assistant concerning
Y a female who
0 on an unspecified date U was vaccinated with a dose of GARDASIL (
n has been received from a consumer concerning one of her cousins who was vaccinated with U MMR II. After receiving the vaccine, the pat
n has been received from a consumer concerning her husband's uncle who was vaccinated U with a dose of MMR II. The reporter stated that
n has been received from a physician Y concerning a 4 year old male who was vaccinated withY the second dose of MMR II "standard dose" (
n has been received from a consumer concerning a male patient who is a member of his wife's N family, who on an unspecified date was vac
n has been received from a medicalYassistant, Y for the Pregnancy Registry
0 for GARDASIL, concerning
U an 18 year old female ###with sulfa aller
U 4/9/2009
t office after getting 4 vaccines. She was standing at window to make another appt. She asked Y for water then
4/9/2009
had a syncopal
4/9/2009 episode with
len, warm, painful; he had fever lastY night) Cellulitis L lateral leg that developed 8 days afterNreceiving immunizations; it is immediately ove
ea of redness & induration at injection site. 4/8/2009 4/8/2009
ver- Sat morning (3/28/09) all at once Y (10am). Seizure from fever (102.9) (at 1:45PM). (HepYA given on3/19/20093/19/09) (MOTRIN
3/28/2009 given even tod
Y Y 3/30/2009 4/1/2009
ENADRYL Rash X 24 hours: StartedY 7 days after antibiotic/vaccine *Rash is worse on Right side (thigh) 3/27/2009 at injection site
4/6/2009
where MMR & VAR
me in for MD visit 4/8/2009, with complaint
Y of on and off neck pain. Patient and pt's mother U feels pain started
8/31/2007
after HPV9/1/2007
vaccines, HPV vac
reports fever ranging from 100 degrees F - 103 degrees F and vomiting starting 4/3/09 through Y 4/4/09. Also 4/3/2009
reports4/3/2009
body aches. No treat
d fever, high 103 degrees after IZS on 4/7/09. F/U in our office on 4/8/09 temp 100.9 taken TYLENOL. U Mom4/7/2009
states household
4/7/2009 sick.
ness & edema left deltoid within oneYwk injection. As redness & edema resolved pain radiated N to left shoulder
1/17/2009
neck right
2/1/2009
shoulder and down
ouch and little swelling LD. Y 4/6/2009 4/6/2009
e same day lasted 3 days. Throwing up two days after. Y 3/31/2009 3/31/2009
U 4/9/2009 4/9/2009
served rash arms, hands, face and Y neck woke developing a redness that I first thought was N sun burn. Over
3/31/2009
the course 4/3/2009
of the next two days
d shingles vaccine @ approx 9:30 am on 3/12/09. R arm. Pt called 3/17/09 @ 10:30 am to report Y R arm 3/12/2009
soreness and 3/12/2009
pain that wraps arou
ash red indurated 1 1/2 inch round red mildly tender area 1/2 inch above injections ; injectionYsite. 3/26/2009
2" duration, warm to touch, swelling. 4/6/2009 4/7/2009
om, he was drinking juice, dropped cup Y & became unresponsive with a blank stare. Eyes rolled Y backward 4/1/2009
& he became 4/4/2009
very stiff. He had b
t arm pain, fever, chills and palpitations lasting 24 hours. Y 4/8/2009 4/8/2009
& slight swelling posterior Rt upper arm Y 3/31/2009 4/1/2009
fever the evening of the immunizations Y admitted abdominal pain. As of 4/7/09, she had had Uthe fever 6 days. 4/2/2009 4/2/2009
ame very pale, lightheaded and felt like she was going to faint. Child was also slightly diaphoretic.Y Had child
4/3/2009
lay down4/3/2009
and gave water.
multiform - treatment 5 days oral steroids
Y 1/2 tsp one daily Y 3/12/2009 3/20/2009
ccine administered to child instead of varicella. No adverse symptoms noted at this time. Vaccine Y was administered
4/15/2009 4/15/2009
4/15/2009 at 10:45 am
ted Left upper arm was swollen, red, Y and warm to the touch 24 hours after shots received. Child
U saw Dr 4/13/2009
4-15-09. Nurse4/14/2009
noted redness and
noted dime size erythemia at SQ injection site of the Varicella vaccine on Left upper arm. OnY04/09/09 at 1215, 4/8/2009 area 4/8/2009
measured 4 x 3 cm an
esented to the emergency room 6 hours Y after shots with febrile seizures. Repeat episode of Yfebrile seizure4/8/2009
24 hours after
4/8/2009
first episode.
er, joint aches Right shoulder very swollen
Y and painful Y 4/3/2009 4/3/2009
-hour of Pentacel injection,
Y patient returned
Y to office inconsolable, copious thick secretions, Y
trouble breathing,
4/3/2009
worsening
4/3/2009
of his eczema. ga
9 mother reported child had seizureY1 hr after arriving home from getting vaccines on 12/16/08. U Skin was "very### hot." Child ###
was taken to loca
lled our office to inform us that she Y had "pumps all over her body and they itch really bad." SheY states that4/14/2009
she woke4/15/2009
up with the pump and
temperature 103.2 F U 4/14/2009 4/15/2009
REA DIRECTLY OVER LEFT DELTOID MUSCLE WHERE VACCINE GIVEN WAS BLISTERED, Y OPEN 4/13/2009
AND OOZING. 4/14/2009
LARGE SURROU
HEA SINCE DECEMBER '08. PREGNANCY TEST NEG. MOTHER REPORTS NEVER HAD N A PROBLEM 1/8/2009
BEFORE 1/20/2009
GETTING THE GARD
n a shot of PPV Pneumococcal Polysaccharide. Reaction: Runny nose, severe Arm Pain, fever U 99.2 next day from shot, temp 102 second
with severe pain yesterday at right upper Y arm injection site. Mom called nurse and discussed. Temp 100.4/13/2009
Redness and 4/15/2009
tight area as big as
ne shot on 4/13, 99.4 fever on 4/14, fever of 102 4/15, Stuffed up nose, cough, breathing impacted. U Muscle
4/13/2009
ache, sever
4/14/2009
are pain after shot
3 days after recieving 1st Gardasil dose in LD, she developed a red, dry, itchy skin rash to leftY arm, shoulder 1/20/2009
to knuckles.
1/22/2009
Also present on kn
post-vaccination with JE-VAX, client's arm was swollen, red, and itchy from elbow to shoulderYand felt hard4/6/2009 to the touch.
4/7/2009
Topical benadryl du
was reported by a healthcare professional and described the occurrence of brainYstroke in aN62-year-old1/12/2009male subject 2/1/2009
who was vaccinated
rash + bruising + oral bleeding 4/10. 4/11 ER - Ytransferred to hospital. 3 IVIG + Prednisone forUthrombocytopenic
3/26/2009 purpura.
4/10/2009
4/21 Link w/3442
01-102. (R) arm erythema and severe Y pain outYof proportion to exam 2 - R/O invasive strep. 4/27/09
Y Received
1/4/2008
hospital1/4/2008
medical records of 1/
p requiring prolonged IVYantibiotics and surgery. Y 5/4/09 Received 14 hospital medical records of
Y 11/11/-11/25/20007.
11/9/2007 11/9/2007
FINAL DX: left hip septi
ed vaccine 3/31/09. Presented with vomiting, lethargy Y on 4/14/09. Required
4 surgery for Intussusception.
Y 3/31/2009
5/14/09 hospital
4/13/2009
discharge summa
04 - Patient received FLU, DTAP, COMVAX, MMR & PNEUM. conj after this did Y not talk, quiet,
N sick, tired, fever### (HOT) 3-4###d. ibu. given did
mitted to hospital for a bowel obstruction on 3-29-08.
Y On 3/29/09 Lap6 appendectomy performed.Y Pt had RUQ
3/2/2009
intussusception
3/27/2009 reduced usin
ly raised sand paper type rash Right cheek, itching. Y 4/8/2009 4/11/2009
red raised itching welts periorbital, both eyes, raised red itching pustules back of both hands. Y Began 3 days 4/6/2009
after vaccine,
4/9/2009presented to clin
rm cellulitis at injection site. Y Y ###
rm cellulitis at injection site. Y Y ### 11/1/2008
und neck, hairline and bilateral ears. Y 4/10/2009 4/14/2009
tous rash, swelling of hands, fever <Y104 X 6 days with negative labs, whelps/wheals 3/31/2009 4/3/2009
nny yellow diarrhea stools every 3-4 hrs. No vomiting. No fever. No URI symptoms. SomeNdecreased appetite 4/1/2009 X2d. Tried pedialyte: diar
had not eaten. Y 4/13/2009 4/13/2009
ceived vaccination. 3/30/09 developed rash along jaw bone on face worse on L then on R - U rash at base3/25/2009
of throat down
3/30/2009
midline shape trian
mother called office approximately after Y leaving clinic stating patient had broken out in a rash.NMother was4/13/2009
instructed4/13/2009
to bring patient back in
there was a 4" circle at injection site 48 hrs after received the vaccine, it was hard, itchy andYwarm to touch.
4/11/2009
The rash4/13/2009
spread pass elbow 9
mild - mod fever, nausea, severe pain Y at injection site evening of 3/16/09. Onset of itching + mild
Y rash over 3/16/2009
body 3/17/2009.
3/17/2009
with swelling to R deltoid. Y 4/10/2009 4/11/2009
ith fever T 103.8. Y Y 4/13/2009 4/15/2009
hed chart note dated 4-15-09 Patient Y presents today for evaluation of reaction to VARICELLA Y vaccine given
4/13/2009
2 days4/14/2009
ago. Red swollen and
e, fever muscle weakness. Y Y 4/9/2009 4/10/2009
n back and on face. U 4/1/2009
+4 HOURS AFTER WE NOTICED THE RIGHT LEG OF OUR BABY REALLY RED (AROUND U WHERE 4/15/2009
THE VACCINS 4/15/2009
WERE DONE). AB
n has been received from a registered Y nurse, for the Pregnancy Registry for GARDASIL, concerningY a 19 year old female
1/27/2009who on 21-AUG-
and no2/16/2009
known drug allergies/d
us case was received on 01 April 2008 Y from a health care professional. A 37 year old femaleUpatient with a history ### of2/28/2008
asthma, high blood pr
E report received on 04 April 2009. This subjectYis a female infant with 2 no family history of seizures
N experienced
8/28/2003febrile
8/29/2003
seizures while enrolle
ness, swelling, fever(101), headache, tiredness, chills, body aches, sore joints, 3" hard massUat injection site, 4/13/2009
sugar spiked
4/14/2009
to 286 (norm has
ED LUMP WITH BLISTER L POSTERIOR Y UPPER ARM QUARTER SIZE DIAMETER. PAINFUL U TO TOUCH.4/2/2009
3 SMALL4/15/2009
BLISTERS AT L E
eported blank stare and unrespoonsive after vaccine, lasting for 30 seconds. Parents never Y sought medical1/14/2009
attention 1/14/2009
after episode.
l pain, irritation, swelling, and decreased
Y range of motion within 30 min. of the injection to theUleft arm. Within
4/14/2009
4 hours 4/15/2009
all of that pain radiate
lar arthritis within 3days of vaccine administration.Y Infant was admitted 3 with lab samples taken Y from CSF,3/19/2009
blood and3/21/2009
urine. He was given pa
pain from Lt shoulder eight hours after Y receiving the tdap boost in the Lt Deltoid muscle. Client U was seen3/30/2009
by her Pvt3/30/2009
MD and dx with tendon
ed his vaccination on Monday April 13 Y around noon
Y time. A fever began
2 within 6- 8 hours after U shots (102.54/13/2009
F), sleepy 4/13/2009
and very irritable thro
orts that 3 weeks after receiving Hepatitis B vaccine #1 she developed lymphedema extending U from her left3/4/2009
neck to 3/25/2009
hip, noticed her left hip
er arm swelling, edema and pain. Event occurred within 24 hours of vaccination and resolving Y by 72 hours. 4/7/2009
Treated 4/8/2009
symptomatically with i
A, Stiff Neck Temp 100 Y 4/2/2009 4/3/2009
1 minute after administering DTaP, Hep A and Hep B vaccines the patient had stiffening of his Y entire body 4/16/2009
with laryngospasm
4/16/2009 which lasted
Anemia, low red and white Y blood cellsY NO FEVER...seizure
Y disorder,8 anemia
Y neutropenia .. checked
U for 3/13/2009
childhood disease
3/23/2009and disorders...
ter vaccination, became overwhelmed with unexplained exhaustion. Had to go to sleep and Y slept for 12 hours
4/15/2009
straight.
4/15/2009
Also next morning h
OTARIX AT 6 MONTHS OF AGE U 4/10/2009 4/10/2009
HAD A REACTION ON LEFT POSTERIOR THIGH WHERE VARICELLA VACCINE WAS GIVEN.PATIENT U 4/15/2009
HAS A 4/15/2009
RAISED REDENED AR
ven in left thigh, brought back by mom Y two days later with swelling from top of thigh down toYthe knee. Advised4/14/2009warm 4/14/2009
soaks three times dai
ED REACTION ON (R)UPPER DELTOID AREA PATIENT DENIES ANY DEVER, NO MALAISE; U REPORTS 4/8/2009
SORE ITCHING
4/8/2009 THAN PAIN.
ot appeared on infant's right thigh after her shots at 6 month old well check up on 1/29/09. Staff U became 1/29/2009
aware of incident on 3/03/09. DTaP
ERYTHEMA, PRURITIS, SWELLING OF ARM Y 3/17/2009 3/17/2009
st vaccination, patient had eruption Y of hives and developed extreme fatigue, arm and leg pain, U and muscle 3/12/2009
weakness, 3/15/2009
severe enough that s
swollen size of dollar bill" 7x11 cm raised erythematous plaque on L anterior thigh. N 4/13/2009 4/14/2009
aised erythematous plaque at vaccination site in R arm after 24 hrs. Y 4/6/2009 4/8/2009
, headache, malaise during night time Y fever prolonged dream state grogginess. Resolved byYnext morning 4/14/2009
4/15/2009. 4/14/2009
X given R thigh 4-1-09 per mom. Pt developed fever and "shakes" that same evening - she called 911 - fever decreased 4/1/2009
to 98 - mom called
as given the GARDASIL # 1 vaccination Y in her right deltoid muscle. Pt. was advice to sit for theY injection but
4/16/2009
refused.4/16/2009
Very shortly after the
d office 4/16/09 0900 to report a baseball sized, red, itchy but not raised area at left upper arm Y at injection4/14/2009
site; no respiratory
4/15/2009 involvement,
ted to PCP 1 wk after she received Y MMR and VARIVAX in R deltoid with 3-4 cm abscess. U 3/31/2009 4/4/2009
nny nose, itching started evening of Y 4-3-09 along with start of rash. Diagnosed with chicken pox Y on 4-6-094/2/2009
by family physician
4/3/2009 Rash mainly
ation of ZOSTAVAX 4-7-09, development of vesiculated, burning, itching lesions of back 4-11-09 U 4/7/2009 4/10/2009
FLUZONE vaccine on 9/16/08. November (date unknown) patient developed abdominal cramps Y & vaginal
9/16/2008
bleeding. 11/1/2008
OB/GYN evaluation r
vaccine: Headache, neck and shoulder pain at noon - chills at temp 101.7 at 1:00 o'clock associated Y to stomach
4/1/2009 discomfort.
4/1/2009 No chest pain
ea of redness - right thigh cellulitis likely reaction to vaccine. Y 3/23/2009 3/25/2009
ccines were given at about 9:30am, pt woke from nap about 3pm with multiple large urticaria Yover back, lower 4/15/2009
extremities
4/15/2009
and abdomen (no
d rash on forearms 7 days after receiving ZOSTAVAX. Y 3/24/2009 3/31/2009
iving shot in AM of 4-7-09 pt c/o shortness of breath in the afternoon at home with mother - *Nurse Y informed
4/7/2009
mom to 4/7/2009
watch patient closely f
ZOSTAVAX 1500 on 4/8/09, morning of 4/10 pt awoke with hard, hot, red, itchy lump at injection Y site about
4/8/2009
the size4/10/2009
of a small egg. Pt calle
cines 4/15 - 4/16 awoke with L arm swollen, slightly tender no erythema no fever. Y 4/15/2009 4/16/2009
-stop for at least an hour. Le were red/swollen no special rx given but pt given TYLENOL in office & advised 4/16/2009
to ice X 4/16/2009
24 hours
erythema, warmth & induration at vaccine site area involved 12 1/2 cm X 12 cm in size. Received Y 2 vaccines
4/15/2009
in left 4/15/2009
deltoid HEP A #2 - MEN
h hot, swollen and red at injection site.Y Y 4/13/2009 4/14/2009
n, slight shortness of breath. Amnesia during and half an hour after receiving vaccination. "Almost" Y passed
4/15/2009
out during4/15/2009
vaccination. Flu like
n has been received from a consumer concerning her first 6 year old child who was vaccinated N with his first dose of MMR II. Subsequently
n has been received from an 18 year old female with migraine and no allergies for GARDASIL, Y a Pregnancy 4/1/2007
Registry4/1/2007
product, who in Febru
n has been received from an office Y staff member Y concerning a patient 0 who on unspecified dates
U was vaccinated with all three doses of RO
rated local reaction. U 4/13/2009 4/15/2009
al reaction 10-12 cm, with pain, mildYpruritis. U 4/13/2009 4/14/2009
rning after vaccine T max 103.1. Y Y 4/13/2009 4/14/2009
a DTAP on 4/09/09. Benefits and risks explained - VIS info given. Mom noted fever at 11 PM U 4-9/09, redness4/9/2009
at site4/10/2009
of injection noted in th
ad GARDASIL #2 at approx. 4:15 pm. Y Took CLARITIN in AM for allergies. Also takes CONCERTA Y and ORTHO
3/20/2009 TRICYCLEN low dose. Use
ute onset of severe vomiting and dizziness. Lasted into next day. Also began to have leg pain Y & perceived 3/17/2009
weakness, 3/17/2009
tingling. The leg sy
Pox with HX of one dose of VARIVAX. U ### 4/13/2009
4/13/2009
ning arm soreness + swelling - ice applied
Y 4/2/09 arm increased soreness, increased swelling, Y warmth, elevated
4/1/2009temp 4/1/2009
+ not feeling well. To
e, bodyache, some nausea. 4/10/09. Advised TYLENOL 500 mg 2 tabs P.O. Q6 PRN. U 4/9/2009 4/10/2009
eg starting swelling right after immunizations were received. Y 3/24/2009 3/24/2009
tomach, chest, genitals U 4/6/2009
swollen, red, and hot to the touch. YPatients arm also had a tight knot under skin. Dr. advised U on 4-11-094/9/2009
that patient4/9/2009
should take BENADR
ed to me by ER physician:] After shots, Y went home, took nap about 1 hrs. Went awake, cried U inconsolably. 4/8/2009
Then had 4/8/2009
stiffening, jerking, &
vomit, diarrhea, stomach pain. 04/10/09 Y fever (104.7) rash. No GI symptoms except anorexia. U 04/11/09 varicella
4/1/2009 - like4/9/2009
rash.
veloped chills overnight after getting the vaccine. Site of injection was Y swollen and red. OnYMarch 29th,3/26/2009
the swelling 3/27/2009
and redness extende
l from parent on 4/15/09 @ 10:15am. She reports child's left arm/shoulder is swollen aroundUinjection site. 4/14/2009
Area, red4/15/2009
per report. Mom states
ue, headaches, muscle cramps, muscle pain, sound sensitivityafter 1st shot. Increased Y in severity
N of all 7/12/2007
symptons. After 9/26/2007
3 rd shot signfican
/2009, PT BROKE OUT ON FACE AND Y FOREHEAD
Y WITH BLISTERS. 2 WAS DIAGNOSED N WITH HUTCHINSON
2/27/2009 VARIATION
4/12/2009 OF FACIAL
nt received the Zostavax vaccine on 4/3/2009. About 2 days after the injection she noticed a Ybig, red, swollen 4/3/2009
area on4/5/2009
her upper arm. She r
nt received the Zostavax vaccine on 4/10/2009. After administration of the vaccine, she reported Y a dollar4/10/2009
size red wheel 4/10/2009
around the injection
pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 5 2/19/2009 with COPD Y exacerbation. 11/7/2007
Vaccination 2/15/2009
ted redness and swelling of Lt arm increasing
Y 24 hrs after injection. Increasing at 48hours. NoU fever. Marked4/15/2009
erythema 4/16/2009
and induration of Lt
d immunizations and about 5 minutes Y afterwards the school nurse brought pt in to where shots Y were being 4/16/2009
given stating
4/16/2009
that pt was having
sized erythema to left thigh . 8 cm raised wheal, old compress was applied for 30 minutes and Y Benadryl 3/26/2009
1tsp given 3/27/2009
po .
veloped red "Rash" according to mother on top of both legs on 4/13/2009 and was taken to U doctor on 4/16/2009
4/8/2009 4/13/2009
Tdap vaccination on 4/13/09 in upper left arm. Injection site is still painful on 4/17/09, but real U issue is pain4/13/2009
caused by 4/15/2009
two pea sized nodule
ed I large area around the injection that was fire red and hot to the touch. It was welped up rasied. U About4/15/2009
the size of 4/16/2009
1/2 dollar or little larger
and swelling at injection site, by 4/13/09
Y fever of 102, sweats and chills, swelling in jaw, swelling
U in R arm 4/9/2009
and joints,4/13/2009
significant drooling, ten
adache ,feels warm ,no feverheadache improving headache ,not weak ,no numbness U 4/16/2009 4/17/2009
d some redness appear at the site of the injection >24 hours after recieving the vaccine. Not U raised, slightly
4/14/2009
warm, 4/16/2009
not hard and not itchy.
immunizations fine Given four on 4/14/2009.
Y Next day 4/15 some tenderness and on 4/16/09 Y noted sweling4/14/2009
left deltoid
4/16/2009
down to elbow with
ARM SWOLLEN AND WARM TO TOUCH. APPRX THE SIZE OF AN ORANGE. PT DENIES U INCREASED 4/16/2009
PAIN. 4/17/2009
NO FEVER. PT FEELS
eption 4/29/09 ReceivedYhospital medicalY records
Y of 4/13-4/15/2009. 2 FINAL DX: Intussusception,
Y enema2/17/2009
reduced Records
4/12/2009 reveal patient e
red and swollen and vomiting / 4th time this lot # has been reported Y 4/16/2009 4/17/2009
mmer of 2008, patient had Y many episodes
Y of anxiety which she never had before, she also isUmore easily confused; ### 6/1/2008 9/30/08 Dr
d with Pneumovax on 3/31/2009. Called office Y on 4/1/2009 stating arm1 was red. sore and hot Y to touch. Advised
3/31/2009 to come4/1/2009
in that day. Came
hot swelling at injection site with pustules inside the swollen area on the first day of the injection.
U Then outbreak
3/30/2009of3/30/2009
pustules scattered over
RTS LOCALIZED (R) UPPER ARM PAIN EVENING OF 4-16-2009. REDNESS, SWELLINGUAND TENDERNESS 4/15/2009 TO 4/16/2009
TOUCH NOTED 4/7
on left arm (arm of injection). Appeared 3 days after vaccine administration. Was very red and U itchy however4/13/2009
not quite
4/16/2009
so bad today. Spec
dness and tenderness 6x13cm. Seen Y on 4/17/09, Cephalexin 500 mg PO given. Pt to f/u withUprovider next 4/14/2009
week. 4/16/2009
ea around injection site tender, red Y and warm. No streaking or adenopathy U 4/14/2009 4/17/2009
d = 4x5 cm area of erythema with subcutaneous
Y induration at site of Tdap injection; no fluctuance; tender 4/13/2009
to palpation;4/15/2009
no streaking; no ade
vomiting, lethargic, breathing difficulties,
Y sunkenY eyes, listless. Baby 1 was brought to hospital,
Y they then transferred
12/5/2008 12/6/2008
her by ambulance to an
tous, warm 7X7 cm. induration left lateral thigh. Y 4/15/2009 4/16/2009
hema + induration 3X2 cm on L - Deltoid arm. Complained L-arm pain. Plan warm compression. U 4/14/2009 4/14/2009
unization was given pt went to the waiting where she stated she was "feeling like she is going Y to throw up". 3/6/2009
Pt was given3/6/2009
.30 Epi pen in left
reaction right upper arm + edema + red. No complaint of tenderness. Treated with BENADRYL Y & TYLENOL.
4/16/2009 4/17/2009
Y 4/9/2009
cines 4/15 - 4/16 awoke with L arm swollen, slightly tender no erythema no fever. Y 4/15/2009 4/16/2009
er followed by generalized seizure - Requiring intubation. 3 seizures back to back. Y
called on 4/16/09 & said 4/15/09 pt had red welt size nickel at inj site and then on 4/16 was size
Y of a quarter.4/2/2009
Pts mom4/15/2009
will give benedryl &
arted on GARDASIL series 5/15/2007- 2nd given 7/16/2007. Mom noticed in fall of 2007 thatNabsence type 5/15/2007
seizures began.
n has been received through the Merck pregnancy registry from a Physician's Assistant concerningN a female
1/22/2008
who is1/22/2008
social alcohol drinker a
n has been received via the Merck pregnancy
Y registry, from a registered nurse, concerning aY 15 year old 3/3/2008
female patient,
3/3/2008
who on 03-MAR-2
n and follow up information have been
Y received from a nurse practitioner for the Pregnancy Y Registry for 2/15/2008
GARDASIL2/15/2008
concerning 23 year old
n has been received from a certifiedYmedical assistant concerning a 16 year old female whoYon 27-FEB-2008 2/27/2008
was vaccinated
2/27/2008 with her first
n has been received through the Merck pregnancy registry, for GARDASIL, concerning a 14Yyear old female 4/7/2008
patient with
4/7/2008
attention deficit di
n has been received from a certified medical assistant for the Pregnancy Registry for GARDASIL Y concerning
3/26/2008
a female
4/18/2008
who on 26-MAR-200
n has been received from a medical assistant for the pregnancy registry for GARDASIL concerning Y an 18 year### old female ###with no known al
follow-up information has been received from a nurse practitioner concerning her daughter aY14 year old female with scoliosis and no previ
n has been received for the pregnancy registry for GARDASIL from a nurse practitioner concerningY a 213/11/2008
year old female
6/2/2008
with no pertinent
Y from a pediatrician, a physician and a registered nurse
Y for the pregnancy
4/21/2008 registry
11/5/2008 for GARDASIL c
n has been received from a certified nurse midwife, for the Pregnancy Registry for GARDASIL, Y concerning 6/3/2008
a 17 year6/3/2008
old female with asthm
Y nurse (R.N.) for the pregnancy registry for GARDASILU concerning1/22/2009a female patient ### who on an unspe
n has been received from a nurse concerning a 9 year old female patient with a history of migraine
Y headaches
2/24/2009and 2/24/2009
no known drug allergies
n has been received from a radiologist reported that a gastroenterologist said he had some patients
U experience stomach pain after receivin
n has been received from a consumer concerning her daughter an 18 year old female with allergy N to (unspecified
2/23/2009medication)
3/6/2009 who on 23-F
Y concerning a 27 year old female with allergy toN thimerosal and no medical 3/9/2009
history who on an
n has been received from a physician concerning Y a young adult female 7 who was vaccinatedYwith the first dose of GARDASIL (lot number n
n has been received from a nurse concerning a 25 year old female who on 20-MAR-2009 was U vaccinated 3/20/2009
with GARDASIL
3/20/2009 (lot number 659
n has been received from a physicianY concerning a 23 year old female patient with no pertinent Y medical history
8/8/2008and no8/8/2008
known drug allergie
n has been received from a 21 year old female with hypersensitivity to yeast who on 3-MAR-2009 N was vaccinated
3/3/2009 with
3/17/2009
n has been received from a physician concerning a 14 year old female who on 27-MAR-2009 U was vaccinated
3/27/2009
with a first dose of GARDASI
n has been received from a physician assistant concerning a "teenager" female who was vaccinatedU with GARDASIL 0.5 ml. After getting G
n has been received from an employee at a physician's office concerning a couple of patients U who was vaccinated with GARDASIL. The pa
n has been received from an office administrator concerning a 19 year old female who on 12-JAN-2009
U 3/18/2009
and 18-MAR-2009
n has been received from a physician concerning his 22 year old daughter who on Y 12-Mar-2009
Y was vaccinated
3/12/2009 with
3/12/2009
her first dose of GARD
n has been received from a RN concerning
Y a 15 year old female patient who on approximately N 16-MAR-20093/16/2009
was vaccinated
3/16/2009 with the first
n has been received from a physician concerning a 15 year old female who on 06-MAR-2009
Y U was vaccinated
3/6/2009
with GARDASIL
3/6/2009 IM 0.5ml. C
n has been received from a physician concerning a female who was vaccinated with the second U dose of GARDASIL (Lot not reported). Sub
n has been received from an office Y nurse concerning
Y a female who12on an unknown date, was U vaccinated with the###third
4/28/2008
dose of GARDASIL
n has been received from a physicianY concerning a female who in 2008, "within the past year", Y was vaccinated with a dose of GARDASIL (
Y Nurse concerning
Y a female patient who was vaccinated
U with a dose of GARDASIL (Lot # not report
n has been received from a physician concerning a 16 year old female who was Y vaccinated N
intramuscularly with a 0.5 ml dose of GARDAS
n has been received from a physician concerning a 17 year old female who was vaccinated Y with the second dose of GARDASIL (Lot # not
Y an 18 year old female who on 20-JAN-2009 was Y vaccinated 1/20/2009
with her 1/22/2009
first dose of GARDASIL
n has been received from a consumer concerning her 18 year old daughter with Nail-patellaUsyndrome who 2/23/2009
in 20082/23/2009
was vaccinated with th
n has been received for the pregnancy registry for GARDASIL from a certified medical assistant U concerning 1/23/2009
a 15 year
1/23/2009
Y a female who on an unspecified date was vaccinated
U with the second dose of GARDASIL. Th
n has been received from a certified medical assistant concerning her 17 year old female friend N with no pertinent medical history who in 20
n has been received from a registered nurse concerning a 22 year old female with pertinent N medical history3/9/2009
or drug allergies/reactions who
n has been received from a nurse practitioner concerning an approximately 20 year old female Y with no relevant
3/11/2009 medical
3/12/2009
history, no relevan
n has been received from a licensed Y visiting nurse concerning a 13 year old female patient whoY on 16-JUL-2007
3/13/2009was vaccinated
### with the fi
Y concerning a 16 year old female with not sexually
Y active and a history
### 1/1/2009
of meningitis as a bab
N with complete GARDASIL
2/13/2009 series. On 1
n hs been received from a physician concerning a female patient who was on unspecified dates U was vaccinated with1/1/2008 0.5 ml doses of GARD
Y a female who patient who on an unspecified date Y was vaccinated IM with her second 0.5 ml
n has been received from a consumer concerning her daughter, a 11 year old female patient, N with no known drug allergies, joint pain and p
n has been received from a licensed Y practical nurse concerning an 18 year old female patient N with no pertinent
3/5/2009
medical
3/6/2009
history and no know
Y (N.P.) concerning a 49 year old female with hypothyroidism
N 3/2/2009
and gastroesophageal
3/2/2009 reflux dise
n has been received from a registered nurse concerning her daughter with eczema and allergies N who in June3/9/2009
2008 was
3/9/2009
vaccinated with the
Y nurse for the pregnancy registry for GARDASIL concerning U a 23 year
1/21/2009
old female with ###asthma and no
Y Nurse (R.N) concerning her 16 year old daughter with N juvenile rheumatoid
11/1/2008 arthritis,### and allergies to
n has been received from a consumer concerning her 22 year old niece who on approximately N 24-FEB-2009 2/24/2009
was vaccinated with a dose o
n has been received from a registered nurse concerning a female patient who was vaccinated Y with her second dose of GARDSIL (lot # not
n has been received from a registered nurse concerning a 19 year old female with no pertinent Y medical history
11/1/2008or drug
11/1/2008
reactions/allergies w
n has been received from a female who in June 2008 and August 2008 was vaccinated withYher first and 6/1/2008 second dose 6/1/2008
of GARDASIL (lot nu
Y concerning a female patient who on unspecified N dates in 2007 was vaccinated with the first t
n has been received from a physician concerning a 14 year old female patient who in approximately
Y September
9/1/20082008,9/1/2008
"4-6 months ago" fro
n has been received from a physician concerning an approximately 12 year old female who N on approximately3/6/2009
6-MAR-2009,
3/6/2009 "about a week
n has been received from a physicianY concerning a "16 years old" female who was vaccinated U with a third 0.5 ml dose of GARDASIL (lot #
n has been received from a consumer concerning her daughter, a 14 year old female with a Nhistory of mononucleosis
3/1/2008 3/1/2008
and no drug reaction
n has been received from an 18 year old female with no known drug allergies/reactions and U no pertinent medical history reported who on a
Y worker concerning a 21 year old female with no medical N history and 3/11/2009
drug allergies
3/13/2009
who on 11-MAR-
n has been received from a physician concerning a female with latex allergy who was vaccinated U with a dose of GARDASIL, IM, 0.5ml. Sub
n has been received from a consumer Y concerning her 15 year old daughter with allergies to N penicillin and1/26/2009
other antibiotic
1/26/2009
and no pertinent m
n has been received from a nurse practitioner (N.P.) concerning a 24 year old female who on Y 16-MAR-2009 3/16/2009
was vaccinated
3/16/2009with a 0.5 ml d
Y a female who was vaccinated intramuscularly N with the second
3/17/2009
0.5 ml 3/17/2009
dose of GARDASIL on
n has been received from a 23 year old female with allergy to anything in the "cillin family" and
N a history 11/5/2008
of cesarean2/16/2009
section and tuberculos
n has been received from a certified medical assistant concerning a patient who in 2007 wasNvaccinated with a dose of GARDASIL. In 2009
n has been received from a healthcare worker concerning a female who experienced groin pain U and a lump in her groin after receiving a do
Y nurse concerning her daughter, an 11 year old femaleY patient with no pertinent### medical
### history and n
n has been received from a physicianY concerning a female patient with a history of urinary tract
U infection who 3/1/2009
in the last couple of weeks wa
n has been received from a physicianY concerning a female patient who on an unknown dateUwas vaccinated with the first dose of GARDAS
n has been received from a certifiedYmedical assistant, for the GARDASIL a Pregnancy Registry, U concerning2/2/2009
a 14 year2/2/2009
old female patient w
n has been received from an emergency
Y medical technician concerning a 15 year old femaleY with asthma who was vaccinated9/1/2008 with the com
n has been received from a physicianY concerning a registered nurse who was vaccinated with U her first dose of GARDASIL. 6 weeks after h
n has been received from a nurse practitioner concerning a 15 year old female patient with no U pertinent 3/17/2009
medical history
3/17/2009
and no known drug
n has been received from a physician concerning a female patient who was vaccinated with Ythe first 0.5 ml dose of 11/6/2007
GARDASIL. Subsequen
n has been received from a registered nurse concerning an 11 year old female with no pertinent Y medical3/11/2009
history or drug
3/11/2009
reactions or allergi
n has been received from a physicianY (OB/GYN) concerning a 21 year old female patient who U on an unspecified date was vaccinated with
n has been received from a physicianY concerning a 16 year old female patient with no known Y drug allergies
1/19/2009
who on1/19/2009
19-JAN-2009 was vacc
n has been received from a physicianY concerning a 24 year old female with no relevant medical Y history or 3/12/2009
drug allergy
3/12/2009
who was vaccinated
n has been received from a registered nurse concerning a 23 year old female with Graves' disease,
Y latex allergy
###and poppy ###seeds allergy w
n has been received from a registered nurse concerning a patient who on unspecified datesUwas vaccinated with the first and second dose
Y nurse concerning a female student in her twenties who U on an unspecified date was vaccinated with
n has been received from a nurse practitioner concerning an 18 year old female patient withYseveral bug7/16/2008
bites who on 7/16/2008
18-MAR-2008 was v
n has been received from a medicalYassistant concerning a female patient who on unspecified Y dates was vaccinated with the first and seco
n has been received from a consumer concerning her daughter, who on 20-JAN-2009 was vaccinated U with
1/20/2009
her first 1/20/2009
dose of GARDASIL. Co
n has been received from a 19 yearYold female patient with no pertinent medical history whoNa few months ago### received
3/18/2009
n has been received from a medicalYassistant concerning a 23 year old female patient with no N pertinent medical history 3/20/2009
and no known drug
n has been received from a registered nurse concerning an 11-18 year old female who was U vaccinated with her first dose of GARDASIL (lo
n has been received from a health professional concerning a female patient between 11-18 U years who on an unspecified date was vaccina
n has been received from a nurse practitioner concerning a female with a history of tension headache
Y who was vaccinated
3/16/2009 with the third 0.
n has been received from a health department nurse concerning a patient who on 04-MAR-2009 U was vaccinated
3/4/2009with3/4/2009
a dose of GARDASIL
n has been received from a registered nurse, for GARDASIL, a Pregnancy Registry product,Uconcerning1/12/2009 a 20 year old1/12/2009
female with no know
n has been received from a physician assistant concerning a 16 year old female on 20-MAR-2009 U was vaccinated
3/20/2009 with3/21/2009
n has been received from a physician concerning a 20 year old female with a history of human Y papillomavirus
2/19/2009
high risk. On 11-FEB-2009, t
n has been received from a certified medical assistant concerning a 21 year old female with N dysmenorrhea 9/23/2008
and no known
11/1/2008 drug allergies wh
n has been received from a female who in September 2008, was vaccinated with her first dose N of GARDASIL. On an unspecified date, she
n has been received from a physician concerning a female who was vaccinated with a dose Uof GARDASIL, 0.5 mL. The patient experience
n has been received from a registered nurse concerning a 14 year old female patient with noNpertinent medical 2/6/2009history
2/13/2009
and no known allerg
n has been received from a 42 yearYold female who on 09-FEB-2009 was vaccinated with the N first 0.5 ml 2/9/2009
dose of GARDASIL.
2/9/2009 After vaccina
n has been received from a physician assistant concerning a 21 year old female patient whoYon 08-JAN-2009 1/8/2009
was vaccinated
n has been received from a medical assistant concerning a 20 year old female with no medical N history or3/24/2009
drug allergy who on 24-MAR-2009
n has been received from a physician Y concerning a 12 year old female with no medical history Y or drug allergies### who was vaccinated
### with th
n has been received from a physician Y concerning a female who was vaccinated with GARDASIL U (unspecified number of doses) may have
n has been received from a physician Y concerning a female patient who on approximately 26-JAN-2009
N ("two
1/26/2009
months 3/16/2009
ago") was vaccinated
n has been received from a physician Y concerning a 25 year old female who was received a first U dose of 3/20/2009
GARDASIL3/24/2009
(lot # not reported) in h
n has been received from a medicalYassistant, for GARDASIL, a Pregnancy Registry product, U concerning 1/29/2009
a 26 year old female with pain in
Y for the pregnancy registry of GARDASIL, concerning
U a 2612/4/2008
year old female
1/15/2009patient with no pe
n has been received from a physician concerning a female who on an unspecified date was U vaccinated with first 0.5ml dose of GARDASIL
n has been received from a 24 yearYold female, for the Pregnancy Registry for GARDASIL who Y on 16-DEC-2008 ###was1/19/2009
n has been received from a 25 year old female patient with penicillin allergy who on August N 2008, was vaccinated
8/1/2008 with the first dose of GAR
n has been received from a registered Y nurse concerning a 27 year old female patient with noYpertinent medical 1/19/2009history
1/19/2009
and no know drug al
n has been received from a consumer concerning her daughter who was vaccinated with a third U dose of2/19/2009
GARDASIL (lot # not reported) 5 w
n has been received from a registered nurse concerning a 19 year old female patient with a N history of mononucleosis
3/16/2009 3/16/2009
at age of 15 who on 1
n has been received from a medicalYassistant concerning her 13 year old daughter with no previous Y medical history
### reported ###who on 17-DE
n has been received from a registered nurse concerning a 12 year old female patient with noUdrug allergies 3/9/2009
or medial3/9/2009
history who on 9-MAR
n has been received from a physician Y concerning a 20 year old female with egg allergy who Non approximately 3/13/2009
13-MAR-2009,
3/13/2009 two weeks ag
n has been received from a nurse concerning a 25 year old female with penicillin allergy whoNon 30-SEP-2008 3/24/2009
was 3/24/2009
vaccinated with her firs
n has been received from a physician concerning a female patient who is also the receptionist N in the office 3/20/2009
and on 20-MAR-2009 was vacci
n has been received from a physician Y concerning a female patient with no pertinent medicalYhistory and no known drug 3/24/2009
allergies/reactions
n has been received from a consumer concerning her daughter who was vaccinated with theNsecond dose of GARDASIL two weeks after th
n has been received from a physician concerning a female who in February 2009, was vaccinated U with the third dose of GARDASIL. Subse
n has been received from a physician Y assistant concerning a 16 year old female with penicillin N allergy and6/5/2008
sulfonamide allergy who on 05-J
n has been received from a Doctor Y of Pharmacy (Pharm. D.) student concerning a 27 year old N female with no medical 3/24/2009
history or drug allerg
n has been received from a nurse concerning a 14 year old female who was vaccinated withYall 3 doses of GARDASIL. That after the patie
n has been received from a 26 yearYold female who in December 2008 was vaccinated with N a first dose 3/17/2009
of GARDASIL. 3/21/2009
On 17-MAR-2009 w
n has been received from a physician Y assistant concerning a 24 year old female with asthmaNand a history 3/25/2009
of urinary
3/25/2009
tract infection who on
(3/8" x l-l/8") around injection site. Forgot to check the site of injection until just now. 12:15 PM
Y 04/18/2009. 4/16/2009
Zostavax INJ
adverently given expired dose of smallpox vaccine. Y 4/18/2009 4/18/2009
atigue (20 hours of sleep for five days)Extreme body ache, confusion, dizziness 4/20/09 Received PCP medical 4/13/2009 records
4/14/2009
of 4/13/2009. FINA
d area induration 10- to 15cm with swelling
Y and erythema, fine vesicles around the injection U site. po benadryl
4/16/2009
, Po Motrin
4/18/2009 for pain and ceph
Y Y N
n was received from an investigator for a study concerning a patient who on an unspecified U date was vaccinated with a dose of PNEUMOV
n has been received from a consumer reporting that she knew some friends who had their children U vaccinated with a dose of MMR II and la
n has been received from a consumer concerning a couple of her friend's children who wereUvaccinated with MMR II (lot# not provided) and
n has been received from a 26 yearYold femaleYfor GARDASIL, a pregnancy 3 registry product,Y concerning 2/1/2008
herself with2/1/2008
no pertinent medical h
Y a 11 year old female patient who on an unspecified
Y date was
7/17/2008
vaccinated2/9/2009
with the first dose o
n has been received from a nurse practitioner, for the Pregnancy Registry for GARDASIL, concerning Y a 1/11/2008
22 year old1/11/2008
female with no medical
n has been received from a physician via agency concerning a patient who was enrolled in aUstudy. This report was part of a post-marketin
n has been received from an investigator via agency concerning a patient who was enrolled Uin a study. On an unknown date, the patient wa
n has been received from an investigator via agency concerning a patient with HIV infection Uwho was enrolled in a study. On an unspecified
N
n has been received from an investigator via agency concerning a child patient with HIV infection U who was enrolled in a study who was vac
n has been received from an investigator via agency concerning a patient who was enrolled Uin a study. On an unspecified date, the patient
n has been received from the agency concerning a patient who entered a study and was vaccinated U iwth a dose of PNEUMOVAX 23. This
n has been received from an investigator concerning a patient who on an unspecified date was U enrolled in a study. This report was part of a
n has been received from an investigator concerning a patient who was enrolled in a study. U On an unspecified date, the patient was vaccin
very slurred speech, lossYof appetite. Y Vaccine was
Y given 7 weeks ago,12 week by week condition U deteriorated,
2/11/2009
no diagnosis
2/12/2009
made. 7/7/09 Ho
ash, left groin area, about 21 papules Y with deep red flat areas around papules alternate burningY and itching. 4/2/2009
I noticed 4/6/2009
rash on 4/6/09 - 3 day
p this am with redness to inj. site, warm to touch and states that area is tender. Y 3/31/2009 4/1/2009
itching to right arm 2d after injection came home from school and mom noticed redness andYswelling to right 4/7/2009
arm. TYLENOL,
4/9/2009 cold compres
clinic today with chicken pox - 3/23/09 1st vaccine 7/3/8 2nd vaccine 2/24/9. U 2/24/2009 3/22/2009
states that pt c/o pain with some swelling @ injection site. Mom states following day worse, w/ Y redness, 3/30/2009
swelling and 3/30/2009
tender to touch. Still w
e "notice bumps on body and itchy"Yon 4/14/09. Seen by ER physician and prescribed BENADRYL Y by mouth.
4/2/2009
Client4/14/2009
came to clinic today 4/
VAX given on 4/1/09 - had pain that day. Rash developed on 4/2/09 - Seen in our office 4/3/09 Y txd with MEDROL
4/1/2009dose 4/1/2009
pack (5 day tx) and
om Pt swollen to Lt thigh. Y Y 4/13/2009 4/13/2009
veloped pain/tenderness to the injected area 8 hrs after the vaccination. The following day developed
Y redness,
4/9/2009 swelling
4/9/2009
& nausea symptom
sh that developed 10 days after imms Y given, skin rash all over body, 2-3 mm macular, papular Y eruption, non-peticheal
3/30/2009 4/9/2009 in nature, lasting 5 da
DTaP noticed red welt on left arm where vaccine was administered about the size of a softball U got worse4/13/2009
(bigger) the4/14/2009
next day, tender, warm
Mother brought pt to office w/ c/o rednessY + swelling in the 14cm x 8.5cm left leg at the injection
Y site of DTaP.
4/13/2009He was 4/13/2009
given BENADRYL in
5 doses of the Anthrax vaccine in 1998/1999. I began feeling chronic fatigue andYarthralgia/myalgia
N in 2000
1/1/1998
and it has 1/1/2000
gotten increasingly w
swelling of face and eyes. Treated Ywith benadryl. Y 4/16/2009 4/17/2009
s after being immunized, patient developed hives in patches all over his body. Y 3/6/2009 3/9/2009
nt stiffness-difficulty in getting out of bed post vaccination Saturday 18ARP2009;feverish;vomitingY 4/17/2009 4/18/2009
as given Chicken Pox (Varicella) vaccine Y on 3/19/09. On 3/24/09 she developed a 104 degree Y fever, runny
3/19/2009
nose, cough,3/24/2009
sore throat, lethar
ash on left thigh, red patches around injection site about 1 inch around, non tender and no swelling.
Y advised
3/10/2009
to give3/11/2009
benadryl q 6 hrs, hydro
child reported that child had erythema bilateral arms. Erythem started on 4-17-09 and no longer Y present4/16/2009
on 4-19-09. 4/17/2009
Mother of child stated
er after 48 hours of receiving the shot. Y Baby got an armpit reading of 102.5 and was feverishYfor 48 hours,4/2/2009afterwards4/4/2009
did not eat/drink for 2
admin 01/08/09, pt started with feverY01/09/09 3:00amY - Mom states3pt was "burning up" andYguessed fever 1/8/2009
at 100 (did 1/9/2009
not measure it). Gav
lowgrade fever day of immunization (early evening)- Tylenol admin and effective. loose BM Y , greenish in color
4/1/200904/02 4/6/2009
- 04/05/09. Then on 04
hat twice since administration she experienced
Y episodes where Left hand became numb and U cold and then
4/13/2009
turned red 4/14/2009
and blue. Upon pres
ay after vaccinations, Face SwellingY2 days after, by day 3-4 rash on face Y 4/8/2009 4/9/2009
e of soreness in arm 4/18/09 while performing routine housework. Noticed red, swollen, warm Y 3 in X 3 in4/17/2009
area 3-4 inches4/18/2009
below injection si
eving vaccine, Mariah started Y havingYbouts of rectal
Y bleeding and diareah.
36 Y In additinY to this she
N had a very 8/23/2007
loud barking 9/1/2007
"chronic" cough. Mo
swelling at injection site. Red and warmY to upper arm . Y 4/16/2009 4/16/2009
aints-screened Jan 13, 2009 denied being pregnant-Her informed choice HPV#1 and Menactra Y given, states
1/13/2009
due Hept A #2 due after 12 Fe
facial redness, itching and swelling 1 day after vaccine administered into left deltoid. Also feltY lightheaded4/6/2009
day of vaccine.
4/7/2009
3/27/2009 N 3/26/2009 3/27/2009
shingles vaccine on April 13, 2009. On Thursday I had a rash which got worse every day. I went to see Dr. 4/13/2009
Jones today.4/16/2009
He diagnosed sh
miting,malise, headache could not get Y out of bed for 2 weeks after 1st shot. Developed
Y periphreal
N neurapathy within
### 30 days ###of 1st shot. H
2 degrees F) lasting 36 hours. ChillsYon 4-11-09 pain in both deltoid muscles radiating into neck N area. Dr visit
4/9/2009
on 4-12-094/9/2009
given RX for ibupr
ction at injection site, left deltoid. Area red, slightly swollen, warm to touch 31/2 x21/4 circumference
Y of needle
4/9/2009
site. Area
4/10/2009
described as itchy
and swelling at injection site. Fever Y of 101.2 with generalized aches. Injection site a dark reddish
Y pink extending
4/8/2009 towards
4/10/2009
elbow, 5" in diame
ed with erythematous macular rashY- descendant type at night on 4/11/09 - taken to ER nextYmorning -(not sure if case 4/11/2009
was reported). Child
l episode Records recieved 05/06/09 for DOS 04/10/09. Office visit. Post anthrax vaccine c/o Y weakness,4/10/2009
pale, slow4/10/2009
to respond to verbal co
at sight of injection. Y 3/30/2009 3/30/2009
ined of severe pain at site of injection, as well as redness and swelling. Also cried for 3 1/2 hours
Y after receiving
3/31/2009 injection
3/31/2009
wollen to the knee. No pain has itching. Y 4/11/2009 4/12/2009
ok patient to walk-in vaccine clinic. Obtained
Y #2 Hepatitis A dose, #4 Pneumococcal dose (each Y in left thigh),
4/1/2009
and Influenza
4/1/2009Split virus dose
pain, high fever due to mistake. My daughter was given vaccinations by mistake twice. Y 1/9/2009
r and swelling due to mistake, and my son was given vaccination twice by mistake. Y 1/9/2009
X given in (L) deltoid on 4-9-09. OnY4-12-09 swelling of deltoid noted, no redness - (+) tender. Y Swelling resolved
4/9/2009 by 4/12/2009
evening 4-13. Also had
njection site within 24 h (as reported by mother) at the time of visit -vesicle 3mm at injection U site with excoriated
4/7/2009 area.4/8/2009
Monitor for infection.
was reported via medical records forwarded byYa lawyer and described the occurrence of arthritis U aggravated
4/19/1999in a 77-year-old
4/20/1999 male subject
NAR administered on 4/13/09 instead of 1. Mother called at 11:30 PM on 4/13/09 and statedUhad fever 102. 4/13/2009
Instructed 4/13/2009
to give TYLENOL an
s after shot: body aches- hives, no respiration distress. 4/13/2009 4/13/2009
e TDAP vaccine 10-29-08. Later that day after vaccine administration, patient complained of Y weakness, dizziness, ###chills and ###
body aches. La
t. noon sudden onset with severe backY pain & body ache like the flu. Diarrhea started - wentY to bed - 200
4/3/2009
went to ER.
4/4/2009
Received a bag of f
of arm at injection site, diarrhea, vomiting,
Y fever.YSymptoms began 24
10 hr after vaccine. Erythema, edema of4/6/2009
Rt deltoid.4/8/2009
BP decreased. 6/24
swelling to the site. Mother states approx. 5X5". Red, hot to the touch. C/o itchy. Painful. Y 4/9/2009 4/10/2009
d 3 seizures following 6 mos vaccines lasting 1 Y 1/2-2 min. 1st was tonic
2 clonic. 2nd was clonic Y with staring.4/15/2009
3rd was 4/16/2009
a staring spell witnesse
er vaccination, patient had about 10 spots of urticaria (red, raised) scattered on wrists, arms Ytrunk & behind 4/15/2009
ear. Relieved
4/18/2009 after bath in the
, rhinorrhea started the following day after vaccination, today 4/20/09 saw MD for treatment.Y 4/15/2009 4/16/2009
9 started with cold & cough, gave TYLENOL
Y for fever. On 3/26/09 Baby was very irritable RYside of body- 3/18/2009
hand & leg3/21/2009
would jerk simultaneo
and ulcers over scrotum, trunk and scalp,
Y >100 lesions. U 4/9/2009 4/16/2009
ollen feet + hands Y N 4/6/2009 4/17/2009
hours, he had an 11 cm sized area of redness at the injection site that was firm & warm & his U thigh was swollen.
4/7/2009The4/8/2009
area was non tender
R) upper arm. Started on KEFLEX - 25x 10 1/2 cm Follow-up in 2 days 4/16/2009 4/17/2009
ox. Patient had vaccine on 11/14/00 N ### 4/15/2009
ction 4x5cm, induration and erythema within 24hrs at MMR site. Advised to apply warm or cold Y compresses, 4/13/2009
TYLENOL 4/14/2009
po, or BENADRY an
perienced a seizure approximately minutes
Y after vaccine administration. Was taken to emergency
U room.4/20/2009 4/20/2009
tient on off dizziness since receiving vaccine on 4/17/09. But complaining on weekend fever U negative, vomiting
4/17/2009negative
4/17/2009
shingle negative fo
post GARDASIL and MENACTRA administration.
Y Patient fractured nose during syncope eventY (hit office 4/17/2009
counter during
4/17/2009
fall).
d fever approximately 8 hours after vaccine. (105 degrees F). Next AM, joint and muscle tenderness;
Y "whole
4/16/2009
body"4/16/2009
5x responded to Ibupr
ad fever 100.1 and chills. Student took Advil and an hour later felt fine. T.100.1 BP 130/80 P100Y 0296904/16/2009
CNRA 4/16/2009
e, nausea after 1st shot, recovered in Y 2 days. Developed rash in a week after 2nd shot. Saw Y dr, dermatologist and allergist finally diagnosed
ven VARICELLA & MENACTRA vaccinations and after he walked into lobby he passed out. YPatient set in 4/13/2009
wheelchair 4/13/2009
& assisted by Dr. . B
congestion, swallowing freq. weak Y nausea - approx. a minute and half - called mom (parents) Y this AM - 4/17/2009
but was unable
4/17/2009
to get update.
9 Mother called and spoke to call center who then called our office. Child received MMR andYVARIVAX today, 4/16/2009
rash 4/16/2009
developed on face, and
d SPV left arm on 4/4/09. On 4/9/09 the pt experienced about 60 min of central chest pressure (2/10). He 4/4/2009
states that4/9/2009
he felt like his heart r
tarted 48-72 hours after Hep A # 2 and no obvious trigger. CLARITIN 5mg/5ml qd prn. U 4/6/2009 4/9/2009
er thigh induration 10x9cm, mild tenderness to left upper thigh. Y 4/15/2009 4/16/2009
nutes of the DTAP, pt had reaction, Y wheezing, sob, tickling in the throat, appeared grayish inYmouth, 2 tsp4/17/2009
BENADRYL, 4/17/2009
alb nebs X 2, SOLU
veloped shingles 4/15/09. U 8/7/2006 4/15/2009
er of Pt; Pt arms became tender + painful (@ injection site) approx 6-7 hrs after injections, the Y hands became 4/9/2009
swollen4/9/2009
itching next day Pt re
ious, spontaneous report of administered expired product was received from a nurse concerning Y a four-year-old
2/20/2009 female,
2/20/2009
subsequent to FLU
ious, spontaneous report of administered expired product was received from a nurse concerning Y a 15-month-old
2/23/2009 female
2/23/2009
subsequent to FLU
2/17/2009 female,
2/17/2009
subsequent to FLU
2/17/2009 female,
2/17/2009
subsequent to FLU
ious spontaneous report of expired FLUMIST given was received from a company sales representativeY concerning
2/23/2009 a 2/23/2009
47-month-old male. O
n has been received from a registered nurse concerning a male who last week was vaccinated U with VARIVAX (Merck). Concomitant therap
MENACTRA 4/8/09 at 4:15PM, close Y to that time. Checked the vial for how to administer, it didn't
Y state, checked
4/8/2009refrigerator
4/9/2009(see attached)
post vaccine -> felt dizzy, diaphoretic helped to sit down no syncope no loss of consciousness Y supine x 4/14/2009
10 min then4/14/2009
sat up received orang
ted with Sx of allergic Rxn after shots.
Y No food, drink or other exposure noted. Sx started about Y 1 hr after4/9/2009
shots. No4/9/2009
probs w/ previous sho
htness of chest next day. Benadryl +Y steroids. Y 4/1/2009 4/2/2009
dasil #3 woke up with shoulder pain L now hands fingers hard to work. Tests for lupus & arthritis N - neg. Now
1/4/2008
very stiff joints hands & knees
ace and trunk extremities. Intense itching.
Y Y 4/15/2009 4/15/2009
ith vesicular rash on trunk 4/16/09 - rash appeared 4/14/09 on trunk. N 11/3/2000 4/14/2009
hysical with immunization 4/3/09 fever Y to 101 X 24 hrs, then 4/6/09 developed no fever. Developed cough, 3/30/2009
cranky, not
4/10/2009
sleeping seen by Dr
n has been received from an investigator via agency concerning a patient who on an unspecified U date was enrolled in a study. This report w
y concerning a patient who was enrolled in a study. This report was part of a post-marketingUsurveillance program. On an unknown date the
n has been received from an investigator via agency concerning a patient who was enrolled Uin a study. This report was part of a post-marke
n has been received from an investigator via agency concerning a patient who was enrolled Uin a study. On an unspecified date the patient
n has been received from an investigator via DAIDS concerning a patient who was enrolled U in a study. On an unspecified date the patient w
n has been received from a registered nurse concerning a 20 year old female with no past drug Y history, 12/6/2008
who on 06-DEC-2008
ort received 07 April 2009 from a consumer
Y who was the patient's mother-in-law. A male patient
N (age not reported) with a history of sleep d
ort received 09 April 2009 from a health care professional.
Y A four-month-old
1 male patient withYa history of eczema
4/2/2009and4/2/2009
an egg allergy, had r
episode, fever - 102.7, partial absence
Y spell or Yseizure which resulted1 in some anoxia post ictal
Y phase, sign 4/7/2009
tachycardia.
4/7/2009
4/29/09 Received
ed child c/o pain, redness and swelling noted to (left) vastus lateralis approximately 3cm x 5 cm.Y 3/31/2009 4/1/2009
ately 15-20 minutes after vaccination Y child became unresponsive, no respiratory distress. Mother
Y emergently
4/16/2009
brought4/16/2009
infant back to office. I
0 min after vaccination given, the patient had a blank stare, turned gray, rapid breathing, gotYstiff eyes, eyes
4/15/2009
rolled back,
4/15/2009
arm and legs stiff a
02 degrees and diffuse urticaria. Began
Y the AM after vaccine administered. Given antihistamine
U as treatment.
4/15/2009 4/16/2009
4/10/09 left deltoid noted to have about 4" round increased redness, warmth and swelling. Instructed
Y to use4/8/2009
ice packs prn.
ived vaccination on 3-27-2009 and came in office with chickenpox on 4-8-09. Y 3/27/2009 4/8/2009
d swelling and hardness at site (L) arm of inj, progressed down arm to below elbow. Described Y as hard, 3/13/2009
warm, very 3/13/2009
tender, entire circumfer
hes over body, especially elbows, knees
Y and hands with swelling and redness within 5 hrs ofYvaccination. 4/13/2009 4/13/2009
male received vaccines 4/10/09. 2hrs Y after vaccine started develop rash to body, which spread Y the following
4/10/2009
day with4/10/2009
swelling. Seen in ER
cella 4/7/09. At 3:30am on 4/9/09 woke up w / 104 Temp. Used fever control methods. Saw Y PCP at 9:30am 4/7/2009
on 4/9/09, 4/9/2009
temp at 99. Large, r
d swelling and pain of injection site >5cm about 8 hours after injection. 12-18 hours after injection
N developed4/9/2009
dizziness,
4/9/2009
nausea and heada
me down with shingles within days of receiving Zostavax. Y 3/19/2009 3/24/2009
veloped painful rash with vesicles at site of injection and mid back. Y 3/19/2009 3/24/2009
vaccine administered 04/15/2009; 36 Y hrs. later I had 3.5 cm indurated, red, sore, warm vaccination
Y site w/surrounding
4/15/2009 4/16/2009erythema accompani
ived PPD and Flu vaccine 4-15-09.Next day he developed fever.Red rashes developed on forehead.Mom
Y gave a dose of benadryl elixir 1 t
s following injection of varicella and mmr to left thigh mom returned with child and wanted usUto see left thigh
4/21/2009
reddness
4/21/2009
and swelling. 2 3/4
nd 4/16 baby was cranky and crying, no fever. On 4/18/09 "baby's eyes started rolling back"Uone time. On 4/14/2009
4/20/09 "everytime
4/18/2009 MOB put bab
tching and rash on arm where vaccines were given. Benadryl cream prescribed by MD. Y 4/13/2009 4/14/2009
en, hot area where vaccine given Y 4/17/2009 4/18/2009
days after getting Proquad VMMR vaccination
Y and Pnem vaccination. My son ran 105 F fever U and I took him to the ER. His temperature w
ed disease of the pericardium. 5-000007Y 4/28/09 Received vaccine & clinic medical records of 3/20/09. FINAL 3/9/2009DX: pericarditis
3/20/2009 Records rev
en, hot area around where vaccine was given Y 4/17/2009 4/18/2009
administration, had flu-like symptoms including chills, aches, and vomited X1. Today (1 dayNafter vaccine 4/20/2009
administration)
4/20/2009she has a runny n
RSE EVENT-MD ORDERED & PATIENT RECEIVED DTaP. THIS VACCINE IS NOT RECOMMENDED Y FOR
9/3/2008
CHILDREN PAST 6 YEARS
episode fainted Y 4/21/2009
d tdap and varicella and passed out. Hit forehead on wall and recieved a lacaration steri strips Y were applied4/18/2009
Pt c/o dizziness
4/18/2009and pain. Pt st
ceived a Tdap and 1st Hepatitis A and Y within 5 minutes, broke out in a rash and had trouble Y breathing and 4/13/2009
swallowing.4/13/2009
Patient reported he
following Twinrix vaccine on 4/15, client's
Y upper lip began to swell. Swelling continued for several
N days. 4/15/2009
Client visited 4/17/2009
primary care physicia
rash starting on face and spreading. Tactile temp, fussy. Multiple papules, vesicles Y 2/18/2009 4/13/2009
y aches HA vomitng for 3 days Y U 4/18/2009 4/19/2009
V injection approx. 8:20 a.m., Immediately felt sick and dizzy, thought she was going to vomit. N There were 4/20/2009
two more4/20/2009
incidents during day on
diagnosis to vaccine-Hypothyroidism, Y Hashimotos,Acid
Y Reflux, Anxiety,
20 Y Depression, OCD and N had occassional
9/20/2007 eye 10/1/2007
tics. Exacerbation of pre
was reported via medical records forwarded by a lawyer and described the occurrence of arthritisU in a male subject in his forties who was v
was reported by a lawyer and described
Y the occurrence of joint pain in a male subject of unspecified
N age who ### was vaccinated with LYMER
vaccines 4/2, on 4/9 developed
Y fevers, sore throat
Y - unresponsiveness21 and encephalitis withNbrain edema4/2/2009
by 4/11. Suspect
4/9/2009 viral encephalit
a fever up to 104 with last vaccines Y and screamed for ten hours nonstop. Y 1/28/2009 1/29/2009
ceived DTap and VARIVAX vaccines on 3/18/09 in right thigh. Patient returned to office 3/20/09 U with large 3/18/2009
red circular3/20/2009
area around injection
ceived DTap vaccine in left thigh on 3/16/09. Parent reported large red swollen area around Y injection site3/16/2009
1 day after3/18/2009
injection. Redness and
at, difficulty swallowing, hoarsenessYand laryngitis. Told to stop VIVOTIF and use ADVIL. Throat U culture pending.
4/17/2009 4/18/2009
get lesion (7cm x 5 cm) with central clearing.
Y Raised, red and warm, but no pain or itching. Y 4/15/2009 4/17/2009
d pain at left upper arm at previous injection site with redness and tenderness (2" x 5" of size).U Pt stated scratching
4/8/2009 area4/12/2009
after 4 days of injec
cold sweats and chills 4-20-09 that evening after the vaccine was administered. Pt also c/o difficult with4/20/2009
forward flexion
4/20/2009
of neck - "mild disc
on L thigh with chicken pox lookingYlesions warm compresses + Augmentin x 5 days. Y 4/6/2009 4/17/2009
tous papular and plaque like lesions - very pruritic on extensor surface of upper and lower extremities.
U This4/7/2009
rash developed
4/18/2009 2 weeks after 2
smallpox 31 Mar 09 Lt upper arm, whichY was followed by swelling, redness, and increasing tenderness,
Y 3/31/2009
no fever, Pt stated
4/1/2009 she was vaccin
ollow-up to a previously submitted VAERS report this 47 year old patient received 4 BIOTHRAX U prior to and1/11/2003
during his
1/13/2003
deployment in 2003.
omiting and diarrhea, subjective fever
Y and hematoma to site. Y 4/8/2009 4/9/2009
Y 4/15/2009 4/16/2009
creased appetite, rash, shaky, vomiting in the 24 hours to 48 hours with the vaccine administration
N on 4/15/09
4/15/2009 4/16/2009
ines were given the patient hopped off the exam table (she was sitting on it) & fell to the floorY and became 3/16/2009
rigid and3/16/2009
looked blue and unresp
<15min) onset of facial swelling afterYvaccine delivery. Y 4/21/2009 4/21/2009
ely after vaccination, eyes rolled back,
Y color became gray/green, leaned to left; mother supported U her - nurse
4/21/2009
attempted
4/21/2009
to assist her to put
08, 2 wks after her 2nd GARDASIL shot, this girl has had severe back pain with diagnosis
Y ofNSacroileitis,7/22/2008
pain Amplification
8/5/2008 syndrome. Pai
9 Patient brought by parents. About 12-18 days after vaccines developed hives on both cheeks N and few scattered on lower legs.
uring swallowing; Febrile seizure. Y Y 4/8/2009 4/15/2009
ter immunization. Woke up next AM with severe swelling to face & eyes, very sleepy. Afebrile, Y no SOB 4/10/2009
or difficulty4/10/2009
swallowing. Took 50 m
ely after receiving 2nd GARDASIL vaccine along with DTap vaccine, patient fainted. She wasYunconscious 4/17/2009
for 2-3 seconds.
4/17/2009 Awoke with sha
is having tingling sensation up and down his left arm, and he stated that his shoulder is sore. U Asked him3/10/2008
is pain severe 4/9/2009
he said that it is eas
as given Hep A 1st, then HPV. AfterYHPV was administered pt tensed up and began to looseYher color, she 4/17/2009
then began4/17/2009
to lean backwards a
dness where injection given area approx. 6in long & 4in with with warm areas + pain. Started Y around 12 hours after inj + worsening over 48
fter vaccine with smallpox, awoke with non painful non pruritic 10 cm red patch with multiple U 2-3 mm satellite
4/13/2009
papules 4/13/2009
around path extendin
after injection erythematous confluent raised rash appeared on dependent surface of L upper Y arm. 1% Hydrocortisone
4/16/2009 4/17/2009 cream bid, extendin
hezia, twice - Fussiness - ConstipationY Y 3/25/2009 4/1/2009
4/15/2009 N 4/15/2009 4/15/2009
erythema, induration at Iz site - VARICELLA Iz right thigh U 4/8/2009 4/9/2009
ne was mixed with sterile water diluent and not HIB diluent. 3/9/2009
n has been received from a 31 yearYold female licensed practical nurse with reaction/allergy
Y Nto DEMEROL7/5/2007and a history
7/5/2007
of function kidney
additional information has been received
Y from a nurse practitioner concerning a 14
Y year old Nfemale who on 17-OCT-2006
### 2/1/2007 was vaccinated w
n has been received from a physician assistant and a licensed practical nurse concerning a U female who was vaccinated with the first dose
n has been received from a physician Y assistant concerning a 20 year old female Y with migraine,
N penicillin8/15/2007
allergy and VICODIN
8/1/2008 allergy and a
ports child woke up "Sunday night atY 1:30" (April 12) with c/o not feeling well, sore throat andYswollen glands 4/8/2009
on side4/12/2009
of neck. Reports c/o h
veloped a skin infection at the site of
Y the MMR vaccination. She had low grade fevers for days Y and was in 4/2/2009
discomfort.
4/11/2009
10 days on antibioti
IVED DTAP INSTEAD OF TDAP. U 4/13/2009 4/13/2009
arm from just above elbow to shoulder
Y joint. Had 4+ edema. Hot to touch, with deeper reddish Y black skin 4/15/2009
discoloration
4/16/2009
below where Kinrix
d loss of consciousness after vaccination, associated with tonic clonic motions of extremities. Y Complete4/14/2009
recovery. 4/14/2009
No prior history of seizu
ived 2 month vaccines as Pentacel, Prevnar and Rotateq. Vaccines given at 10:30 AM, Infant Y had inconsolable
4/21/2009 crying
4/21/2009
and mild fever (not
ceived vaccinations and about 5.5 - 6 hours later experienced weakness, fatigue and fever ofU 102.5 axillary. 4/21/2009
No other4/21/2009
symptoms other than
ARICELLA VACCINE RECEIVED. PREVIOUS DOSES ON CHILD GIVEN ON THESE DATES: U 4/21/03,4/17/2009
04/18/20074/17/2009
rned pale and diphoretic after administration of first Gardasil vaccine. Patient complained of feeling
Y like she
4/22/2009
was going4/22/2009
to pass out. Patient w
nderated at injection site. Heat and Yprednisalone Y 4/15/2009 4/16/2009
al reaction from left elbow to over left shoulder including underside of arm. Red, hot to touch,Uskin hard and 4/20/2009
swollen,4/21/2009
painful, no enlarged ax
er receiving his 4 month booster vaccines
Y patient
Y started having seizures
1 Y which have
Y resulted
N in several9/26/2007
hospitalizations,
9/29/2007
numerous medica
4 HR OF VACCINES, PT GOT RAISED Y RASH ON BOTH ARMS. RX KEFLEX 250MG TID FOR 1 WK. CLARITIN 4/20/2009 RX, 4/21/2009
BENADRYL HS PR
OID MACULAR RASH,MILD SWELLING, Y WARM TO TOUCH. CLARITIN RX/BENADRYL RX. RETURN 4/17/2009 IF NOT IMPROVED.
4/21/2009
d large local reaction at site of vaqricella
Y vaccine Y 4/17/2009 4/18/2009
was reported by a lawyer and described
Y the occurrence of joint pain in a female subject of unspecified
U age5/4/2000
U age 7/8/2002
came dizzy, pale, clammy & sweaty lethargic stated his very tired. Pulse droped into the 50's Y - oxygen @ 4/21/2009
3 liters had
4/21/2009
patient lie down chec
telephone call from patient on 4-16-09 stating the she had slight nausea and slight swollen lymph node 4/14/2009 in (L) clavicle
4/15/2009
area. No fever. 4-21-
SM referred from aid station for left Yfacial swelling in temporal association with the receipt ofYAVA and Typhoid4/7/2009vaccines. Symptoms: Swel
njection 02/13/2009 @ 4:00pm 36 later Pt states fever of 100, chills body ache L arm, headache. Y 2/13/2009 2/15/2009
n on 4/8/2009. Pt noted symptoms. Flu like achy onset 4/18/09. Stopped 4/21/09. Rash onset 4/21/09 - ongoing. 4/8/2009Rash4/15/2009
on side of face, nec
ccinated with Hepatitis A and Hepatitis B vaccines 15-20 seconds after vaccines administered Y patient fainted.
4/22/2009Per guardian
4/22/2009"patient has al
large area redness/heat denies itching mildly painful area raised warm area breadth of thigh with central4/20/2009
clearing around
4/21/2009
vaccine site. Ben
ng office, parents report baby turned blue, when strapped in her car seat lasted few secondsY-> pinked up on her own. Brought her right ba
on 4/17 - Sore, red and itchy, and aYlittle swollen. Saturday swollen and warm.- little fever. Monday 4/20,4/17/2009
still sore and
4/18/2009
warm. Dr. prescribed
eft thigh around on a or injection and fever of 100.2 U 4/16/2009
d hives 3 days after getting HPV vaccine for the 1st time. Y 4/16/2009 4/19/2009
Y for the pregnancy registry for GARDASIL, concerning
Y a 23 year old female
5/21/2008
with a history of 2
n has been received from a 22 year old medical assistant who was given the second dose ofNGARDASIL "subcutaneously instead of intram
n has been received from a Nurse Practitioner concerning a patient who on 13-FEB-2009 was U vaccinated 2/13/2009
with an inadequate
2/13/2009 dose of GAR
n has been received from a physician concerning a 16 year old female who on 12-JAN-2009Uwas vaccinated 1/12/2009
with the second dose of GAR
n has been received from a medical assistant concerning a 11 year old female with a historyYof pharyngitis 2/26/2009
streptococcal
2/26/2009
who on 26-FEB-2
n has been received from a Registered Nurse concerning a 16 year old female who was vaccinated U intramuscularly with her third dose of G
n has been received from a physician Y concerning a 19 year old female with penicillin allergyUwho on 19-FEB-2009
2/19/2009 was 2/19/2009
vaccinated IM into t
n has been received from a physician Y assistant concerning a 15 year old female who on 27-FEB-2009
U was
2/27/2009
vaccinated2/27/2009
with a first dose of G
n has been received from a 25 yearYold female who on 18-FEB-2009 was vaccinated with her N first dose 2/18/2009
of GARDASIL and the patient had
Y a 13 year old female who on 26-AUG-2008 was N vaccinated 11/2/2008
with her first
12/1/2008
dose of GARDASIL
n has been received from a physician concerning a 14 year old female patient with no pertinent N medical 2/12/2009
no known drug allergie
n has been received from a physician Y assistant concerning a female under 18 year old who Y on unspecified date was vaccinated with her th
n has been received from a registered nurse concerning her 16 year old with no pertinent medicalU history and no ###drug reactions/allergies
### w
n has been received from a consumer concerning her daughter (approximately 17 year old) N with codeine allergy who9/1/2008had been experiencin
n has been received from a registered nurse concerning her 14 year old daughter with frequently Y injection site reaction after unspecified va
n has been received from a 41 yearYold female patient with an allergy to "cloricidin" and a history
U of bleeding3/2/2009
during pregnancy
3/2/2009 who on 2-M
n has been received from a female who was vaccinated with a first and second doses of GARDASIL U on an unspecified date, respectively. T
n has been received from a nurse practitioner concerning a female patient who was vaccinated Y with a dose of GARDASIL. 3/2/2009 On 2-MAR-2009
n has been received from a registered Y nurse concerning a 24 year old female who in approximately
Y February
2/1/2009
2009, about
2/1/2009 1 month ago, wa
U medical9/25/2007
history or drug
2/24/2009
reaction/allergies w
n has been received from a physician concerning a 14 year old female who 25-FEB-20009 was U vaccinated 2/25/2009
with a dose
2/26/2009
of GARDASIL (lot #
n has been received from a radiologistY concerning her niece (a 14 year old female) who on 08-FEB-2008
Y 2/4/2008
was vaccinated
2/8/2008with her first dose
n has been received from a Nurse Practitioner (N.P.) concerning a female who was vaccinated N with 0.5 ml dose of GARDASIL. The patient
n has been received from a registered Y nurse (R. N.) concerning a female patient at one of the U local schools who had an aluminum poisonin
n has been received from a physician concerning a female patient who was vaccinated intramuscularly with 0.5 ml dose of GARDASIL. Co
n has been received from a mother concerning her daughter who on unspecified dates was U vaccinated with all the three doses of GARDAS
n has been received from a physician Y concerning a female teenager who on an unspecified Y date was vaccinated with the first dose of GAR
Y a 17 year old female patient who on 28-FEB-2009
N was vaccinated
2/28/2009with 2/28/2009
n has been received from a physician concerning a 13 year old female who on 22-DEC-2008 Y was vaccinated with ### her
2/23/2009
first dose of GARDA
n has been received from a physician Y concerning a 15 or 16 year old female who was vaccinatedU with the second dose of GARDASIL. On
n has been received from a registered Y nurse concerning an 18 year old female with an allergy U to naproxen 11/1/2008
who on 23-APR-2008
11/1/2008 was vacc
n has been received from a consumer concerning her 23 year old daughter with no pertinentNmedical history 8/1/2008
and no known
8/1/2008 drug allergies o
n has been received from a physician concerning a female who on an unspecified dates wasUvaccinated with first and second doses of GA
n has been received from a school nurse (registered nurse concerning a high school aged female U who was7/31/2007
vaccinated with a dose of GAR
swelling ANT LT Thigh, delayed onset Y after immunizations 4/9 am, either soft tissue infectionU (cellulitis) vs4/9/2009
delayed and4/9/2009
severe local reactio
m red patch on L thigh 2 days with vaccine
Y administration tender + hot no systemic signs or symptoms.
U 4/16/2009 4/17/2009
was considered medically important. Information regarding PREVNAR was received from a U consumer regarding a 5-year-old male patient
eared over mid back and buttocks 7/30/08. Progressed to localized area over left thigh, clustered, mean spots,### very7/30/2008
pruritic. Area persisted
mmunization clerical staff stating client
Y had left phone message stating that she had blistersUat the site of 3/1/2009
her shingles shot. Said area was
lled Pt. crying, unable to console X90 min. Tylenol given - phone call 4/17/09. Pt doing better,Y cried for 24/16/2009
1/2 hrs. and 4/16/2009
is fine today- had low
iving a HEP A injection pt walked to front desk & ran into the exit door. She stated "every thing
Y was purple 4/17/2009
because4/17/2009
the shot hurt so much.
hema and edema extending 10 cm X 4 cm around injection site. Decreasing edema and erythema Y daily.4/13/2009 4/14/2009
Mom called re: 4 bumps to left thigh Y with redness. 3-13-09 mom brought child to MD with increased
Y redness
3/11/2009
and selling.
3/12/2009
3-14-09 ED visit, la
A (intense when moves head) aching all over and a slight cough.Tem.101.Advised to see PCP U if T. 102-1034/21/2009
and if sxs
4/21/2009
not subsided in 48 h
ates that a few hours after the patientY received Y his shots she fed him1and put him down for aYnap. She states4/20/2009
she went
4/20/2009
in to check on him a
NURSE PHONED TO SAY RIGHT ARM RED,SWOLLEN,TENDER--REDNESS EXTENDS U 3CM BELOW 4/20/2009
ELBOW---ADVISED
4/22/2009 TO SEND T
ng of 4/22/09, the day after vaccination, parents noted that left arm was swollen above the elbow,
Y red and4/21/2009
hot to the 4/22/2009
touch. Child had not co
e on 4/15/09 at which time vaccinesYadministered according to CDC recommended schedule. Y Parents report
4/15/2009
that on4/16/2009
4/16/09 patient develo
muscle pain in the deltoid area beginning
Y withing days after the shot. It has been 9 months and
N the pain 7/15/2008
is only slightly
7/17/2008
better.
dose of oral typhoid in the morning of 4-21-09 and began to feel intestinal discomfort the in evening
Y of the4/20/2009
same date. 4/21/2009
Started with diarrhea
inistration of a subcutaneous MMR vaccination using a VanishPoint syringe, a black dot appeared U on the site of ###
injection. ###
nausea w/o emesis and Crampy abdominal Y pain 30+ episdoes of watery diarrhea no blood inY24 hours. Orthostatic
4/22/2009 and 4/23/2009
fatigue.
bcutaneous injection of the MMR vaccine using the VanishPoint syringe, a black dot appeared U on the child's left ###
arm. ###
D T-DAP 4/1/09 AT BEGINNING OF 12 HOUR SHIFT (0700) AND HER SHIFT EXTENEDED Y UNTIL 0300 4/1/2009
THE NEXT 4/3/2009
DAY. ON THE NIG
d severe pain at injection site and upper arm,prickly reddened area around site, dizziness, fever,, U nausea,lymph
4/20/2009 glands
4/21/2009
swollen in axilla
minutes after second vaccine injection(HPV) client stated that she felt hot,then did not respond Y to verbal4/23/2009
stimuli, eyes4/23/2009
open, and body beg
009, arm was sore and red at site ofYinjection. Redness gradually worsened. At time indicated N in number4/20/2009
11, patient4/22/2009
began to feel nauseate
rm redness, swelling, fever, skin hot, red rash on arm, pain in arm for one week, egg sized lump. Y Symptoms 4/14/2009
resolved 4/14/2009
on own after one wee
e shingles vaccine administered on the 21st of April at 10:00a.m., became very red, itchy andY swollen to 4/21/2009 three inches 4/22/2009
in diameter, 1/2 inch h
was reported by a lawyer and described the occurrence of joint pain in a male subject of unspecifiedU age7/30/1999
Y theY occurrence of throat0 tingling in a 45-year-oldUfemale subject
9/17/2008
who was 9/17/2008
vaccinated with influe
ng office Pt had a delayed fainting spell - Returned to office - No injury. Y 4/23/2009 4/23/2009
ter injection - pain at site -nausea-vomiting 9 hrs- Temp -101.4 - 12 hrs. See attached for detailedY acct 4/14/2009 4/14/2009
ure starting within 24 hours of injections with lack of appetite & fatigue. Cough developed within 24 hours 3/25/2009
with positive3/26/2009
strep (rapid test) 3/3
s red, swollen, itchy Y 4/21/2009 4/22/2009
degrees (rectal) on 4/23/09, redness Y and warmth to both thighs U 4/22/2009 4/23/2009
red area on LA last night 4/15/09. School nurse (called 4/16/09). 3/4" wheel - 2" flare -red-hot; Y dermis itching
4/14/2009
- no rash-
4/15/2009
no resp. problems
after vaccines given mom stated pt vomited in bathroom. Once out of bathroom mom statedYpt feet "hot".4/17/2009 Temp was 4/17/2009
99.8 axillary 15 min la
d redness, swelling, pain 5/10 and heat stating 4 days after injection. Erythematous and edematous Y area 4/6/2009
9 cm X 7.54/10/2009
cm at injection site. St
9, he was given MMR in right upper arm. Later that evening, he developed a red whelp and Y swelling of the
4/17/2009
right upper4/17/2009
arm (deltoid area) No
cm redness & swelling around site of Y immunization left and lateral thigh Y 4/21/2009 4/22/2009
appeared on arm in vicinity of vaccines - 4 days later on 04/6/09 and 4/20 severe rash on face - 4/21 severe 4/2/2009
generalized
4/6/2009
indurated pink pap
eived varicella vaccine on 4/21/09. Y Developed edema of R arm extending from deltoid to mid forearm erythema 4/21/2009 over4/23/2009
deltoid.
m to touch, inflammation instructed to give child, children's Motrin or Advil. U 4/21/2009 4/23/2009
r arm is red, hot to the touch and feels hard @ injection site. <- hist Dx Skin is mildly red-notY hard child 4/21/2009
not ill- playful-
4/22/2009
afebrile.
egular shaped welts - No temp. - Itchy on parts of arm/legs and torso - Recommended BENADRYL U _ See4/21/2009
Dr. if not 4/22/2009
better.
iness symptomatic tx Y 4/22/2009 4/23/2009
ling, redness at site of injection (improving 4/21/09) fever & chills over night nausea. Y 4/20/2009 4/20/2009
swelling, heat (L) upper arm and developed several hrs after injection, Rx BENADRYL/VICODIN Y and cold
4/20/2009
packs. 4/21/2009
tching - burning - tired - achy Had emp. health physician check patient Y 4/21/2009 4/21/2009
post pt left boyfriend called back stating pt's tongue was starting to swell & have blisters on tongue.
Y Told4/21/2009
boyfriend 4/21/2009
to return to clinic. Dr ex
min child had cough, wheezing, difficulty
Y breathing, pale Oxy 93-96% on room air then developed Y itchy rash
4/22/2009
all over4/22/2009
the body. Got XOPEN
spot at injection site. Y 4/15/2009 4/16/2009
4/22/09 with rash. Y Y 5/30/2006 4/21/2009
ever and erythematous, blotchy rush all over - day after PENTACEL and ROTARIX Y 2/11/2009 2/12/2009
eport that after shots on 2-19-09, pt cried non stop greater than 3 hrs. Y 2/19/2009 2/19/2009
n has been received from a physician concerning Y a 12 month old patient
0 who on 20-JUN-2008, Y 06-AUG-2008 10/1/2008and 01-OCT-2008
4/7/2009 was vacc
n has been received from a physician concerning Y a 17 month old patient
0 who on 20-DEC-2007, Y 20-FEB-2008 4/17/2008and 17-APR-2008
3/16/2009 was vacci
rmation has been received from a physician
Y and follow up information has been received from Y a registered4/14/2009
nurse concerning
4/14/2009a 15 year old
ort was received 17 April 2009 from Y a consumer, who is the patient's parent. An 11-year-old male Y patient (also
6/1/2008reported
6/1/2008
as 12 years of age)
ng of the vaccine swelling developed at injection site. The next day she developed a headache, Y chills, nausea
4/22/2009and sweating.
4/22/2009Today (day 3)
nt had a seizure on the Friday after Y getting the vaccine. Patient had a seizure w/u-extension,YLP/UDS. Patient 4/8/2009
had CT 4/17/2009
scan and EEG. The E
nt received travel vaccines (yellow fever,
Y meningococcal, typhoid) at an outpatient travel clinic Y 4/1/09. He4/1/2009
developed4/1/2009
a headache about 5 m
pneumonia vaccine 4/20/09 in left arm. Y Stated it was immediately painful. Localized swellingUoccured over 4/20/2009
the next4/20/2009
6 hours. Swelling incre
had slight swelling about 5cm, redness, itching, and pain Y 4/1/2009 4/3/2009
U 4/14/2009 4/14/2009
ceived her 4 month vaccines on approximately
Y Y4/12/09 of this year (2
2 injections, 1 to the R thigh
U and 1 to4/12/2009
the L thigh4/16/2009
presumably pentacel a
s started exactly 2 months after her Y 2nd shot. Started
Y with headaches, 1 nausea, vomiting,
Y strep
N throat and11/7/2008
body aches. 1/7/2009
Continues on with no
as vaccinated 4/14. Presented for urgent care 4/23 with three patches of vesicles on left back. U 4/14/2009 4/22/2009
ere muscle pain in lower legs that continued for 7 days, and they are still sore, but not so severe Also after4/8/2009 3 days, I4/14/2009
started to have muscle
9/17/2008 N 9/2/2008 9/2/2008
d shortness of breath, wheezing,
Y cold extremities,
Y and hives within 5-152 minutes after receiving Y four immunizations
4/23/2009 and 4/23/2009
PPD. 5/14/09 hosp
perienced two episodes of syncope after receiving vaccines on 4/21/09. First episode immediately Y after 4/21/2009
receiving vaccines,
4/21/2009 then 15 minute
minutes of receiving her first Gardasil injection the patient blacked out. SHe was treated with Y smelling salts
4/17/2009
to try and
4/17/2009
rouse her and was p
hrs after receiving the immunizations Y listed below, patient's rt. arm began itching at the varicella
Y site, then 3/23/2009
she noticed 3/24/2009
swelling and warmth
ed this facility and stated that since she was administered her Td vaccination in the right deltoid on 3/27/09 3/27/2009
she has 3/27/2009
had "pain off and on in
s after receiving MMR vaccine subcutaneously,
Y developed a 1.5 cm wheal that itched and hurt Y at the site4/23/2009
of this vaccine
4/23/2009
administration. Tre
vaccination on April 16th 2009 I noticed at the injection sight his arm was swollen, red and very N hot to the4/16/2009
touch. Everyone
4/16/2009told me he was f
was reported by a lawyer and described the occurrence of joint pain in a female subject of unspecifiedU age who was vaccinated with LYME
4/21/2009 N 4/16/2009 4/21/2009
eption, Bilious vomiting, Irritability, Listlessness.
Y YIntermittent vomiting1 episodes starting on 4-12-09.
Y Increased
4/7/2009
vomiting
4/12/2009
noted on 4-21-09. D
cines emesis about 10 minutes afterYvaccines, developed
Y facial and arm rash 20 minutes after Y vaccines, 4/15/2009
Pt sleepy. BENADRYL
4/15/2009 15 mg IM a
eption, s/p surgical reduction.
Y 4/28/09
Y MR receivedY for DOS 4/16-19/2009
3 with D/C dx: Intussusception.
Y 4/14/2009
Pt presented 4/15/2009
with vomiting, fussin
ter received her second GARDASILYvaccine and had 2 30-45 second seizure 15 minutes after U the injection
4/21/2009
in the doctors
4/21/2009
office on the floor
reviewed PROTCOL questions with patient, denied steroid use 4/24/09 - patient came to pharmacy U and4/23/2009
showed pharmacist
4/24/2009shingles-like ra
headache, - flu-like symptoms, -nausea; -muscle pain Y 4/22/2009 4/23/2009
iving IM DTaP and IM PREVNAR onY 4/20/09 to (R) thigh, pt. developed red, warm area and Ytemp described 4/20/2009
as "hot"4/21/2009
per mom day after sho
t was given a DTaP immunization Y 4/20/2009
swelling, redness, and warmth to immunization
Y site (right posterior upper arm). 4/23/2009 4/23/2009
es, shortness of breath, very painfulYwith in 5 hours after injection, Pt states arm very painful Yunable to lift4/21/2009
on 4/22 + 4/21/2009
4/23 area near injection
f the she c/o itching at the site - red area appeared 3 days later 15mm x 20 mm now. StartedUsmall welting 4/7/2009
after - no 4/7/2009
fever, no swelling in ar
erebral Palsy, 1 seizure periodically Y 12/08, sees Neurologist, EEG 12/08 abnormal, on KEPPRA, U this episode4/20/2009
= day 4/21/2009
after immunization mom
r to elbow swollen twice the size & with erythema. Y 3/11/2009 3/13/2009
ived 2 chicken pox vaccines, chicken pox rash on 4/17/09 Y 6/20/2007 4/17/2009
d hives within 10 minutes of HIB / PREVNAR administration. BENEDRYL given in office. Monitored Y X 20-30
4/2/2009
min 4/2/2009
Y 4/20/2009
0PM Hep A #1 given LA. After injection, Y stated she was dizzy and tip of tongue numb. Color Ypink. 2:35PM 4/16/2009
HR 34 R 4/16/2009
20 BP 110/60 talking w
U 2/11/2009 2/12/2009
vaccines - approx 30 mins later father Y returned to clinic stating child c/o "scratchy throat" - no Y SOB - vomited 4/7/2009
x3 - c/o4/7/2009
chest tightness EPI. 3
GARDASIL shot. Approx 3-5 min. later had several vials of blood drawn. After last vial pt. became Y "rigid",4/16/2009
had muscle 4/16/2009
contractions, eyes we
by parent, Pt.'s R arm and shoulder Y at injection site became very swollen, child taken to ER.UParents thought 4/14/2009needle was in arm. Arm X ra
warm area without induration occurred 4/19 (2 days after vaccines given). U 4/17/2009 4/19/2009
red ROTATEQ orally before other vaccines - within 1 min of giving oral vaccine, infant mucous Y membranes 4/15/2009
of upper4/15/2009
and lower lips began to
here for evaluation of dizziness andYsymptoms that she thinks may be related temporally to the injection 4/14/2009 of a TDAP 4/14/2009
that was given on 4/14/
ht arm within about 4" from injectionYsite bright red, swollen, hard and hot to touch on 3/19/09. Y 3/20/09 signs
3/18/2009
and symptoms
3/19/2009 persist with larg
as brought back to office 25-30 minutes Y after injection given complaining that his chest hurt. Patient
Y exhibiting
3/13/2009welts,3/13/2009
wheezing, welt around
jection site 2" x 1" redness w/ 2" raised
Y areas w/i. No vesicle. No streaky redness. U 4/14/2009 4/24/2009
n in Rt. deltoid about 2-3 hours afterY receiving pneumonia vaccination. Pt could not move her U arm or fingers
3/18/2009
and went3/18/2009
to the ER. Pt given a
st 66, have always had a healthy, activeY lifestyle; have been energetic & chipper Y- hard to keep N me down, 6/10/2008
some favorite
6/11/2008
activities being aer
was considered medically important. Information regarding PREVNAR was received from a U healthcare professional
8/3/2004 regarding a male patie
was considered medically important. Information regarding PREVNAR was received from a U healthcare professional regarding a patient wh
was considered medically important. Follow-up information provided recovery status. Information Y regarding PREVNAR### was received form a
was considered medically important. Information regarding PREVNAR was received from a U consumer regarding her granddaughter who su
n regarding PREVENAR was received from a healthcare Y professional
0 regarding a 19-month-oldY male patient who experienced drug ineffec
was considered medically important. Information regarding PREVNAR was received from consumer U regarding
4/9/2008a 15-month-old male patien
provided Quality Assurance
Y Results. Information Y regarding PREVNAR was received from a N healthcare professional
8/28/2008 9/12/2008
regarding a 3-month-o
received provided additional patient details, medical
Y history, event details,
0 and test results. Information
Y regarding
8/14/2008PREVNAR
10/1/2008was received
n regarding PREVNAR was received form a consumer regarding a 5-month-old male patientUwho experienced### multiple seizures.
### The patien
n regarding PREVNAR was received from a healthcare Y professional regarding a 12-month-old Y male patient who experienced
10/1/2008 drug ineffecti
n regarding PREVNAR was received from a healthcare professional regarding a 6-month-oldY female patient who experienced a linear, raise
n regarding PREVNAR was received from a healthcare professional regarding a 4-month-oldY male patient 9/24/2007
who experienced
11/5/2007injection site a
information provided patient demographics, recovery status, concomitant vaccine, and doseYdetails including lot ###numbers.### Information reg
n regarding PREVNAR was received from a healthcare professional regarding a 4-month-oldU male patient 2/15/2008
who developed
2/26/2008 petechia 11 days
n regarding PREVNAR was received from a healthcare professional regarding a patient whoUwas administered the vaccine that was stored
n regarding PREVNAR was received from a healthcare professional regarding a 4-month-oldU female patient 6/16/2008
who inadvertently
6/16/2008 was given a
n regarding PREVNAR was received from a healthcare professional regarding a 2-month-oldY female patient 6/30/2008
who experienced redness at th
information was received that provided patient information and lot number. Information regarding U PREVNAR
7/28/2008
was received
7/28/2008 from a healthca
n regarding PREVNAR was received from a healthcare professional regarding a patient who experienced low antibody titers. The patient re
mation was received in dose details and source details. Information regarding PREVNAR was N received from a ### mother4/8/2008
and a physician rega
n regarding PREVNAR was received from a healthcare professional regarding a 2-month-old patient who 8/14/2008
experienced 8/14/2008
administered improp
n regarding PREVNAR was received from a healthcare professional regarding a 4-month-oldN male patient9/5/2008 who experienced
9/10/2008rash from head
Information provided test results and a possible cause for the reported events. Information regarding
N PREVNAR
9/22/2008was received from a healt
n regarding PREVNAR was received from a healthcare professional regarding a patient who received PREVNAR that had been frozen on a
n regarding PREVENAR was received from a company representative regarding a male patient who experienced decrease in babbling. Th
n regarding PREVNAR was received from a consumer regarding a 4-month-old female patient U who experienced ### administered### the 2nd dose
n regarding PREVNAR was received from a patient's mother regarding her 4-month-old sonYwho experienced 4/1/2008
injection site swelling, body t
n regarding PREVNAR was received from a healthcare professional regarding a 9-month-oldY patient who experienced facial rash. The pat
n regarding PREVNAR was received from a healthcare professional regarding a patient whoUexperienced induration. The patient received t
n regarding PREVNAR was received form a consumer regarding a 4-month-old male patientUwho experienced broke out all over with a rash
n regarding PREVNAR was received from a pharmacist regarding a 4-month-old patient whoUexperienced5/6/2008 rash and fever.
5/6/2008At 4 months of a
n regarding PREVNAR was received from a pharmacist regarding a 15-month-old patient who U experienced 5/6/2008
fever of 103.9
5/6/2008degrees. The pa
n regarding PREVNAR was received from a healthcare professional regarding a 2-month-oldY female patient who experienced red swollen l
information was received that provided medical confirmation of the events, and also included Y patient demographics,
7/9/2008 7/9/2008
and recovery status. I
n regarding PREVNAR was received from a nurse regarding her grandson, a male patient (age U unknown), who experienced reaction on the
n regarding PREVNAR was received from a mother regarding her 12-month-old female daughter N who experienced
9/2/2008 swelling
9/3/2008 and redness at
n regarding PREVNAR was received from a healthcare professional regarding a 2-month-oldY male patient9/8/2008 who experienced
9/12/2008urticaria on bo
n regarding PREVNAR was received from a healthcare professional regarding a 2-month-oldY male patient7/3/2008 who experienced
7/8/2008rash from head
n regarding PREVNAR was received from a healthcare professional regarding a 13-month-old Y male patient 8/6/2008
who experienced
8/9/2008 hives, extens
n regarding PREVNAR was received from a healthcare professional regarding a patient whoUexperienced 10/1/2008
decreased 10/1/2008
appetite and widespre
n regarding PREVNAR was received from a healthcare professional regarding a patient whoUexperienced extreme pain when PREVNAR w
n was received from a pediatrician regarding a 4-month-old patient who experienced diarrhea. The patient received a dose on an unspecifi
n regarding PREVNAR was received from a pediatrician regarding a 6-month-old patient who U experienced diarrhea. At 6 months of age, th
n regarding PREVNAR was received from a pediatrician regarding a 6-month-old patient who experienced diarrhea. At 6 months of age, th
n regarding PREVNAR was received from a pediatrician regarding a 12-month-old patient who experienced diarrhea. At 12 months of age
n was received from a healthcare professional regarding a 13-month-old male patient who experienced U injection
2/3/2009 site 2/4/2009
swelling and fever of 1
n regarding PREVNAR was received from a healthcare professional regarding a 6-month-oldU male patient2/3/2009 who experienced
2/4/2009injection site sw
n regarding PREVNAR was received from a healthcare professional regarding a 2-month-oldN male patient 12/9/2008
who experienced
12/9/2008injection site h
ped a sore throat and fever 2 days after receiving the vaccine. Fever resolved after 1 day, but U sore throat4/20/2009
persisted 4/22/2009
for several days.
injection site reaction. Softball sized slightly swollen and red injection site area in left arm inYsubcutaneous4/16/2009
upper tricept
4/17/2009
area. Received in
old me today at a sibling's visit that ~2 weeks after patient received her Varivax she developed Y a fever and4/19/2004
what looked 5/2/2004
like chicken pox lesi
edness, swelling, induration, & pain at injection site. unable to lift arm. Started taking TylenolN1000 mg per 4/23/2009
recommendations.
4/24/2009
weating, chills, fainting, pain deep in ears Y 4/24/2009
ours after the vaccine my upper arm began to swell. The injection site had a rash, my entire U upper arm looked
4/24/2009
like a4/24/2009
giant hive. It was very
rhea, crying (insolable), stopped eating
Y typical foods she liked, needed to be in constant
Y motion
N (baby jumper)to ### be happy,### didn't want to be
(pneumococcal polysaccharide) my husband had swelling at the sight and red and very hot.The Y redness4/20/2009
and swelling 4/20/2009
went down the inside
n has been received from a 45 year old female nurse who on 16-APR-2009 was subcutaneously N vaccinated
4/16/2009
with a dose
4/16/2009
of ZOSTAVAX (M
n has been received from a consumer Y concerning his now 5 year old son with developmental N delays, who10/1/2005
at the age 10/1/2005
of 18 months was vac
n has been received from a consumer concerning her approximately 12 month old male withNfood allergies and no pertinent 6/1/2007medical history
o small pox lot number VV04003a. Pt. Y Developed Rash Covering entire body 6 days after vacination.
U poc4/19/2009
fully formed 4/25/2009
then reaction accured
ENTS WIH SKIN IRRITATION AND RED SPOTWS ALL OVER BODY SINCE 25 APR 2009YPT SEEN PROVIDER 4/15/2009 ON 4/25/2009
26 SPR 2009. PT A
d TD vaccination 18 April 09. C/O increased pain over right deltoid muscle on 19 April. Pt states U that pain
4/18/2009
has been4/19/2009
stable for the past wee
es son ran high fever (102 to 103) starting
Y "about an hour after the shots" for most of weekend. Y Developed 4/23/2009
severe headache
4/23/2009and "walked in
ction at injection site. Redness, swelling heat and hardness extending from injection site at left U deltoid to4/24/2009
just aboce 4/25/2009
the elbow. Injection ad
G RIGHT ARM FROM DELTOID AROUND UNDER ARM PIT DOWN TO WRIST, STARTEDY 4/24/09 4/23/2009 4/24/2009
GIVEN TDAP AND MENACTRA AND FAINTED FOR A 15 SEC AND VERBALIZED FEELING Y DIZZY. PT. 4/27/2009
LAID ON 4/27/2009
THE FLOOR AND COL
e and fever reported on 4/3/09 via a phone call to the LPN working at the outpatient clinic. No Y treatment noted.
4/1/2009 4/3/2009
er, child started with fever of 103.7 degrees
Y Fahrenheit on 4/11/09 and she gave him TylenolYand then temperature4/7/2009 went4/11/2009
to 104 degrees so
d with severe arthus allergicY reactionY and pulmonary distress. Treated with high and prolonged U dose of prednisone
3/30/2009 -4/10/2009
ongoing at present.5/4
ather reports elevated temp at home Y 4/23/2009, for which he did administer tylenol. States childY woke up 4/23/2009
approximately
4/24/2009
5 am 04/24/2009 w
eived the flu shot I developed severYnumbness on my extremities witihn 2-3 weeks. Y After thatNI developed severe ###weakness,
11/1/2007loss of motor p
04, not responding to infant Ibuprofen. Up to 1 1/2 days prior, child's personality was a bit off Y (fussy and4/14/2008
not eating 4/21/2008
as well), but no other h
ely after receiving her second varivax in her L arm she began to have hives that would comeYand go. She4/25/2009 was given4/25/2009
2 tsp of diphenhydrami
uth pain on right leg and itching the Y day after. Five days later gave shingles 4/22/2009 4/27/2009
at site starting at 4/23 increasing toYredness and swelling at the site on 4/24. Headache, diarrhea, U nausea,
4/23/2009
vomiting, 4/23/2009
anorexia beginning on
d increased pain that evening and then had red stripe formed below injecttion site- still present U 2 days later.
4/20/2009
Lips became
4/20/2009 swollen for 2 day
ne disease fibromyalgia,Yraynods, numbness,
Y flushing/sweats, anxiety,headaches, Y exhaustionN to the point9/8/2008
where its12/1/2008
impossible to work, tot
ort was received on 21 April 2009 byYanother manufacturer that received the report from a healthcare N professional
2/26/2009on 13 April 2009. A male
ort received on 21 April 2009 from the Y patient's spouse. A male patient (demographics not provided),
N who has autoimmune reactions to milk
mptoms for two to three Yweeks. Numbness
Y in feet
Y - leg cramps - back
30 Ypain in spinal area - problem
U walking (paralysis).
### Hospitalization
### - tes
9 pt came to my office - her VARICELLA vaccine site had a 3 inch circle that was red, hot, painful Y and hard.
4/18/2009
Call to 4/18/2009
mom, ice applied, BENE
& swelling after inj. given & cont >4d after inj. while pt on AUGMENTIN for puncture injury 4/23/2009. Y 4/23/2009 4/23/2009
9 pt presented with classic herpes zoster outbreak (R) side torso (not crossing midline). U 10/6/2008 3/24/2009
anus shot in clinic on 4/21/09, seen in Y urgent care on 4/24/09, site of injection upper left arm,Uwarm, red, tender,
4/21/2009 reaction
4/22/2009
first noted by patie
/2 hr after immunization given, pt noticed slight nausea. At 5:25 PM she became very nauseated U + vomited
3/26/2009
small amt.
3/26/2009
TPR 99 degrees F
area with redness, warmth approximately 6cm X 4cm. No induration temperature 99.4 f (tympanic) U Rx: Apply
4/17/2009
cold compresses
4/19/2009 to site pm Ty
called doctors office 4/16/09 @ 1424 Y and left message for doctors office that pt was in ER on Y 4/15/09 for 4/7/2009
seizure episode.
4/15/2009 Records receive
-09-09 I started getting a 'burning - itchy' feeling on right (back) thigh - it was painful - itchy for
Y about 9 days
3/13/2009
- (and red) 4/9/2009
it was now gone.
Flu and PNEUMOVAX 3/24/09 one in each deltoid. Pain since - Limited range of motion, very Y painful. Referred
3/24/2009 to physical
3/24/2009 therapy - Given
rent called, red puffy (R) leg - local imm. reaction - 1/15/09 Parent called, fever >101 on 1/14/09. Y Red bumps 1/5/2009
on face,1/15/2009
neck, belly and arm -
injection erythema and pruiritis localized to site 1X2 L upper arm. Oral antihistamine and steroid Y cream prescribed
4/20/2009 after4/21/2009
days with injection.
swollen arm, hot tender Y 4/15/2009 4/15/2009
swelling of arm; Hot. 4/15/2009 4/15/2009
sh, few hives occurring after 15 minutes of MENACTRA Admom. Given 37.5 mg BENADRYL Y P.O. 5 minutes
4/16/2009
later c/o
4/16/2009
tight chest - given E
d first GARDASIL injection 4/10/09. On 4/12/09, noted 1cm round tender axillary node. U 4/10/2009 4/12/2009
ankles, elbows, arms, and legs. C/o rash being itchy; 0 trouble breathing. U 3/30/2009 3/31/2009
loose stools, fever Tylenol. U 4/15/2009 4/15/2009
itching, Skin Inflammation topical Cortisone,
Y Oral Prednisone Ultra violet light N 1/21/2008 ###
4 1/2 hours after patient got the vaccineY she felt light headed + dizzy and then became unresponsive,
Y eyes
4/17/2009
deviated4/17/2009
upwards, slight jerking
utes after Pt received 2nd VARIVAX, she started to c/o of sore throat, PF; bilat. wheezing, no Y swelling of4/23/2009
lips; improved
4/23/2009
after Epinephrine 0
cella at VARIAX shot site 1 - 1/2" closed up vesicles on red base. Y 4/6/2009 4/18/2009
9 around 11:30 A.M. had vaccine within minutes felt light-headed and woozy, strong feeling Yabout 2 hrs,4/16/2009 then took 3hr 4/16/2009
nap and gone when
omplained of itching at injection site within 5 mins. of administration. Red rash appeared at Y 10 mins Benadryl
4/22/2009given4/22/2009
to member.
vaccine 041409 fever low grade -> Y 101.8 from 041409 -> 042009. Anorexic, personality changes. U Fever4/14/2009
- no response 4/14/2009
to Tylenol or Motrin.
eloped on back, abd, arms & leg. RednessY & itching. 0 sob Symptoms began 4-21-09 p.m. Y 4/20/2009 4/21/2009
break along 2 T-11. Dermatome within 48hrs of receiving vaccine U 4/14/2009 4/15/2009
rted "dime" size swelling- redness at Y inj. site - "nickle" size swelling/redness itchy under injection
Y site on 4/13/2009
4-14- Child4/14/2009
to ER R/T swelling/redn
after vaccine administration, child felt sick, went to bed early. Awakened in AM with arm pain, swelling, redness 3/30/2009 increasing
3/31/2009 so much that cou
vaccine on 4-21-2009. When awoke on 4/22 didn't notice rash. Got to school + noted rash> Y went to school
4/21/2009
nurse who 4/22/2009
stated she has' hives
unable to bear weight on left leg). Per Y mom happened after given vaccine. N 4/8/2009 4/9/2009
7:50 PM Mother called to after hours triage and report states that Mom reported 'arm swollenYfrom shoulder 4/20/2009
to elbow,4/21/2009
mild redness - no red
pper arm: L red, warm, indurated. Slightly tender. Y 4/15/2009 4/15/2009
ollowing vaccinations, then labwork (Had vaccines, then labs, then syncope occurred - Nothing Y to eat today).
4/23/2009 4/23/2009
4 cm allergic skin reaction CLAITIN/ZARTAC U
OSTAVAX vaccine 4/14/09. Pt developed Y painful case of shingles 4/27/09 requiring treatment U in the ER4/14/2009
(Valacyclovir,4/27/2009
Vicodin)
nd the area itchy, raised area from the Y base and warm to touch, she had Td 10 years ago butNno reaction. 4/17/2009 4/22/2009
hy. Knee pain. Fever. Rash. Y U 4/8/2009 4/12/2009
w hours - splotches noted on both hands Y - Inj given @ 5:15 pm 4/22/2008 1) Eye swollen 2) splotches
Y - now
4/21/2009
hives on4/21/2009
chin / both ears/ rash
ved 4/20/09 - Pt states itching and feet swelling started next day - took BENADRYL - helped,Ubut is having 4/15/2009
itching and4/16/2009
swelling in feet today
tenderness & increased warmth at injection
Y site. Y 1/19/2009 1/26/2009
n has been received from a consumer Y concerning a her daughter 21 year old with Y penicillin allergy
N and no6/17/2008
pertinent6/17/2008
medical history who in
n has been received from a physician concerning Y a male patient who 0 was vaccinated, "within N the last few4/18/2009
days", with 4/18/2009
ZOSTAVAX (Oka/Me
ort received on 15 April 2009 from a pharmacist.Y A 42 year old female 1 patient, who has no known
Y allergies,4/8/2009
a history4/11/2009
of hepatitis B infection,
us case was received on 20 April 2009 Y from another manufacturer whose initial reporter wasUa consumer. A male patient (age not provided
se effects. Received the Tdap vaccination and current age is 69 years. Y 4/27/2009
PED FEVER ON 4/23/09. TOTAL BODY Y RASH(MORBILIFORM) DEVELOPED ON OR ABOUT N 4/24/09.4/15/2009 4/23/2009
8 Client received both Pentacel (DTaP, IPV, HIB) and Pediarix (DTaP, IPV, Hep B) at the same U visit. 4/22/2009 4/22/2009
as very irritable and "not himself" for a duration of 3 days after administration of the second dose Y of Hep A 4/21/2009
vaccine. 4/21/2009
tient recieved four doses of Anthrax between the dates of 02-JUN-08 and 06-AUG-08. U 3/19/2009 3/19/2009
OT SLEEP AT ALL, JOINT PAIN, SWEATS, CHILLS, SWOLLEN ARM Y 4/27/2009 4/27/2009
profuse sweating, disoriented for 10 minutes Y 4/24/2009 4/24/2009
ours of Tdap and Varivax administration,
Y patient experienced redness,itching,and swelling ofYLeft upper 4/24/2009
arm.Mom applied4/24/2009 cool compresses
minutes after IPV,Prevnar and Hep A given, child developed 3-4cm hive on right wrist and 2 Ysmaller hives 4/28/2009
on back and4/28/2009
chest.Wheals noted
ctivity taken by ambulance to hospital Y 18 hours after vaccine given. Patient has no previous U events of seizures### ever. 5/4/09 ### MR received fo
HAD VACCINE ON 4/21/2009AM, CAME BACK ON 4/22/09PM AND WAS COMPLAINING U OF PAIN AROUND
4/21/2009 THE4/22/2009
INJECTION SITE, LE
ated on a chair in exam room one with mother and younger brother present. Patient given HPV, Y Tdap, and 4/20/2009
Menactra 4/20/2009
vaccines at 4 pm by R
### N ### ###
s: hives, vasculitis, joint pain, swelling
Y of feet, hands & eyes, extremity pain, fever up to 101. Ufor 3 days. Treatment:
4/15/2009 benadryl,
4/16/2009steroid pack,
ped an egg shaped reddened, hot area on the upper back part of her right arm where she got Y her varicella
4/27/2009
shot yesterday.
4/28/2009 It was noted by
VEN 4/22/09 IN AFTERNOON. LEFT Y UPPER ARMS SORE REST OF LAST WEEK. EMPLOYEE Y DESCRIBED
4/22/2009 A FIRM
4/27/2009
LUMP AT INJECTI
oke out in hives all over her body, which was highly pruritic. Felt some throat swelling but not Y enough to 4/21/2009
constrict airway
4/21/2009
completely. This o
ped hives after injection and was seen Y in the ems - f/u at pcp today 4/23/2009
eived the influenza, pneumococcal (PPV23), Tdap, MMR, Hepatitis A, Hepatitis B, and shingles U Vaccine 4/22/2009
at 10:10 a.m. 4/26/2009
at clinic. Client then
d Tdap on 4-22-2009, IM in left deltoid swelling stated 3 days later. Redness from top of deltoid U to elbow4/22/2009
and area is4/25/2009
hard and warm to the
ates arrived home @ about 11 am. YPt. began having reaction starting @ about 11:30 am. Began Y with swollen
4/24/2009 mouth,
4/24/2009
then right eye, then c
C/O PAIN STARTING 8 HOURS AFTER Y SHOT WAS GIVEN. REDNESS ON ARMPIT AND LEFT DELTOID. 4/24/2009 4/24/2009
ived a 4th DTaP and IPV as well as a 5th Hep B when she was given a Pediarix vaccine 4/22/09 Y at less4/22/2009
than 12 mos 4/22/2009
old, 1 Pediarix not on
ately 1 minute after receiving the vaccines the patient passed out without any warning - he had Y a mild tremor
4/28/2009of the arms
4/28/2009
and legs that last
tient was quite irritable and slept a lot, maybe for the first three days. The worst symptoms IUsuspect come 4/20/2009
from the4/20/2009
rotateq vaccine, since
hange in feeding pattern and marked temporary loss/regression of social milestones approximately Y 1 week7/20/2007
following7/27/2007
routine 2 month immun
eloped bilateral buccal mucosa swelling Y 7 hours following MMR vaccine. swelling is non tender N and only 4/28/2009
from the inside.
4/28/2009
no visible external
was reported by a lawyer and described the occurrence of arthralgia in a female subject of unspecified
U age who was vaccinated with LYME
Y of arthralgias
0 in a male subject of unspecified
U age who was vaccinated with LYME
Y of Guillain-Barre
0 Syndrome
Y in an adultN male subject12/1/1996who was vaccinated with INFL
eption reduced 5/04/09 Received vaccine & PCP Y medical records of1 4/13-4/27 as well as hospital
Y d/c summary
4/13/2009 of 4/27-4/28/2009.
4/26/2009 FINAL
Yellow fever immunization 3-18-09 prior to trip Y to a foreign country. 3Developed flashing spells Y 3-29-09. Received
3/18/20093 L3/29/2009
IVF prior to departure.
surfaces rash on elbows, knuckles, Y knees. SkinYbx: leukoclastic vasculitis
2 consistent with erythema
Y elevatum 7/1/2008
diutinum.
7/26/2008
5/26/09 medical rec
h screams for 3 days and for 10 days: Y lethargy (limp)
Y - Non reactive - lack eye contact avoid communication
Y 3/2/2009
- stopped3/2/2009
feeding - stopped lau
Flu Vaccine on Oct. 10, 2008. 5 days Y later began fatigue which progressed to anaphylaxis,
Y episode
N 1 on October. ### Received ###corticoteroids.
aricella #2 9/26/9 (1st dose was 5/03) within 24 hrs flat rash noted on chest, face & neck. Wo Y c/o rash to chest c/o itching on neck, face wit
rm swelling red, tender, itchy after vaccines given 2 d ago- progressively worse 4/26/09 afterYpain but mostly 4/23/2009itchy. 4/23/2009
L arm few small slightly
oster type rash developing on R lower leg 6-7 days after vaccination examined today 4-27-09. N No other identifiable
4/13/2009 cause.4/20/2009
th pain at the injection site 5 1/2 hrs after immunization, low grade fever 18 hrs after injection; Y 24 hrs after4/24/2009
injection arm
4/24/2009
painful to touch, sw
le of erythema on right side of (L) thigh.
Y A bit of induration, but no underlying mass and no warmth."Y This4/21/2009
is MD's report.
4/22/2009
Also says "local rea
of breath, tingling, sweating. Y 4/28/2009 4/28/2009
es, high fever. At night chills, sweating, sore joints. Symptoms continued until Friday. Sunday U slept late4/23/2009
still had sweating/chills.
4/23/2009 Right now
4/28/2009
nto office + reported vaccine site was red, raised + warm to touch. Presently abscent disappeared Y on its own. Zero intervention needed.
s after getting vaccine, arm becameYred, swollen, and described itching at site of vaccine, pain Y to move. 4/24/2009
Applied ice4/24/2009
that evening. Mom stat
d to hospital 4/23/09 with reported edema - redness and tenderness of left deltoid. Treated with Y KEFLEX 4/20/2009
250 mg TidX7days.
4/23/20094/27/09 only s
n at injection site beginning 4/13/09 in the evening. States she noticed inflammation, redness, Y and warmth 4/13/2009
at injection
4/13/2009
site on 4/15/09. Relie
a of petechiea under right eye within 5 minutes of vaccine adm., approx 1/4" wide X 1/2" wide Y -was crying4/22/2009
vigorously4/22/2009
prior and during vaccin
shakes chills abdominal pain sore throat, headache started at 10 pm on 4/6/09. Y 4/6/2009 4/6/2009
orts rash to inner arms approx. 10 minutes after receiving vaccines on 04/09/09. Clients states Y she began4/9/2009
to experience4/9/2009
pain in Rt shoulder
ools, crying spells, abdominal pain crumps,
Y decreased appetite, diarrhea. Per mom Y 2/24/2009 2/26/2009
loped rash behind ears, back of neck and on face then went to arms, torso and legs. Had running nose : raspy 4/6/2009breathing.
4/19/2009Saw on 4/23.
ack into office. Per mother child had been crying since received vaccine. On examination swelling Y of the4/20/2009
upper R thigh4/20/2009
warm to touch red a
stered VARIVAX and DAPTACEL in (R) Thigh on 4/21/09. On 4/22/09 Pt developed quarter N size area of 4/21/2009
redness, swelling,
4/22/2009 with pruritus. Gi
eneralized 2 days after immunizations Y Y 4/15/2009 4/17/2009
en instead of TDAP. Y 9/12/2008
of LA, tender, hot, itchy - 2nd patient with same reaction to same Immunization Y 4/21/2009 4/21/2009
er vaccine developed diarrhea, > 10 times per day initially, some mucus - straining noted, noYblood. No 2/25/2009
fever, no ill 2/28/2009
contacts.
ness, itching & induration @ left thighY surrounding site of immunization within about 24 hrs. of U vaccines -4/20/2009
treated with 4/21/2009
BENADRYL
4/23/2009
er had bad stiffness on back of neck and then it went down both sides of torso. Called doctor U but said not
10/1/2008
related to vax. Pain on back sub
t 8:45am patient was vaccinated at Y the Health Department with Hepatitis A vaccine at 8:47am Y patient fainted.
4/27/2009Nurse4/27/2009
saw her unresponsive,
4/20/2009
rapid hair loss a month after administration of GARDASIL vaccine 8/1/2008 3/15/2009
eloped 2 days after shot - first on arm where shot was given then all over body. Headache today N - 4-28-09. 4/20/2009 4/22/2009
r HEP A with in 24 hr ATAVAX if needed. Y 4/8/2009 4/9/2009
ad at clinic c/o having reaction - redYrash noted on arms, legs, face - stomach and back approx U 2 min hard 4/28/2009
hot redness
4/28/2009
area noted at injecti
dness, edema 3 d after vaccine. 4/21/2009 4/24/2009
Mom reports that client "walks strange, bobs head, hands shake, and coordination is off" afterNseries of hepatitis 7/1/2001b vaccines
8/1/2001in 2001-2002.
swelling and pain at injection site. Tenderness and slight rash also noted. 4/14/2009 4/15/2009
vaccine on 4/13/09- symptoms began morning of 4/18/09, severe headache - 2 reddened areas N R shoulder;4/13/2009
one just
4/18/2009
above acromion proce
ction at injection site right thigh - warm, red & swollen Rx'd with MOTRIN & warm packs. resolving U 4/23/09
4/21/2009 4/22/2009
esented to clinic on 4/24/09 c/o right arm pain extending to neck and fever. Upon examination, U right arm 4/22/2009
edema from 4/24/2009
shoulder to elbow. Rig
hoarse and hives - She lost her voice I was very scare so I took her to her doctor. Y 4/7/2009
unk and back that started about 4 days Y post smallpox VX. U 4/10/2009 4/16/2009
VAX administered right deltoid 4/21/09 after leaving office, pt started to develop pain in rightYupper arm. 4/21/2009
During rest4/21/2009
of day and night, pain i
ped hives right after vaccinations and for 1 week has raspy voice - increased vomiting, crankiness Y and episodic
4/15/2009 hives.
4/15/2009
Was treated with 3 d
hours, developed fever - 101.8 degree - Aching joints, headache. Treated with Ibuprofen. Duration Y - 12 hours.
4/17/2009 4/18/2009
er, with bulging fontanelle and CT scanY with prominence of anterior CSF Spans over both frontal Y and temporal
4/6/2009
lobes 4/7/2009
- No hydrocephalic. Th
d rash appox. 1 1/2 " X 1 1/2. Very itchy. Pt. observed for one hour post 25mg po Benadryl. Y 4/14/2009 4/15/2009
tous area surrounding injection site 5x5 cm diameter with mild tenderness to palpation no fluctuance.
U Will try for possible infection. AUGME
e pale after the vaccination, lost consciousness
Y for 3 minutes - appeared to have a seizure vital
Y signs stable.
4/18/2009Paramedics
4/18/2009came and pt. refu
ceived BIOTHRAX in 2000. Over the last year his ankles, wrists and knees became inflamed. N He was diagnosed
6/3/2000with4/4/2008
autoimmune hepatiti
n has been received from a health careY professional
Y concerning an 311 year old female patient
Y who on an12/1/2008
unspecified 12/1/2008
date was vaccinated
n has been received from a consumer concerning her now 5 year old son with OMNICEF allergy N and a history
10/1/2004 of bronchiolitis
10/1/2005 at 5 weeks of
n has been received from a female Y patient, with iodine allergy and "severe food allergies", who
Y on approximately
5/9/197709-MAY-1977,
5/9/1977 at the age
n has been received from a consumer concerning her friends' boys who on an unspecified dates U were vaccinated with MMRII. "One week l
t was received from a health care professional Yon 16 April 2009, and 1 refers to a serious adverse
Y event experienced
11/3/2008 12/1/2008
by a subject participatin
ort was received 28 January 2009 from Y a consumer, who is also the patient. A 59-year-old female N patient with
5/1/2007
history 7/1/2007
of a recent black wido
ering entire body, swelling of joints, Y
benadryl, oral steroids Y 3/9/2009 3/9/2009
min. post injection patient had mood change, redness, swelling at injection site along with legYpain. We watched 4/27/2009 patient
4/27/2009
for a while and then
eived Tdap without any symptoms of concern. Then, immediately after HPV vaccine was given, Y the client4/29/2009
complained 4/29/2009
that her arm hurt. She
o Tdap, muscle aches, headaches, fatigue. Worst was injection site allergic reaction to pertussus U vaccine.
4/24/2009
Arm was 4/25/2009
very red, swollen, ver
a around the Shingles vaccine U 4/27/2009 4/29/2009
eports beginning to feel nauseous 6 hours after receiving vaccine. 18- 24 hours post vaccination Y member4/27/2009
reports nausea
4/27/2009
and 2 incidents of
VER WITH NORMAL CBC,PARENT REPORTED 106 DEGREE FEVER THE NIGHT VACCINE Y WERE GIVEN 4/28/2009 4/28/2009
d MMR and Varicella vaccines and immedicately developed redness and swelling at both injection Y sites 4/17/2009
and hives on 4/17/2009
abdomen. No respira
oid- 2 days sfter vaccine administration, the injection site is hard, red, warm to touch and tender upon palpation. 4/27/2009 4/28/2009
oster C34 dermatoma Greater than 20 vesicles U 4/1/2009 4/29/2009
igns begin with a pain in my right arm Y three-four Y days after my vaccine.
6 I was not able to raise
N it above my head. ### The
11/2/2008
pain moved to my sh
RASH THATS GETTING WORSE AND SPREADING U 2/15/2008 4/24/2009
njection in deltoid. developed over next 24 hours swelling, erythema, pain, and fever and general Y mailaise.
4/17/2009
this lasted
4/18/2009
for three days.
m injection site a 15x15cm soft nodule appear while appling pressure to syringe with some resistence noted. 4/29/2009
Soft nodule
4/29/2009
with reddnes and n
, facial swelling- in pts temples U 4/28/2009 4/29/2009
4/24/2009 N 4/21/2009 4/23/2009
le subject was enrolled in non-GSK study. Medical Y conditions at the0time of the event included U seizure disorder.
8/28/2003 Concomitant
8/29/2003medications i
tient consult has been requested onYa 20 y/o WM Y ADSM hospitalized for severe thrombocytopeniaU and ITP4/16/2009
in association
4/23/2009 with the receipt o
. Baby presented the day after receiving his immunizations
Y with fever,
2 vomiting and diarrhea.Y Baby had been4/21/2009
having4/22/2009
watery stools 2 to his
patient came for a well childY check, Y immunizationsY given at 9:30AM 3at around 1:30PM patient U woke up from4/27/2009
sleep cried
4/27/2009
and turned limp, ca
usea, HA, sore throat, rhinorrhea, + Ycough. Sx started hours after typhoid vaccine given. Given Y Augmentin 4/17/2009
875mg 4/17/2009
BID x 10d.
ction on R upper arm (injection site) with erythema, warmth and mild tenderness. Keflex 500Ymg PO BID4/28/2009 x 7 days BENADRYL
4/29/2009 25 ml after 6
arm was sore for 3 days. Then in a week Y she started having spasms in her arm that continueNto happen at 10/8/2008
night still.10/9/2008
Has gotten a steroid s
dministered on 4/23/09. Immediate Y bruising noted 1/2 dollar size. Bruising dissipated over weekend
Y but Pt4/23/2009
developed 4/23/2009
site of erythema, rais
udent in nurses office or immunization clinic. Rec'd 5 vaccines - after several min of sitting lookingY @ stickers
4/29/2009
leaned4/29/2009
to (L) an fell out of cha
U 4/27/2009 4/28/2009
3-4 lesions with cellulitic area on (L)Y thigh. Topical warm compress and PO Augmentin. Y 4/20/2009 4/28/2009
hematous rash under the skin on the anterior aspect of both lower legs, vaccine site normal. YRash was noticed 4/28/2009right4/28/2009
after vaccination. Obse
wollen and red about 10 cm X 6 cm Y within 1-2 hours after getting vaccine - given oral steroidsU and Antihistamine.
4/28/2009 4/28/2009
ADACEL on 4/16/09 and by 4/18/09 the right arm became entirely swollen and the injection Y site became4/16/2009
indurated, 4/18/2009
reddened, painful and s
out in hives face to legs 1 1/2 hour after receiving MMR II vaccine. Parent went to daycare, did Y confirm hives
7/21/2008
with moderate
7/21/2008 wheezing. BEN
iven 10:15 A and by 12:00 MN 102 Y deg and 4:00 increased 103.7 vomiting and fever. Seen Y by Dr later in4/20/2009
day 2 pm 4/20/2009
c/o pain (R) shoulder, r
meter redness, and warm to touch area Y surrounding shot site. U 4/23/2009 4/24/2009
ed the Zostavax vaccine on 4/3/2009. About 2 days after the injection she noticed a big, red,Uand swollen4/3/2009 area on her4/3/2009
upper arm. She repo
received the roto vaccine - by mouth - along with her other 2 month vaccinations - injections-. U She had blood in her4/22/2009stool and extreme disc
er DTAP, arm red & swollen & warmYdeltoid area. No fever. U 4/27/2009 4/28/2009
n has been received from Y a certifiedYmedical assistant concerning a 71 year old maleY who on Y 01-JUL-2008 7/1/2008
was vaccinated
7/7/2008 with PNEUMOV
n regarding PREVNAR was received from a healthcare Y professional0regarding a 2-month-oldY female patient
4/27/2009
who experienced
4/27/2009 apneic episo
was received from a health professional Y on 07 November 2008, and represents a cluster of Y 20 patients. Twenty ###
patients, ###all employees of
n has been received from a licensed Y visiting nurse, for the GARDASIL a Pregnancy RegistryYconcerning3/20/2009a 23 year old3/20/2009
female with hypothy
Y a 36 month old male who on 07-MAR-2006 was N vaccinated4/4/2007
with a first 4/4/2007
dose of PEDVAXHIB
n has been received from a nurse, for Y the Pregnancy Registry for GARDASIL, concerning a Y27 year old 7/22/2008female with7/22/2008
cephalexin allergy and
stered to patient. Less than 3 minutes Y later patient was leaving clinic and collapsed to floor. YHe did not have
4/29/2009
any trauma.
4/29/2009He was cold and s
udent mistook Menactra as the diluent for the varicella and injected it subcutaneously. No problems Y with4/29/2009
patient therefor
4/29/2009no treatment need
veloped maculopapular rash over entire Y body 14 days after vaccine administration. Patient seen
Y 4/18 for 4/1/2009
this rash (by
4/14/2009
MD), and unclear if v
ills, Bodyaches, Nausea, Vomitting,Yand local site reaction (redness, tenderness) U 4/27/2009 4/28/2009
9 PATIENT WAS ADMINISTERED THE SMALLPOX VACCINE AS A REQUIRED PROPHYLACTIC Y BEFORE 4/3/2009
DEPLOYMENT
4/20/2009 WITH HIS U
ential swelling and redness to right upper
Y arm/deltoid, especially near area of vaccine administration,
Y +pruritis,
4/28/2009w/in 4/28/2009
the first 24hrs of vaccine
esented to the ER with R arm swelling Y with redness and puritus. Y 4/28/2009 4/28/2009
e severe pain in left arm, 'as though someone just broke it'; headache developed; 24 hours ofNjoint and muscle 2/23/2009pain;2/23/2009
within weeks, sharp sta
WAS GIVEN ALL THREE VACCINES HEP A#1 (RIGHT ARM), MCV4 AND HPV#1 (LEFT ARM) Y IN THAT 4/29/2009
ORDER,4/29/2009
WHEN I WAS APPLYI
arm to the touch and red Y 4/27/2009 4/28/2009
aricella rash began 04/28/2009 treating with Y 4/7/2009 4/28/2009
lled me the day after the administration complaining of Headache, Fever, Chills, Loss of apetite. U I explained that she was experiencing a ra
.3F and chills and Severe headache Y began at 2:30am. Pt came to health unit at 0830. Pt given Y Tylenol 650mg
4/28/2009 and 4/30/2009
slept. At 11:30 pt report
ed today, stating she had just noticed a rash around the site of injection, also c/o itching fromUrash. NO fever 4/23/2009
or other
4/30/2009
symptoms.
as seen by this physician three days after administration of Menactra. He was complaining ofU back pain,3/24/2009 shoulder pain,
3/24/2009
headache, lighthea
ening, fussiness, constant crying, poor Y appetite, vomiting, skin rash (head, face, neck, ears, Ybehind ears,4/14/2009
abdomen,4/17/2009
back, legs, arms, feet),
4/27/2009 N 4/24/2009 4/27/2009
wn with Evans SyndromeY3/15/09. Seen Y for irritability
Y 3/7/09. 5/4/0919Received
Y hospital medical
U records of 3/4/2009
multiple admits.
3/15/2009 FINAL DX: throm
d neck right arm pain immediately afterY head/neck trauma in Mar 2003; received AVA#4 Y oneNmonth later4/26/2003
with continued neck pain, intermitt
veloped severe systemic rash, elevatedY temperature, continuous crying, inabilityYto sleep. ANmonth later patient### stopped smiling,
### and devel
h stomach pains, rash on the top and Y bottom ofYboth feet. Stomach14pains were intermittent then Y became2/28/2008
constant. 13/10/2008
year later 2/09 diagno
+ swelling, heat @ site of injection erythema 130mm X 70 mm - slightly indurated. Y 4/29/2009 4/30/2009
ived above listed vaccines 11-20-08Y at routine WCC visit at 12 noon. Child developed tactileYtemp 11-21-08 around ### 1pm followed
### by pruritu
mplained of headache, ringing in ears, + occasion blurred vision. Given a Medrol Dose pack.U 4/22/2009 4/22/2009
warmth to injection site - 4/28/09 @ 8 AM followed with itching, increased heat/swelling on same morning. 4/27/2009
By 9 PM4/28/2009
on 4/28/09, she had a l
ports patient complaining of severe headache and (L) arm pain at school today (11 AM) -Become Y unruly 4/27/2009
and "violent" 4/28/2009
with staff at school. T
d 12 month vaccinations on 4/18/09. Y She had zero reaction at first, but 1 week after shots pt. Y began having 4/8/2009
a fever.4/20/2009
This lasted 4 days off
Hrs of vaccine, pt noted extreme tenderness, and swelling of upper arm. Sx worsened over next N 48 Hrs. 4/27/2009 4/27/2009
x 15 min & c/o HR. No sensitivity to light/sound, dizziness, lightheaded. Pt instructed to take U Tylenol & call
4/23/2009
if symptoms
4/23/2009
persist/worsen.
d swollen with erythema over large area. (4" x 3") Y 4/28/2009 4/29/2009
er arm with redness, swelling & warm Y to touch qcm in size Dx with cellulitis. Y 4/21/2009 4/22/2009
wollen, hot, reddened (size of a softYball) hard lump - VARIVAX. Right arm same but the sizeNof an apple4/22/2009 - MENACTRA. 4/23/2009
face and back. Y 1/12/2009 4/25/2009
erythema & swelling extending 3 cmY inferior to lower shot & 1/2 cm above upper injection site Y - supportive4/16/2009
care ZYRTEC
4/18/20091/2 tsp daily prn -
e slightly lightheaded immediately after receiving GARDASIL #3. She layed down but continued Y talking 4/17/2009
& said she 4/17/2009
felt fine. She walked ou
eloped chicken pox disease - in clinic 4-24-09. U 10/2/2008
er injection: lip swelling, nausea, redYinjection site. 48 hrs after injection: larger area of redness
Y with central4/13/2009
bullous lesions.
4/15/2009 Treated for 1 1/2
es 2 days after vaccines patient's eyesY rolled back in her head, she stiffened out and was "slobbering".
Y Denies
4/1/2009
increased
4/3/2009
temperature. Calle
miting + diarrhea 48 hours after vaccines
Y given. Went on to develop URI sx's - v/d were <24Uhours. 4/22/2009 4/24/2009
use my arm/shoulder, extreme pain & tightness. Unable to work due to some of the requirements N of my3/18/2009
job. I had 3/18/2009
X-rays taken & have be
s, odynophalgia, nausea, vomiting, decrease appetite, dizziness. Y 4/20/2009 4/20/2009
immunization site reaction 4cm X 6cm Y erythematous area on upper right arm. Warm, clearlyYdemarcated2/25/2009 area, tender2/27/2009
to touch, no streakin
pain, local reaction seen in office 2/25/09 T97.7 P75 R16 Erythema at injection site rest of exam U normal,2/18/2009
BP 124 / 76 2/18/2009
Wt 215 lbs, 4/7/09 sti
was reported by a pharmacist and described the occurrence of injection site pain in a subject U of unspecified age and gender who was vacc
Y and described the occurrence of wrong route of administration
N 1/7/2009
in a 19-year-old
Y and described the occurrence of wrong route of administration
N 1/7/2009
in a 19-year-old
Y the occurrence of watery eyes in a 58-year-old male
N subject who was ### vaccinated### with (FLULAV
reported by a healthcare professional via a sales representative and described the occurrence U of injection site reaction in a subject of unsp
Y the occurrence of itchy rash in a 75-year-old maleN subject who 11/5/2008
was vaccinated
11/7/2008 with (FLULAVA
: SM contacted VHC reporting receipt Y AVA #2 on 4/8/2009 (lot# unknown). The next day he U had numbness 4/8/2009
to right 4th/5th
4/9/2009 digits. 4/10/09 th
ter was given all three doses
Y of Gardasil
Y on 8/28/08,
Y then on 11/1/08,3 and the last on 3/7/09.NOn April 11,3/7/2009
2009 my daughter
4/11/2009suffered with t
BALL SIZE NODE IN ARMPIT OF SAME ARE ARM AS INJECTION SITE. MADE SLEEPINGUDIFFICULT4/20/2009 AND ARE4/30/2009
MOVEMENT PAINFUL
00.7F, body aches, HA, sore throat, fatigue, dizziness, sore arm Y 4/27/2009 4/28/2009
indegestion, lack of appetite, weightloss,
Y dizziness, abdominal pain, fever, fainting, listlessness
Y and nausea. 1/7/2009
This lasted
1/8/2009
from date of vacci
erythema Left shoulder and axillaryYarea. Lymphadenopathy. Y 4/17/2009 4/27/2009
r chest, back, and arms. ITCHING,YNO DRAINAGE. Y 4/17/2009 4/27/2009
ports client with elevated temperatureY (average 101) following vaccinations,also reports moderate Y cough.4/24/2009
Temperature 4/24/2009
continued elevated
ardened red area mid clavicular, leftYside, pea-sized. Vaccinatiion site, left deltoid, erythematous.Keflex
Y 500
4/18/2009
mg 1 tab 4/18/2009
4Xday X10 dys
mom stated symptoms of redness and Y swelling at injection site on left upper arm developed on Y 4/28/09 in4/27/2009
the evening.4/28/2009
Arm felt hot to the to
dministered on 04/28/2009. Within 24 hours swelling, fever at injection site, tenderness,and N increasing redness
4/28/2009 appeared.
4/28/2009 Within 48 hours
stated sylmptoms of redness and swelling @ injection site of left deltoid on 4/29/09 in the morning.
Y Arm4/27/2009
felt hot to the
4/29/2009
touch Dr. Knox at No
hrs after DTaP pt had fever with seizure.
Y He had had a febrile seizure the night before with diagnosis of4/29/2009
ear infection.4/29/2009
nd Pain at injection site, increasing Y
in size. Cramping in stomach with meals. Cellulitis LeftYArm. Keflex 4/18/2009
EQ 250mg 4/30/2009
4 times daily X10 day
SEIZURE ON 28APRIL2009, MOTHER Y OF PATIENT CALLED 911 AND WAS TAKEN TO THE Y ER BY 4/20/2009
AMBULANCE 4/28/2009
Erythema Multiforme on back associated
Y with puritis and uncomfortable. No respiratory distress.
Y Epinphrine
4/16/2009
0.3mg4/30/2009
IM, Benadryl 50mg IM
area at site of each injection. N 4/23/2009 4/24/2009
MATELY 3-5 MINUTES AFTER RECEIVING THE VACCINE THE PATIENT SUDDENLY PASSED Y OUT4/27/2009
- SHE HAD 4/27/2009
NO WARNING - SHE
after administration of MMR client noticed reddness the size of 50 cent coin. The following day Y (5/1/09) swelling
4/24/2009 had 4/30/2009
increased to 50mm in s
Left legs had cellulitis, redness. DidYrequire IV Yantibiotics for 4 days.1 5/22/09 Received hospital
Y medical4/27/2009
records of 4/28/2009
4/29-4/30/2009. FINAL
N
he day after receiving the vaccine) Y the patient returned to the provider's office with-3 spots ofU maculopapular
4/28/2009
rash on 4/29/2009
9, Pt came in for #2 GARDASIL. Pt had no adverse reaction to #1 dose. Pt had a vasovagalYepisode immediately 4/24/2009after 4/24/2009
vaccine given. Pt ha
hours after admin of vaccines began Y vomiting Q 30 min- was taken to ED- called night clinic X2. 4/29/2009 4/29/2009
ea on right deltoid of erythema and induration, noted about 24-36 hours after vaccine. Ice applied. Y 4/29/2009 4/30/2009
ke a size of a baseball hot and red. Y 1/14/2009 1/15/2009
eaded with tunnel vision (compared to distorted vision experienced with ocular migraine headaches Y experienced).
5/1/2009Bp5/1/2009
156/90, pulse and res
area red and swollen about half of back arm, hot to touch, hurts to touch and itching. Y 4/29/2009 4/29/2009
on (MD): Pt had dried like zoster rash Y to forehead X 3 days with mild fever only. Now has vesicular (urticaria) 4/16/2009
rash with
4/26/2009
sciatica without feve
thy 4 mo. old admitted toY ER statusYepilepticusYand intubated upon 7 arrival. During hosp. hadYposs. aspiration
3/23/2009
pneumonia
4/13/2009
(+) culture Moroxe
area right upper arm warm, pink sl. firm. Symptoms decrease today with papular at injectionYsite. No anaphylaxis 4/25/2009sx4/26/2009
- no encephalopathy s
m Erythemic warm rash on Lt thigh. Mom putting salve on it. That is helping. Pt mom statesNgot whole body 4/24/2009
rash @ 2 months with vacc.
open cut. used rubbing alcohol to clean at home. Has clear liquid at injection site after couple Y of days, then12/2/2008
it scabbed
12/2/2008
over and got better.
welling and redness of whole right upper arm for 3 weeks. Hives and welts everyday for several U months, stomach ### shut down for about 3 we
Y Y 4/10/2009
Y U 4/29/2009 4/30/2009
ported severe injection site soreness. Y N 3/12/2009 3/12/2009
rm redness with swelling slight induration 10cm X 8cm. Y 4/22/2009
as given Pediarix vac. but was supposed to get a DTAP vac. 4/27/2009
d region w/ 7x7 cm round, well circumscribed
Y erythema. Are defined by rash is tender & indurated.
Y Dx cellulitis
3/6/2009 + abscess
3/6/2009
Keflex 500 mg o
in a rash that evening. Rash is on the face, neck, both arms legs and abdomen. No temperature. Patient4/24/2009 stated her4/24/2009
Band Aid at home she
neralized weakness + malaise. Y 4/20/2009 4/20/2009
vaccine was administered first. Then PENTACEL (IPV-DTAP-HIB) was administered IM in the U right thigh, 4/30/2009
then PCV75/1/2009
administered IM left
ocalized redness + swelling, hot to touch, no pain or tenderness. Complaints of itchiness. No Y fever, patient
4/14/2009
took Benadryl
4/18/2009
for allergic reacti
action - hives - severe wheezing, breathing,
Y throat. U 4/28/2009 4/28/2009
as given HEP & DTAP vaccine in the (L) arm on 4/28/09, 1 day later was noted to have swelling, Y redness4/28/2009
itching on the (L) deltoid area, les
ven MMR vaccine instead of MENACTRA. Y 4/27/2009
EP B & MMR given in (L) upper arm. Arm swollen with hive - like rash from elbow to deltoid on U 2/3 of arm4/27/2009
circumference.
4/28/2009
Cold compresses
was given MMR & VAR pt started crying. Y When pt was given HEP A. pt started crying and gaspingY for air.
3/23/2009
Pt also sweating.
3/23/2009
multiforme - minor. U 4/17/2009 4/25/2009
r VARICELLA was given on 4-16-09 Pt developed a red swollen area located where vaccineYwas given. 4/16/2009 4/25/2009
s swollen, puffy and red with peelingYof skin and crusting. Y 4/27/2009 4/28/2009
lesion trunk with scabbing and diagnosis of herpes zoster. Y 8/30/2007 4/18/2009
ped a local rxn one day after vaccine DTAP was administered. Also papular lesion developedY on chest area. 4/29/2009 4/30/2009
hours, pain, swelling at injection site. Low grade temperature 99 degree to 100 degree. Myalgias, U malaise. 8/27/2008
At 48 hours8/29/2008
with squamous eryth
called stating child complains of seeing snakes. Anxiety and hallucinations. U 4/30/2009 5/1/2009
rs, ipsilateral axillary pain, fullness. Low grade (unmeasured) fever. Local tenderness, swelling Y at the injection
4/20/2009site. 4/22/2009
was reported by a consumer, the subject's
Y mother, and described the occurrence of swellingNin a 5-year-old 3/31/2009
male subject
3/31/2009
who was vaccina
N in a 5-year-old
4/9/2009female4/9/2009
subject who was v
Y and described the occurrence of erythema i a 4-year-old
N female
4/10/2009
subject 4/12/2009
U in a 4-year-old
4/13/2009male 4/15/2009
subject who was vac
was reported by a physician via a GSK representative and described the occurrence of red N spot at injection
4/16/2009
site in a4/16/2009
was reported by a healthcare professional via a sales representative and described the occurrence U of swelling in a child subject of unspeci
vaccination 10/30/07; returned to doctorY with pain
Y in left shoulder (same
3 as vaccinated
Y arm) Nwithin two months;### began1/2/2008
experiencing pain, n
he, lethartic onset 48 hours after vaccination with guardisil Y 4/24/2009 4/26/2009
er, very tired and rash (skin raised, hot, not itchy, red) on upper left leg appeared. Shot put U in back of left4/21/2009
arm. 4/27/2009
e rash all over legs and arms appeared 2 days following injection. Rash lasted 8 days and continued Y to leave
4/17/2009darkened
4/19/2009
spots for over 2 ad
numb for approximately 30 minutes after receiving Anthrax vaccine, event has happened forYthe past 2 doses 4/30/2009 4/30/2009
mptoms, shaking, "bobblehead" mannerisms,
Y "dizzy appearing" per parents starting 3 days after
U vaccinations.4/22/2009Self-resolved
4/25/2009 by 6 days, but
LITTLE OVER 24 HOURS. FIRST SIGNS, SEVERE SORE THROAT, NECK PAIN, ARM PAIN, U STOMACH 4/20/2009PAIN,4/22/2009
A PINK EYE TYPE INF
ide of cheeks. Y Y 4/28/2009 4/28/2009
rned to office - stated "my son passed out" - Found seat belted into passenger seat - eye opened Y responded 5/2/2009
by name. 5/2/2009
Asked what happen
a tetanus shot for an infection, and received the tdap. I experienced a sort coughing spell within Y 10 hours, 4/30/2009
mild cold 4/30/2009
symptoms the next mor
njection 5/1/09 yellow fever vaccine.Y Noted arthralgias, myalgias, swollen hands and fingersUand bilateral5/1/2009 lower leg red5/2/2009
rash. Specific manu
ustular rash extending from L shoulder Y near vaccination site, across back and upper chest, few U lesions on4/22/2009
thighs 5/28/095/2/2009
ED records receiv
Vision,Blood restal,soryasisY 6/8/09 Received medical records from 7/20/2006-6/4/2009. Records N reveal patient
4/23/2003 experienced:
6/20/2006exacerbation o
n has been received from a TV news Y report and the patient's father concerning his 16 year oldY daughter who 3/1/2008
in March 3/1/2008
2008, was vaccinate
n has been received from a consumer concerning her son, an 11 year old male who was born N prematurely and was diagnosed with cerebra
n has been received from an 83 year Y old male with no pertinent medical history or no allergyYwho on 31-MAR-2009
3/31/2009 was 4/3/2009
vaccinated with ZO
n has been received from a registered Y nurse concerning a 25 year old female with no medical N history or 3/13/2009
drug allergy3/24/2009
who on 13-MAR-2009
n has been received from a registered nurse, for the GARDASIL, concerning a 17 year old female Y patient3/19/2009
with a history
3/19/2009
of pelvic inflammat
us case was received on 21 April 2009 from a healthY care professional.
3 A 29 year old femaleYpatient received 1/26/2009YF VAX1/27/2009
(lot number UF428A
ort received on 24 April 2009 from aYhealth care professional. A 35-year-old female patient, who U had a concurrent
4/20/2009urinary
4/20/2009tract infection, had
us case was received on 27 April 2009 Y from a health care professional. A female patient (age N not specified)
4/24/2009
with a history
4/24/2009 of high blood pre
ated at approx. 0830 4/22/09. Mother Y reports that
Y pt. had increased temp
2 starting at 1200 4/22/09.
N Mother 4/22/2009
reports to4/22/2009
clinic 4/22/09 with child
ven SQ left arm of VARICELLA vaccine #2. Soon after applying band aid pt complained of itching. Y I talked
4/10/2009
to M.D. and
4/10/2009
he ordered 50mg IM
ter shot, fever, headaches, chills, body aches, nausea symptoms resolved completely- 4 pmY4/28/09 4/27/2009 4/27/2009
heet - mom reports infant spit up milk Y and some "white" stuff and declared it had to be due toYthe liquid medicine
2/20/2009 we2/21/2009
gave. Had 2 mos shots
as given initial dose of ROTARIX @ 28 weeks. Then follow up dose 4 weeks later was given. Y However ROTATEQ
3/24/2009 was given at that point.
nal chest tightness without wheezing - within 5 min of HAVRIX (Hepatitis A) & POLIO (IePV)Yvaccine Resolved 4/23/2009 in 204/23/2009
min after liquid BENAD
darkened raised area on Pt's left upper arm over deltoid muscle that measures 8 MM X 5 MM. N Pt. C/o dull 5/13/2008
pain when 5/13/2008
spot is touched. Also
ived 2 vaccines, MENACTRA and GARDASIL # #3, in opposite deltoids. Within 5 seconds after Y receiving 4/17/2009
the 2nd shot4/17/2009
child had a seizure
er vaccine was administered site was red and "bumpy". Y 4/23/2009 4/23/2009
llowing vaccine, swelling distal to vaccination site - specifically dorsum of hand & wrist (left arm
Y only); pain 4/21/2009
and reddish
4/23/2009
(blanching) discolor
ost vaccine rash "mini measles" all overY trunk. Not ill. Y 4/13/2009 4/24/2009
3, start at 9pm & vomited x2. Y 4/27/2009 4/28/2009
d screaming/crying. Y 2/24/2009 2/24/2009
hours of shot fever,paleness, weakness, dizziness,tight chest, hard to breath.Patient remains N sick still after
4/28/2009
6 days with
4/29/2009
contiued fever, dizz
nd swelling, painful at site of injection, approx 4 inches in diameter Y 4/28/2009 4/30/2009
pain and swelling at injection site Y 4/20/2009 4/23/2009
ports extreme pain at site of injectionY which began immediately and continues x 11 days. NoUfever, no local 4/23/2009
redness, 4/23/2009
swelling or induration
er receiving the for about 4 weeks after the shot I experienced deep aching of my muscle and Y arm and couldnt
2/13/2009 move 2/15/2009
my arm without pain.
nd pain at site of injection and medial arm. Redness approx 5-6 inches medial to injection site. Y 4/14/2009 4/20/2009
ceived Zostavax Vaccine on 4-29-09Y and had been warned about the localized red itchy weltUthat could occur 4/29/2009at the injection
5/2/2009sight and it did
the MMR vaccine on 4-20-09. I amYexclusivelyYbreastfeeding a 14 3 week old infant. On 4-29-09Y she developed4/20/2009 a fever
4/29/2009
of unknown origin.
red yellow fever vaccination to rt deltoid.
Y 20 minutes after vaccination, pt. left clinic and reportedly
U walked 5/1/2009
to another 5/1/2009
building to complete th
2 HOURS: SEVERE DROWSINESS; Y 24 HOURS: Y VERTIGO, DIZZINESS;
2 36 HOURS: NUMBNESS
N &4/30/2009
TINGLING LEFT 5/1/2009 ARM, SHORTNE
ted thigh swelling at injection site two days after immunization. Patient was seen in office and Y examined: 4/22/2009
left thigh with
4/24/2009
10x6 cm indurated,
ablity and rash about 9 days after the well visit on 04/14/09. Patient seen in office on 04/24/09 Y for rash-4/14/2009
five petechial4/23/2009
on neck and chest.
minutes post injection patient developed redness, swelling, 30 mm in size4 with warmth andYhardness at 5/4/2009 the injection5/4/2009
site. Dr. notified, and
on was received on 4/28/2009 in LeftY Arm. Client was brought back in the HD on 05/01 with Y very red swollen
4/28/2009
LA, with4/29/2009
a temperature of 100
, projectile vomiting, lethargic, dehydration, stopped
Y breathing while4sleeping - we were ableYto resuscitate 5/27/2003
him, lips turned
6/1/2003 blue,
eaction to right deltoid after Tdap administered
Y "started two days after the shot was given." (Hep
U B immunization
4/21/2009 was
4/23/2009
administered to patien
00-102 within 24 hours. Muscle spasms Y x5 days now. 4 inch area of swelling around injection U site. Pustule 5/1/2009
at injection
5/1/2009
site. Soreness limi
scribed onset of large 'orange sized' hot lump in the area of administration, onset was approx Y 72 hours after
4/29/2009
admin. 5/2/2009
patient stated lump wa
d regular vaccines at two months and began spitting up blood for the following 24 hours. AtY4 months we 4/30/2009
administered4/30/2009
only one vacc/week
awoke with severe pain and weakness in Right deltoid. Significant Pain and weakness continued N for 2-3 days.### Then the pain ### decresed to m
cellulitis developed at immunizationYsite 2 days after immunization given. Pt initially treated with
U Keflex and 5/1/2009
Bactrim but5/3/2009
cellulitis worsened
9 patient started to develop red rash in which progressively increased in numbers and intensity. Y Rash was 4/16/2009
coalescent.4/26/2009
Patient seen on 04
king across the leg from the site of Y injection, as well as a swollen, firm leg. She was given injections
U today5/4/2009
with Pentacel,
5/4/2009 HepB, and Prevn
after injection - mom noted swelling tenderness and erythema - 36 hours after he has swelling 1.5 inches lareger 5/1/2009 on that
5/2/2009
arm with tendernes
N 4/29/2009
sle like red, raised bumps all over body.Y Y 4/8/2009 4/20/2009
RSE EVENTS, SYMPTOMS, OR TREATMENT Y 4/2/2009
TIS LEFT LEG DIAGNOSED IN ER Y MAY 3, 2009. CELLULITIS BEING TREATED WITH SEPTRA ORAL 5/1/2009 ANTIBIOTIC. 5/1/2009
er administration of rotateq child developed fever to 102, and a few episodes of loose stool and Y vomiting-- 4/27/2009
report being4/29/2009
filed at mom's reque
honed clinic and left a message on 5-04-09.
Y Her call was returned and the following information
Y was received. 5/2/200929 hours
5/3/2009
after immunizations
n R hand started 12-24 hours after injections.
Y Dizziness - resolved.5/18/09 records received-office
N visit 12/28/08
5/1/2009 C/O 5/2/2009
swollen glands, lethar
out with 9 blisters on 5-3-09 Mom states looks like chickenpox. Blisters on back and neck. 4/27/2009 5/3/2009
ven 2nd dose of Hep B series at 2:00pm Y 4-13-09 - At 5:00pm noticed a rash around belt line Y - progressed4/13/2009
to entire body
4/13/2009
- He had also recei
cellulitis at administration site - Started on OMNICEF. U 4/29/2009 4/30/2009
syncopal episode after taking 2 steps when she got off the exam table - 11 feet and hit headYagainst door frame. BP was low and remained
ped shingles 7 days after ZOSTAVAX injection. N 3/25/2009 4/2/2009
ed from stating pt seems to be in severe Y pain; severe hard crying off and on since vaccines received today. 5/4/2009
Pt states5/4/2009
left thigh is slightly sw
nted to GARDASIL clinic 7-22-08 to begin series. Completed series 4-17-09 after reporting LMP U 3-26-09.4/17/2009
Presented to health department fo
& Lg redness at injection site Y 4/28/2009 4/30/2009
wollen from upper thigh to knee. 3 cm larger than (R) thigh. Area a little reddened. Afebrile. U 4/28/2009 4/29/2009
asting 15 seconds - returned to normal LOC. Y 5/4/2009 5/4/2009
R upper chest welt 3 cm raised macule + dermatographism benadryl given PO - will give benadryl Y + MMR -> #2.
ed left upper arm approx size quarter. Pt able to use arm. Y 4/28/2009 4/30/2009
B #3 vaccine given on 4-29-09. Pt. c/o swelling and redness of (L) arm where injection givenYon 4-30-09.4/29/2009 Pt. stated on 4/30/2009
5-1-09 that redness w
ld given Hep A vaccine instead of Hep B. No immediate adverse reaction. No treatment given. U 5/4/2009
r vaccine site (deltoid) was reddened, Y warm + itchy on 4/25-4/26 worsened @ 48 hrs after inj. U Patient went 4/24/2009
to ED to4/25/2009
have checked. Now re
0 min after vaccinations (HEP A #1,YVARIVAX #2) child started vomiting and became increasingly Y lethargic,
4/29/2009
No total4/29/2009
LOC. Non discrete urti
rts eyes red, puffy & warm red area right upper arm Y 4/21/2009 4/22/2009
ed 6 mon vaccinations at 2 hrs after Yhe ran a Temp of 100.4 and large warm red lumps formed Y at inj sites.4/27/2009
Tylenol and 4/28/2009
bath given with some
rash trunk after 8 hrs. Temps are as high as 101. Maculopapular rash chest abdomen, legsYface. Rash became 4/6/2009cellulitis
4/11/2009 in 240 with contin
4/26 - Rt arm swollen, hot, red. Y 4/25/2009 4/26/2009
es reddened area around injection site Y that goes down arm to elbow. Also reports pain under Y arm sore.4/27/2009
Knot increased4/28/2009
from under quarte
patient returned to clinic 2 days after vaccination to have right arm evaluated. Raised reddened Y area 9 cm 4/27/2009
X 6 cm right
4/28/2009
upper posterolatera
4-17-09, 7 PM. On 4-18-09 upon awakening had eyes swollen shut, face incl tongue puffy and U red, eyes4/17/2009
were also red.4/17/2009
Facial swelling/redn
ash with pain and swelling; fever atYinjection site; cough, red throat; post-nasal drip; bruisingU- treated with 4/17/2009
ZITHROMAX 4/17/2009
antibiotic; cough s
ort was received 05 June 2008 from a health care professional. A 54-year-old male patient had U received an 6/3/2008
intramuscular
6/4/2008right deltoid inject
of four cases of injection site swelling, heat and tenderness in addition to large nodule at injection
Y site out6/30/2008
of an unknown number of patients
ort received from a consumer on 08 August 2008. A 63-year-old female patient received a leftNdeltoid intramuscular 3/20/2008 injection of DECAVAC (
ort received form a health professional on 04 November 2008. A cluster of three cases of flu-like U symptoms 10/1/2008
and injection site tenderness ou
old male patient with a history of back pain and previous eye injury received an intramuscular U left deltoid injection### of11/1/2008
DECAVAC (lot numbe
-old female patient, who has medical Y condition of hyperlipidemia for which she takes ZOCOR, Y had received 1/13/2009
a left deltoid
1/15/2009
booster dose of D
-old male patient, who had medical Y condition of glaucoma and erectile dysfunction , had received
Y a left deltoid ###
booster dose ### of DECAVAC (
ort received 27 February 2009 from a health care professional. A 31-year-old female patient had received2/23/2009 an intramuscular right deltoid inje
ort received from a health care professional on 23 April 2008. A 21 year old, male patient (with Y no medical 4/16/2008
history) reported
4/17/2008 having symptom
ort was received 15 May 2008 from a Y health care provider. A 26-year-old patient had received Y an intramuscular
5/14/2008 left deltoid
5/14/2008 infection of DECA
ort was received 20 May 2008 from a consumer, who is also the patient. Additional information Y was also 21 4/1/2008
May 20084/2/2008
from the patient's phy
1 mo after receiving vaccine that beginning night of vaccination nausea and vomiting persisting Y X 2 weeks, 3/20/2009
SOB 243/20/2009
hrs after vaccine, insom
d Immunization on 4/22/09. Onset of symptoms on 4/23/09. Nausea, headache, Stiff neck,Narm weakness, 4/22/2009
flushing,4/23/2009
dizziness, lethargic, fe
lt dose of HEP A instead of Pediatric dose Y 4/24/2009
lt dose of Hep A instead of pediatric dose. Y
zed inflammation to left upper extremity - no streaking noted. No fever - began morning afterUvaricella SC 4/29/2009
injection. 4/30/2009
s. High pitched crying x1 hour - inconsolable; slowly resolved over next hour - onset = 5 hours Y after injection
4/29/2009
- on follow
4/29/2009
up exam - family rec
accine 4/16/09 - Mother called with complaint of half dollar size of local swelling where shot given.
Y Told 4/16/2009
to ice ibuprofen
4/17/2009or TYLENOL
ection site swollen and painful - o/v 24 hrs later. (2) glomerulonephritis (post strep) Dx'd 4/21/09.
Y 4/6/2009 4/7/2009
m and itchy area over TRIPEDIA injectionY site. U 4/26/2009 4/29/2009
ameter area of erythema on LT deltoid around immunization site. Instructed to apply cool compresses U and
4/27/2009
call if area4/28/2009
increases.
nted, difficult to arouse (12 sec) utilized
Y ammonia to arouse. Patient stopped breathing during Y fainting spell.
4/29/2009
Patient 4/29/2009
cold, pale and clammy
ived Kinrix injection in R thigh on 4/27/2009. On 4/28/09 - child seen by doctor diagnosed with U (hives) reaction
4/27/2009 to Kinrix.
4/28/2009 Given Benadryl.
4/30/2009
today 4/29/09 at 12:10 PM to reportYbreaking out with rash around injection site on 4/26/09. Y States has other
4/23/2009
areas 4/26/2009
involved now (legs, face
d vaccine on 4/24/09. She called on 4/27/09 to report that later 4/24/09 in the pm she brokeYout with a rash 4/24/2009
that looked
4/24/2009
liked chickenpox an
n has been received from a consumer Y concerning her approximately 24 month old Y son with N no medical history
1/1/2006
or drug 1/1/2006
allergies who in Janu
n has been received from a physician Y concerning Y a 15 year old female
0 Y who on 13-AUG-1998 U was vaccinated
8/13/1998
with the4/22/2009
first and only dose o
n has been received from a physician concerning a 22 year old female who on 23-APR-2009Nwas vaccinated 4/23/2009
with the4/23/2009
second dose of GAR
n has been received from a registered Y nurse concerning a 19 year old female with no medical Y history and2/5/2009
no known drug 2/5/2009 allergies who on
rmation and follow up has been received Y from a nurse and consumer for the Pregnancy Registry Y for GARDASIL
8/22/2007 concerning
3/24/2008 a 17 year old fe
site still itches. Recently blistered &Ykeloid. Pt c/o severe itching @ vaccination site. 5/26/09 Received clinic 9/9/2008
medical 10/1/2008
records of 9/3/2008-4
m area of redness 1" diameter No fever. Y 4/27/2009
njection site Benadryl 25 mg PO + triamcinolone cream to site. 1/13/2009 1/13/2009
en lump at injection site (R arm). Benadryl given by mother (day after injection) Y 4/2/2009 4/3/2009
over all of body, tongue + lips. Referred to Dr at Health office. U 4/29/2009 4/29/2009
esions eruption 4/27/09 AM U ### 4/27/2009
ceived both TWINRIX & TYPHOID before Y collapsing on the chair. Immidiately patient startedY to cease. 3/24/2009
Patient was3/24/2009
moved to the floor and
came lightheaded, pale, and unresponsive for approx. 1 minute. BP 90/48. Placed on couchYw/ feet elevated. 5/5/2009
Given 5/5/2009
apple juice after alert &
oncerned that vaccine (s) have caused Y chronic pain. Has had ulcers and cholecystectomy (abnormalN gallbladder
7/30/2008 scan),
8/26/2008
but persists with ab
d Varicella vaccine on 4/30/09. On Y 5/1/09 pt's parent reporting approximately 1" swollen area U around injection
4/30/2009
site. Was5/1/2009
seen in clinic on 5/
dness + swelling at injection site afebrile;
Y no pain; warmth to touch Y 4/29/2009 4/30/2009
swelling @ upper arm - 8" length 5th" width Benadryl/Tylenol. 4/27/2009 4/28/2009
& fussiness 9 days after MMR vaccine given (along with PENTACEL). Patient's fever resolved Y by 48 hours 4/20/2009
and there 4/29/2009
were no other assoc
ction swollen redness injection site left T size right to left 25 X 25 mm up and down sore andUhard. 4/21/2009
Rash on Rt leg above knee- both feet - rash is spotty and puffy, worse in AM - better in PM. Took Y Benadryl4/6/2009
4/09 rash 4/6/2009
still present -not as re
experiencing rash/hive type symptoms on his arms + legs. This started on 4/25/09 and wasUstill present4/24/2009 on 5/1/09. 4/25/2009
Pt was advised to take
ction right arm Y 4/27/2009 4/29/2007
.8 at 5:00 pm day following vaccine. Continued with fever 5/1/09 - sibling sick with otitis startedY on ZITHROMAX.
4/27/2009 4/28/2009
ction left arm Y 4/27/2009 4/28/2009
ur after vaccine administration c/o flushing of face with temp elevation to 99.6 F. Also reported U vomiting. Vomiting
5/4/2009 and 5/4/2009
facial flushing contin
ured 9 days after administration of HPV,Y HepA and Varicella vaccines Y 4/22/2009 5/1/2009
on, some lost of vision 1/13/2004
S ADMINISTERED 4-13-09 ON 4-21-09 Y PATIENT DEVELOPED A FEVER AND HAD A SEIZURE Y LASTING
4/13/2009
2 MINUTES.
4/21/2009 TRANSPORTED
with heat and edema surrounding injection
Y site with erythema ring approx 3-4 cm surrounding Y pale area 4/24/2009
appearing 44/28/2009
days after vaccination
ted for pre-travel vaccinations prior toY travel. Vital signs at presentation were as follows; B/PY120/62, T 97.7, 5/4/2009
R 12 and 5/4/2009
HR 60. Cursory phy
from pt. wife stating husband c/o sore throat and one side of his tongue is sore, being tired and Y that injection
4/17/2009
site is 4/18/2009
swollen and warm and i
er vax on 2/4/09. Rcvd call from pt.Yon 4/24/09 10:16a. She reports the following: on 3/28, she U experienced 2/4/2009
pain in3/28/2009
scalp and jaw and blur
CALLED AND STATED HE HAD SHOTS Y YESTERDAY, WHEN SHE GOT HOME WITH THE Y CHILD HIS5/4/2009
LEGS WERE 5/4/2009
VERY SWOLLEN,
owing, swelling, itchiness and pain at site of injection increasing to giant hives on neck, trunkUand arm. Considerable
4/10/2009 4/11/2009
pain, throbbing and itc
arre' Syndrom 6/8/09 Hospital
Y records
Y and DCYsummary received 14 DOSY 4/03/09 to 4/17/09. Final
Y Diagnosis:
3/13/2009
Guillain-Barre
3/28/2009 syndrome. Post
ates that he developed diffculty breathing and chest Y pain on 3/18/09
10and went to the EmergencyY room where 3/6/2009
he was3/18/2009
admitted for a pulmon
VAX .5 CC GIVEN R DELTOID IM APPROX 10 A.M.. PT STATES THAT EVENING ARM TENDER, Y SOME
4/30/2009
SWELLING,4/30/2009 WARMNESS AT
ived the MMR vaccine and varicellaYvaccine at one time. Developed measles from the vaccine. Y No treatment
4/17/2009prescribed.
4/26/2009 Began with rash
swelling of the site w/ redness and painY same day as vaccine. pain, swelling slowly resolved Y over few days.4/29/2009
No respiratory
4/29/2009 complaints or dy
came lightheaded and lost color in her skin. Patient also complained of ringing in the right ear. Y Symptoms5/5/2009
occured approximately
5/5/2009 1 minute
ling, itching on back of arm and neck. Also has been vomiting. Y 5/4/2009 5/4/2009
ated area of injection had egg-size swelling the evening after injection. Over the next 2 days,Yswelling appeared 4/29/2009 to spread
4/29/2009 down to elbow ar
ately 4-5 hours after receiving the vaccine, I broke out in hives large about 5 in in diameter and Y raised. These
4/30/2009 were on4/30/2009
my stomach. I had re
was reported by a physician and described the occurrence of rectal bleeding in an infant male U subject of unspecified age who was vaccina
was reported by a physician and described the occurrence of rectal bleeding in a 4-month-old Y male subject
4/13/2009
who was 4/13/2009
vaccinated with ROTA
fever, 2 days of rash. Had CSF, blood & urine cultures
Y & stool culture
3 obtained & viral panel.YGiven CEFTRIOXONE
4/28/2009 4/28/2009X3 days. 5/18/09 ED
mergency Rooms. 6 days Y Hospital Stay.
Y 6 daysYIn House Rehab. 5/13/09
12 hospital records received
N DOS11/5/2008
12/4/08-12/9/08.### FINAL DIAGNO
redness & swelling @ sites of injection,
Y diagnosed in ER on 4/30/09 with right thigh cellulitis,Y treated with
4/28/2009
KEFLEX 4/29/2009
& BACTRIM
TYLENOL at home. Pt. received MENACTRA Y on R deltoid on 5/1/09. About 30 hours later on Y 5/2/09; mother5/1/2009
noticed5/2/2009
redness, induration pa
24 after shot, erythema tender (swollen started 3 days after shot , all erythema approximately U 4cm disterl4/29/2009
to shot site.
U 4/24/2009 5/1/2009
nd out pregnant 2 wks after receiving vaccinations. Due date of 9/01/09. Client gave permission on 5/1/09 to report ### to VARIVAX registry fo
d been diagnosed with shingles on 04/29/2009 U 5/7/2008 4/29/2009
x 5 cm swelling and redness to RPUA. Y 4/22/2009
d swelling, redness, and itching at injection site week after injection. Pt stated sxs was resolvingY without 4/29/2009
tx. 4/30/2009
tion administered - child sitting in chair with mom at side. Approx. 10 min. passed and then finger Y stick hgb.5/5/2009
done. Child 5/5/2009
uncomfortable with
d combination vaccine of DTAP, HEPB, Y & POLIO on 4/24/09. Pt. had no fever or s/s of anyNillness @ time 4/24/2009
of vaccination.
4/27/2009 Pt. returned to c
dness, swelling at injection site 9-10 days after vaccine. At time of visit, no fever, swelling subsided
Y 4/23/2009 5/2/2009
child called Health Dept 5/1/09 withYcomplaints of redness and swelling in child's arm - childYhad Tdap inject. 4/30/2009L delt. 4/30/09.
5/1/2009Mother was re
child was in the ER last night. AfterYleaving our office @ 2:06 pm. Patient was fussy, throwing Y up, and swollen
4/15/2009 on 4/15/2009
the admin. site.
h present on knees, elbows & buttocks. Bx of elbow Y lesion -> herpetiformis
2 dermatitis. Treatment
U with DAPSONE
2/15/200825mg 9/29/2008
twice daily - revise
e 2008, noticed large ecchymoses on Y left flank. On June 10, a CBC showed platelets to be 36, U 000 (normal3/11/2008
140, 0006/10/2008
-250,000). Saw hema
red 4:05pm. Reacted at 4:20pm with Y anaphylaxis - Left eye swelling, shallow breathing, no airway
Y edema,5/5/2009
+tongue swelling.
5/5/2009Given Epineph
, Tiredness and poor appetite, Non-Stop
Y cry for more than 3 hours, complains of pain in the N nose, Difficulty5/4/2009
breathing, 5/4/2009
wheezing, paleness,
n has been received from a consumer concerning her husband who in approximately 1970, U was vaccinated with MMR II. The consumer rep
n has been received from a female consumer who stated that her uncle received on an unspecified U date an unspecified MUMPSVAX (man
n has been received from a physician Y assistant concerning a 61 year old female Y patient withNcodeine allergy,
4/20/2009 post menopausal,
4/21/2009 lipid and an
n has been received from a nurse concerning a her great-niece 13 year old female with no known N allergies
4/28/2009
or medical 4/28/2009
history reported, who
n has been received from a physician Y who reported that a patient's mother told him Y that her U 24 year old daughter, on an unspecified date w
rned red, very sore, itchy.erythema Ymedial aspect left uppr arm, none at outer deltoid at sited Y of pneumovax
4/29/2009injextion.Area
4/29/2009 tender, erythem
A vaccine--became dizzy and was lowered to the ground. BP 80/50, color pale. Color returned Y quickly, BP4/28/2009
110/70 twenty
4/28/2009minutes later
hot child had some congestion, but normal
Y temperature. Shot received at 9AM. Fever first noticed
Y at 2PM4/15/2009
(approx. 4/15/2009
101-102 degrees). Tre
PRESENTED WITH TEMP OF 104.1, Y STIFF NECK,Y & ELEVATED 2WBC COUNT ONE WEEK U AFTER ADMINISTRATION
4/30/2009 5/2/2009 OF IMMUNIZAT
C/O BEING COLD, DIZZY, THEN MOUTH, Y ARMS, AND HANDS STARTING TWITCHING, ALONG Y WITH 5/6/2009
BIG TOE. AMBULANCE
5/6/2009 CALLED
female had foot stuck with pin. Had cellulitis and susuptiple to Tetnus. Physician did not have any Td on4/23/2009hand so administered Tdap off-lab
ported to student health services 2 days
Y after receiving his Varicella Vaccine (04/08/2009). He Y present with 4/6/2009
right upper 4/7/2009
arm mild swelling an
ately 2 minutes after receiving 3rd HPV immunization, client fainted. Client was unconsciousYapproximately 5/6/2009
10 seconds, 5/6/2009
for 3-5 of those se
shot in a.m. on Monday 4/29, symptoms started in the late afternoon: fatigue, pain in arm, sudden Y nausea,4/27/2009
dizziness,4/27/2009
fever of 102 degrees,
RTS DIFFICULTY BREATHING 2 HRS AFTER INJECTION. SHINGLES RASH ON HIPS WITHIN N 12 HRS 5/4/2009
OF INJECTION5/5/2009AND CONTINU
after vaccine pt. reports a "different rash at a different spot every morning and at night whenUI go to bed". 4/28/2009
"I have a4/30/2009
red ring and a big knot
s after gardasil #1, patient reports left index and middle finger is mildly swollen and difficult toUbend. Vaccine 5/5/2009
was given 5/6/2009
in the same left arm
H AROUND INJECTION SITE Y 5/4/2009 5/6/2009
NJECTION-LEFT ARM IS SWOLLEN, WARM TO TOUCH,ITCHES AND HURTS Y 5/4/2009 5/5/2009
ed vaccines listed below at 4:30pm. After receiving vaccines, pt. was walking in the waiting room Y and sat down 5/6/2009 in one5/6/2009
of the waiting room c
ours of vaccine child had high fever, red bumps on her face, very lethargic when not screaming, U excessively 5/6/2009
tired. 5/6/2009
eceived TdaP and menactra and felt dizzy and like she was going to faint yesterday. Still feels Y "terrible"4/13/2009
today. Some 4/13/2009
headache but she a
us case was received on 23 April 2009 Y from a consumer (patient's mother). A 13 year old female U patient4/20/2009
with a history 4/20/2009
of asthma and gastri
ort received on 28 April 2009 from aYconsumer. A female patient (demographics not reported)Nhad received 7/3/2008
on 16 June 2008 a dose of Hep
was considered medically important. Information regarding PREVNAR was received from a U healthcare professional ### regarding a male patie
n/v fever, headaches 12-24 hours after every AVA Y vaccine, but had 32 episodes cp/sob after AVA #3/SMPX 6/28/2004
vac, wt loss,
6/28/2004
hungry, insomnia..
onsolable. Swelling of thigh (left) knee
Y to hip, hotY to touch. Shots given
1 at about 1040a. Still Y crying presently5/6/2009
3pm.5/13/09-records
5/6/2009 received
mins of receiving immunizations, left warm + nauseous. Stood up + opened door at which point Y fainted. I saw5/4/2009
her + helped
5/4/2009
her to floor so no
vaccine received 24MAR2009. Symptoms began 13APR2009 with lesions on arms, legs, face, Y and trunk 3/24/2009
with clear4/13/2009
discharge. Biopsy was
ely after receiving GARDASIL injection, Y pt passed out with her head on a desk. She quickly Y regained consciousness
5/4/2009 5/4/2009
& required sutures.
Y 5/6/2009
cellulitis 5 cm X 5 cm red, warm U 5/4/2009 5/5/2009
cellulitis at administration site. Started on OMNICEF. 4/29/2009 4/30/2009
nch area of redness, warmth and induration
Y treated with KEFLEX 500 mg BID x 7d 5/1/2009 5/2/2009
R on 4-29-09 c/o fever nausea and Ydiarrhea and pain left arm - Followed up @ doctors officeY 4-30-09 and 4/28/2009
5-6-09 4/29/2009
g joint pain, numbness (left leg/hand), Y leg coldness, and stroke after AVA #4: 06 Jan 2003 AVA N 1 w/o AE.1/6/2003
AVA2 was given ###23 JAN 2003 w
veloped itching on his back 3 days Y after receiving the vaccine; 1 day later, he developed swelling
Y + 3 lesions
4/17/2009
on his4/20/2009
right jaw; 1 day later h
Y 4/30/2009
eared at site of vaccination. It was warmY to touch and slightly itchy. 2 small spots appeared next
Y to it. Rash 4/17/2009
lasted 5 4/29/2009
days.
after 24 hours and warmth after injection Zero fever. U 5/4/2009 5/5/2009
10ml around injection of chicken pox Vax. Y 5/4/2004 5/6/2009
ed, warm with pain -> treated with KELFEX -> seen next day on 5/5/9 with response to antibiotic Y 5/1/2009
njection site showed redness, warmth, swelling. Area was also tender to touch. Also startedYw/temp 99.35/4/2009 today 5/4/2009
al reaction redness & swelling down into elbow. Clarinex 5 mg Y 3/31/2009 4/1/2009
@ throbbing pain L arm + hand. Info given by son. Pt does not speak English. U 1/29/2009
nt developed shingles on left side back Y and lateral chest wall. Antiviral medication not given asU it was 1 week
4/21/2009
after onset
4/30/2009
of symptoms. The
of the Rt upper arm, temp of 101 XY2 days, itching and pain and tender axillary Adenopathy.YPt given Keflex 4/24/2009
500mg4/25/2009
tby mouth QID on 04-2
lling, redness, large circle @ inj site.Y Taken to PCP & informed to switch from Ibuprofen to TYLENOL.
U 5/4/2009 5/5/2009
given @ 4:30 pm- Pt C/0 itching @ approximately 7:00 pm. Noticed both legs and R arm hadYhives approximately 4/27/200910:004/27/2009
pm. Low grade tem
ined of having dizziness, pain at injection site, fever with joint pain. Y 5/1/2009 5/2/2009
ght tricep area with induration, warmth, confluent fine papules Y 4/27/2009 4/28/2009
er erythema 1-2mm vesicle in center - has burst Y 4/27/2009 4/28/2009
n right arm post receiving VARICELLA vaccine. Swelling & reddness began 4/29/09. Tx'd with Y XYZAL 54/28/2009
mg daily. Was already on MINOC
0 minutes after vaccinations (Hep AY#1, VARIVAX #2) child started vomiting and became increasingly Y lethargic;
4/29/2009 no total
4/29/2009
LOC, non discrete
-103, rash on face - dry cheeks. Vomited
Y once resolved in 24 hour without further fever, rashY on new symptoms.
3/31/2009 4/4/2009
was received from a health professional. A 41-year-old female patient, with a history of asthma, N received3/31/2008
an intramuscular
3/31/2008 left deltoid third
ort received from a health care professional in the USA on 23 April 2008. A 21 year old, maleYpatient (with 4/16/2008
no medical 4/17/2008
history) reported havi
ar-old female patient, who was hospitalized from 18 July 2008 to 19 July 2008 because she became U confused
7/21/2007
and angry after receiving a fir
-serious case received from a healthY care professional on 17 September 2008. A 40-year-old N female patient
9/3/2008
received
9/15/2008
the first three doses
rmation was received on 01 December 2008 from a consumer. A 59 year old female patient U with an allergy9/5/2008
to penicillin
9/1/2008
received an injection
-serious case received from a patient Y on 05 August 2008. A 68-year-old female patient experienced
N headache,
7/29/2008 forehead
7/29/2008
swelling, sleepless
n has been received from a physician Y and a nurse concerning her 13 year old daughter
Y withNasthma and4/22/2009
no known 4/22/2009
allergies who on 06-AU
n has been received from a consumer concerning her friend's 15 year old daughter who wasUvaccinated with two doses of GARDASIL. Afte
n has been received from a pharmacist concerning a 23 year old female who on 08-FEB-2008 Y was vaccinated
2/8/2008with her second dose of GA
n has been received from a consumer Y concerning Y her son with neutropenia, who when vaccinated
U with any vaccine including RECOMBIVA
ort received 29 April 2009Y from a health care professional.
Y An 8-week-old female infant had received
U a first
4/27/2009
dose of right
4/27/2009
thigh injection of PE
us case was received on 30 April 2009 Y from a health care professional. A 57 year old (correctedU on 05 May
4/21/2009
2009) female
4/22/2009 patient with high
was received on 01 May 2009, via another
Y manufacturer (document number 956545). The event occurred to a subject enrolled in a study.
n regarding PREVNAR was received from a healthcare professional regarding a 2-month-oldY female patient 1/15/2009
who vomited
1/15/2009blood. The patien
ever with chills - arm swollen 4/30 threw
Y up. U 4/28/2009 4/28/2009
ere migraine headache unresponsive Y to prescription meds. Onset 10/08. Abdominal pain and N some dizziness.
7/14/2008 Treated
10/1/2008
by pediatrician and
9 Mom called on her son who had shots Y on 4/27/09. His left leg is sore, red and hot today. Y
I told mom to 4/27/2009
put ice on4/28/2009
his leg and have him u
er flu shot, I developed a rash. This rash was all over my body except my face. The dr's that U treated me10/6/2008
were dermatologist, ### family dr., Al
rm was red/irritated no pain no fever didn't feel hot. Y 4/6/2009 4/21/2009
ATEQ vaccine 4-14-09. Developed vomiting on 4-17-09 - lasting 24 hours then had 4 days ofYwatery diarrhea. 4/14/2009
No fever.
4/17/2009
Sibling then develo
ver body, swollen and hot. Y 4/20/2009 4/22/2009
102 for 3 days with mild posterior lymph Y node swelling and one left axilla, and neck tenseness gradually resolved.
alls the day after immunization was given c/o fever low back and B/L hip pain. States "difficult Y to walk" due4/28/2009
to pain. 4/28/2009
Symptoms occurred (o
reaction 13x26mm induration with redness. Y 5/5/2009 5/6/2009
0 cm length width erythema, edema, Y tenderness, dryness to right arm Y 5/4/2009 5/5/2009
or 5 hours crying, given Tylenol with Y some relief. Y 5/6/2009 5/6/2009
er administration of TDAP vaccine in Y right deltoid, patient developed severe pain and bruising U at injection4/27/2009
site with report
4/29/2009
of chills, nausea.
arm red, warm to touch, swollen, indurated
Y Y 5/5/2009 5/5/2009
tired, muscle ache lasting 1 1/2 weeks. No treatment. Y 4/9/2009 4/11/2009
patient states patient received vaccine and then "slumped over in chair". Mother left room toYget addional 4/23/2009
help. When 4/23/2009
mother returned to ro
Imm given in AM. The following day he woke at 6AM with bilateral eye pruritis. He notices eyelids N red and5/1/2009
whites of eye5/2/2009
a little red. Pruritis
E FUSSINESS AND 103 DEGREE FEVER 24 HOURS AFTER GIVEN. TREATED WITH MOTRIN. Y CBC 5/5/2009
WITHIN NORMAL 5/6/2009LIMITS AND N
hest 104.6, hives off and on all over body Y 4/28/2009 5/1/2009
Telephone consult) rash on face andYback of neck, no respiratory distress per mother. AtaraxUq6 hours as4/27/2009 needed. Mother
4/29/2009instructed to sche
ely 28 hours after vaccination the patients
Y Right forearm began to have hives on it. The following
Y morning
4/30/2009
approximately
5/1/2009
42 hours after va
d 5 pox blisters/spots 11 days after vaccination. No other symptoms i.e. fever. Site of injection Y is itchy as4/21/2009
of today. 5/2/2009
4 months and was given vaccine that was for 5yrs and up..... Y 5/1/2009
negative BHCG on 30Mar2009. SM received Anthrax and Smallpox on 2Apr2009. SM tested U positive BHCG 4/2/2009on 4May2009.
5/4/2009 Last Menstru
accines at 11a.m. and returned to clinicY at 1p.m. due seizure like activity as witnessed by mom. Y Per mom 5/7/2009
pt began drooling,
5/7/2009clenched jaw l
accines at 11a.m. and returned to clinicY at 1p.m. w/ twin sibling. Upon examination pt was found Y to have temp 5/7/2009
of 104.35/7/2009
(rectally), content, im
aP INSTEAD OF Tdap U 4/24/2009 4/24/2009
proximately 5-10 minutes of vaccineYadministration, pt. c/o momentary changes in vision, was U pale and diaphoretic
5/7/2009 and 5/7/2009
vomitted. VS as fol
-umbilical follicultis on 2 May 09. No tx. required. U 4/30/2009 5/1/2009
ness and swelling 4 cm x5 cm Y 5/6/2009 5/6/2009
ncopal episode 15 min after administration of vaccines. Y 5/6/2009 5/6/2009
se event reported. RN gave Tdap instead of a Dtap. Y 5/5/2009
or after getting vaccines. Pt was paleY and staring straight ahead with 2 shakes of head. RN was U able to arouse5/6/2009
pt and5/6/2009
handed pt to father. A
muscle was extremely painful, pain also felt in L side of neck on day of administration. Approx Y 36 hours5/6/2009
later, L deltoid
5/7/2009
reddened, somew
ctivity 3-4 hrs after receiving vaccine on 5/5/09,Yseen in ER - Head CT 2 and CBC WNL, admitted U to Hosp. Plans5/5/2009for o/c5/5/2009
5/7/09 - Temp in ER
up blood, chest pain, and Y acute onset.
Y Complete Y heart failure. Two10thrombi
Y also Y
noted in leftNventricle. Pt has defibrillator
### 1/6/2009 now on Chronic m
11 AM 4/28/09 - taken by ambulance Y to E.R. In-patient
Y 2/28/09 - 4/29/09
1 - high fever. 4-30-09U - Back to Dr.
4/27/2009
office, severe
4/28/2009diarrhea. 5/18/09
s: 1. Rash 2. local swelling. SuspectY Drug #1 Dosing: one time vaccine dose. U 3/18/2009 3/18/2009
opted at about 7 m/o from a foreignYcountry. Her Y shot records weren't2 available to us. With consultation,
Y 10/1/2008
the recommendations
10/2/2008 was to immu
and swelling at injection site/entire upper arm; Left swelling 2-3 times normal size of arm. Fever, U vomiting5/5/2009 5/5/2009
thigh - fever 101.7 given Rx KeflexY5/1/09. Seen in office 5/7/09 - given Rx for Omnicef. FluUoffice visit in 4/30/2009
1 week. 5/1/2009
AM shaking arm when reaching, falling Y over after waking in am by 3/16/09 condition in am + N pm - falling over,
3/9/2009
trouble3/10/2009
balancing 3/19 - not a
& swelling noted at injection site Y 5/4/2009 5/5/2009
degrees. Diarrhea. Vomiting. RashY/ red / swollen right arm. Antibiotics by PCP. Y 4/24/2009 4/25/2009
sicular rash over torso / proximal extremities and fever present x 2 days. U 4/27/2009 5/7/2009
9 - Injection given R shoulder. ClientY describes pain in R shoulder joint, trouble lifting arm. Pain
U was immediate
4/29/2009 after4/29/2009
shot then next day, we
seizure like episode and stopped breathing
Y per mom. Pt was admitted to hospital for observation.
Y 5/6/2009 5/6/2009
mo vaccines on 4/24/09. Initially had Y a knot (no reddness or drainage) at site of PCV + VZVYshots. She now has some redness of skin with
cm area of erythema with slight induration,
Y minimally tender. Y 4/28/2009 4/28/2009
rythema at injection site. Y 4/27/2009 5/4/2009
ccines (shots) for flu, polio, & yellow fever- She also started oral typhoid vaccine on 5/05/09. YShe awoke 5/06/09 5/5/2009@ 6am 5/6/2009
with nausea by 9a
vaccination in left arm on April 14, 2009.
Y On April 16th, noted tenderness on left hip which spread
U to groin.
4/14/2009
Pain continued
4/16/2009 and days later a
reas other various locations of diamond shape rash. C/o itching 0 SOB or other signs of distress. Y
after vaccination given, patient passed out, lost consciousness for about 3 seconds, then spontaneously
Y 4/28/2009
woke up. Patient was given water
redness, and warmth. Y 5/4/2009 5/7/2009
- No initial local reaction until 4 day post injection, 0 fever 0 change in appetite, sleep or play.N 9 days post4/6/2009
injection 4/10/2009
site increased size, war
ZOSTAVAX was given got warm, swollen & sore. It was the size of a half dollar Y 5/1/2009 5/1/2009
adache and feeling of inside of scull on fire - lasted 3 hr and lifted. Went to ER. Y 4/29/2009 4/28/2009
0 - vaccination administered 0933 - pt. stated "light - headed, clammy, body feels tense, "really
Y hot" BP = 5/7/2009
120/80 P = 5/7/2009
76 RR = 20 0945 - "in
t a lump on left arm after administration of vaccine, and evaluated 5/1/09. Returned 5/5/09 with
U redness/4/20/2009
warmth at 4/20/2009
injection site and compl
n has been received from a 24 yearYold femaleYwith citric allergy who2 on an unspecified dateNwas vaccinated with a single dose of MMR II .
n has been received from a consumer concerning her brother who on an unspecified date was U vaccinated with MMR II and then developed
n has been received from a 74 yearYold female registered nurse with no allergiesYand a history N of hip replacement,
6/18/2008 24/24/2009
TIA (transient ischaem
was considered medically important. Information regarding PREVNAR was received from aUconsumer, the mother of a patient who experie
was received on 01 May 2009, via another
Y manufacturer (document number 956545). The event occurred to a subject enrolled in a study.
ort received from a health care professional
Y on 15 August 2008. A 39 year old, female patient, U with a medical7/31/2008
history1/23/2009
of no known allergies a
er Mother walked into Center. Pt received immunizations 05/04/09. Pt now c/o of dizziness, headacheU & chest
5/4/2009
discomfort.
5/5/2009
Follow-up phone
rs, significant Local Reaction - Site erythematous, warm to touch - Softball size area. Y 5/5/2009 5/6/2009
9 Tetanus/Diptheria toxoid was given in the left arm along with influenza and pneumonia which Y were given 3/12/2009
in the right
3/12/2009
arm. That night the p
sh back of both hands and both elbows since getting small pox 16 Apr 2009. U 4/16/2009 5/1/2009
emperature of 100 F within 24 hours Y of injection as well as tenderness; both were controlledUwith Tylenol.5/6/2009
After 24-hours
5/7/2009
warmth and swelli
swelling upper arms 5/7/2009 5/7/2009
EK AFTER SHINGLES VACCINE CLIENT HAD DEVELOPED RASH ON ENTIRE BODY AND Y IT LASTED4/3/2009FOR ONE 4/10/2009
MONTH. NO FEVER
d with ACAM2000 during pregnancy Pregnancy resulted in full term healthy delivery 7/8/2008 7/22/2008
U 4/21/2009 4/21/2009
as given his 2 month routine Vaccines which included the Rotavirus. This was done on Wednesday May 6, 5/6/2009
2009 about 10:30am. On Friday
p Lt upper arm at injection site notedY soon after vaccination 4-3-09. Presented for care on 5-1-09
Y with 2d4/3/2009
history increasing
4/29/2009 size of lump an
Y in a 4-year-old
4/13/2009male 4/14/2009
subject who was vac
ived oral Rotavirus vaccine
Y Jan 30 Y 2009. Had some
Y nausea, vomiting,
3 fever for 24 Hrs then Yresolved but1/30/2009
5 1/2 wk later3/5/2009
developed intussus
d fever 3/14/09 - 3/18/09 with rash head
Y to toe -Yrash eventually peeled. 1 Hospitalized after 2 ERY visits - had3/4/2009
a/c for Kawasaki
3/14/2009 with cardiology
ness pain, swelling at and around injection site. Y 3/20/2009 3/20/2009
circle around shot. Now white circle, swollen arm, 6 inches across red circle. N 4/28/2009 4/29/2009
alized erythema/ induration on left shoulder after vaccines placed Y 5/7/2009
appetite Tremors Loss of mobility Dizzy
Y Weight loss. N 1/22/2009 1/29/2009
ven shots on 5-1-09. 45 mins after shots
Y started fever, body aches, nausea, on sat started reaction
Y around 5/1/2009
shot area5/1/2009
red, very itchy hot to t
mpanying note. Y 4/29/2009 4/30/2009
controllably for 5 days after shots given. Y 11/4/2008 11/4/2008
vaccine breakthrough diagnosed by Dr in our office on 5-1-09. Had VARIVAX X 2. Sibling also U has varicella. ### 4/30/2009
Vaccine Breakthrough. Diagnosed in office by Dr. on 5-1-09. Had 30 lesions. VARIVAX X 2. U 11/5/2008 4/29/2009
change. Sleepy day after vaccines. A few days later, more resistant behavior in this easy going Y toddler- irritable,
3/3/2009clingy,
3/4/2009
decrease appetite
ates pt has red, swollen, itchy area where shot was given. Left arm, 1/2 dollar size. U 5/6/2009 5/8/2009
eived immunizations (Preona #4 Hep Y A + VARIVAX) then developed raised red itchy rash 5/7/09. Y No fever,
4/29/2009
illness or5/5/2009
fussiness.
as lethargic moaned and maintain a fever in excess of 103 degrees for six hours. Unable to U fully wake up. 9/18/2006 9/18/2006
him a shot by annual check up. AndYhe had UGI. 90 minutes later after shot he start havingYhives, itchy, slight 5/5/2009dyspnea.
5/5/2009
We brought him b
rgic reaction, rt arm redness, & swelling
Y U
sig. facial swelling Benadryl + Epinephrine
Y given. Y 5/4/2009 5/4/2009
edness and hardness pt. denied any pain except when someone touches with hand. Mom noticed U 48 hours5/5/2009
after immunizations
5/7/2009 treatment
eived vaccinations @ approximatelyY2 PM 5/7/09 fussy @ 5 PM 8-9 Developed fever 104.0 FY even with TYLENOL 5/7/2009 every5/7/2009
4 hrs @ 1 am fa g
s red, swollen, hot to touch, tender.YRt thigh 2 hrs 6 x 10cm, Lt thigh 8 x 12 cm. Started with U redness + swelling
5/4/2009-> dramatically
5/5/2009 worsening
ess-instructed to lay down waited for 15 min and sat up slowly. No further problems. Y 4/21/2009 4/21/2009
mph nodes @ neck, rapid heart rate dizziness, weakness, headache, shake, nervious feeling Y feeling, nausea,
2/9/2009
rash,2/10/2009
body aches, tiredness.
after receiving MMR she broke into a rash all over body with hives. She was extremely fussyYand miserable 4/22/2009
for the next
4/24/2009
48 hrs No treatmen
ted 6 days after vaccines - lasted 3 days; Temp 104.8 degrees no other symptoms but of above Y from mother 2/2/2009 2/11/2009
ver 102 degrees - 103 degrees axillary,
Y cranky saw Dr (PMD) 5/01/09 Rash face, neck, chest, U underarms, 4/21/2009
abdomen 4/28/2009
& back - progressed t
vaccine break through. Diagnosed in office by Dr with varicella on 4-28-09. Had 7 lesions. NoYfever. Had VARIVAX ### x4/26/2009
2.
multiforme- started 5/2/09. ThoughtYto be hives- nuclear by E multiforme on 5/4/09. BENADRYL Y tried w/o 4/15/2009
relief. 5/2/2009
4/23/2009 4/23/2009
ort received on 02 April 2009 from aYphysician. A 16 year old female patient, with no medicalYhistory, received 3/6/2009
the following
3/8/2009vaccines in the
with Very sore arm (painful to touch in shot area), a general headache (which I normally do not U get), and achiness
5/8/2009 all5/9/2009
over. I had received th
eizure lasted 60 seconds self-resolved,seen
Y in ED dxed with Bilateral Otitis Media treated with
Y Amoxicillin 5/1/2009 5/8/2009
tly serving my 4th deployment since 2003. I received
Y 6 doses of the4 Anthrax vaccination between
U December 2003 and April 1st, 2009. I n
he day the first dose rabies vaccine Y was given symptoms included swolen lymph glands, soreness Y in left 4/20/2009
arm, dizziness,
4/20/2009
exaustion, headach
id with induration, mild erythema, slight itching. 5/8/2009 5/10/2009
swelled up to double its size and was Y very hot and painful. I couldn't lift my arm for two days.YThe day after5/6/2009
the vaccination
5/6/2009I developed flu li
n has been received from a consumer Y concerning her son who on an unspecified date was vaccinated
N with the first dose
4/1/2008
of MMRII (lot not
Y from a consumer concerning a 13 year old Y female with
N no pertinent9/26/2008
medical history and no drug re
n has been received from a registered Y nurse, for the Pregnancy Registry for GARDASIL, concerningY a 21
10/2/2008
year old female
11/1/2008 with CECLOR al
n has been received from Y a physician's wife concerning her daughter, an 15 year old femaleNwho was on unspecified dates vaccinated with
n has been received from Y a physician's wife concerning her daughter, an 11 year old femaleNwho was on unspecified dates vaccinated with
Y through a pregnancy registry for GARDASIL, Y concerning a7/31/2008
20-year-old 7/31/2008
female, with prior hist
n has been received from a licensed Y practical nurse through a Pregnancy registry concerning Y an 18 year 8/1/2007
old female who3/5/2008
in June 2007 and
n has been received from a physician Y concerning Y a 15 month old patient who was Y vaccinated
U with a dose of ROTATEQ (lot number and ro
n has been received from a physician Y concerning Y a 15 month old patient
0 who on YunspecifiedUdates was vaccinated with all three doses of R
time of injections noted client flinched
Y mildly. 5/6/09 Contacted client after receiving a phoneYcall from his 5/5/2009
employer of5/5/2009
an adverse reaction.
ld received immunizations of DTap,Yhepatitis B, rotavirus, HIB, PCV, and IPV on 5/04/2009. YHad 5 minute5/4/2009 generalized5/4/2009
seizure and when p
d patient's father returned to clinic approximately
Y three hours after Varicella vaccine administrered
Y (administered
5/5/200905/05/09).
5/5/2009 Patient had de
ARTED ON 5/10/2009 FROM FACEYCOVERED ALL LIMBS BY 5/11/2009 5/1/2009 5/10/2009
f injections got fussy, then had generalized
Y fine shaking. Prior to shaking had episode whereYshe straightened 5/5/2009
out. Spell
5/5/2009
lasted less than 2
d fevers, malaise and headache within 24 of administration of Menactra. Now feeling somewhat better 4 days 5/7/2009
after administration.
5/8/2009 Previou
h and/or Hives, swollen feet, hands, Y face and entire
Y body. Extremely2itchy. went to the EmergencyN room on4/17/2009
4/20/09 and
4/17/2009
was kept overnight
after the injection (5/2), developed injection
Y site pain and swelling, shoulder pain. On 5/7 developed
U rash4/30/2009
on upper back 5/2/2009
and increase in pa
AR bill redness c some swelling and itching on Left Upper Arm subcutaneous Y 5/8/2009 5/9/2009
XN R>L THIGH W/IN MINUTES - BLOTHCY ERYTH. Y 5/8/2009 5/8/2009
administered in school setting on 4/30/09.
Y Mother reports that arm appeared ok that night andY next am.4/30/2009
Child began 5/1/2009
complaining of arm h
XN R THIGH W/IN MINUTES WITH BLOTCHY ERYTH. Y 5/8/2009 5/8/2009
0 hours after receiving vaccine, patient developed nausea, vomiting, vertigo, abdominal cramps, Y and temp. 5/8/2009
of 102.5. 5/9/2009
Symptoms lasted appr
ates that patient had on left arm- swelling,
Y red streaks, knot, fever up to 101 degree after varicella
Y injection
1/13/2009
in left arm.
1/14/2009
Went to Dr. Williams
ht swelling of the left deltoid muscle with redness, itching and skin warm to touch. Mother verbalized
Y that 5/8/2009
patient had5/8/2009
severe headache hou
ovitis (L) hip. 6/24/09 Hospital recordsY receivedYDOS 5/2/09 to 5/3/09. 1 Assessment: Toxic (Transient)
Y synovitis
4/29/2009of hip.5/3/2009
Patient presents with
second dose of GARDASIL. Approximately 16 hours later developed dizziness and fooling fainted and nausea. 5/6/2009Fever5/7/2009
weakness continued
5/8/2009
ns in left hip with weakness and nauseaY - developed rash on left side of back that radiates toNhip. Received 5/5/2009
ZOSTAVAX 5/7/2009
on Tues - 5/5/09. S
ped a right upper extremity tremor sites
Y after administration of vaccines persists at 48 hrs. No U other neurological
5/6/2009 findings.
5/6/20095/14/09 Receive
ported C/o redness and soreness at injection site. Observed slight bruising / redness at injection Y site area 4/14/2009
on 4-30-09.4/15/2009
s after 3rd dose of GARDASIL, Pt developed, headaches, dizziness, abdominal discomfort, N various aches 2/27/2008
/ pain, dairy
6/15/2008
sensitivity, elevated
redness, pain. Entire deltoid area was swollen + red warm compress, Benadryl and Ibuprofen Y given w/ good 5/5/2009
response 5/6/2009
decrease swelling.
iven instead of VARIVAX (ZOSTAVAX) 5/11/2009
gan around 6pm on 4/28/09 started on her face, 4-29-09 in morning woke up with all over still N with hives4/28/2009
today 4-30-094/28/2009
has had 5 doses of
er shot arm sore and some swelling. May 7 arm swollen and Erythema 4 inchs aprox. May 8 arm swollen5/6/2009 and " 4 inches
5/7/2009
aprox. May 11 ar
ensation in right arm; arm is hot, red,Yswollen; Pt has "extreme fatigue" Blood pressure has been U elevated5/8/2009
about 1S5/11/2009
points has a rash on rig
9 Severe Seizures < 3 days TransportedY by ambulance to renown medical center. OngoingNseizures until 2/23/2009
under control
2/24/2009
with phenoborbitol
ction, quarter sized erythema to arm. Blanches, non tender, not raised. Y 5/8/2009 5/10/2009
Swelling itching warm to touch > Onset later that right mom gave BENADRYL & ice over the Yweekend 5/8/2009 5/8/2009
d tender mildly pruritic erythematousYpapules over bilateral hands, dorsal > palmar surfaces,Yonset approximately 4/3/2009184/18/2009
days following receipt
hrs following vaccinations c/o swelling, pain + warmth @ injection site Rt deltoid (MENACTRA). Y 5/7/2009 5/8/2009
gave oxygen and checked vitals. Y 5/11/2009 5/11/2009
m area of erythema with slight induration,
Y minimally tender. Y 4/28/2009 4/28/2009
pular/macular erythematous rash and Y fever X 2days. U 4/22/2009
lling + tenderness at injection site. 4 days after Typhim developed soreness in arm, tenderness U (no swelling)
4/28/2009
in axilla,5/4/2009
Tingling in L fingers b
acular erythematous rash Y U 4/28/2009
c 4:30 p 4/27. Pt went to school 4/28 Y - was fine then. 4/28 night developed red area, hot to touch,
U 9x9 cm 4/27/2009
approx at4/28/2009
vacc site. Talked to on
ours after shot developed generalized Y arthralgias, headache, hot touch but no fever, chills. Severe
Y leg and
4/20/2009
arm pain.4/20/2009
Seen in ED @ hospita
local. Myalgias. Arthralgias. Fever >Y 102. Palpitation. Onset hours > vaccine. Pt seen 2 d > vaccine
U rx. NSAIDS
5/9/2009 / TYLENOL.
5/9/2009
RICELLA vaccine on 4/20/09 - On 5/9/09 Y developed some itchy spots on truck with eye pain and frontal 4/20/2009
headache - On 5/9/2009
5/11/09 Dx'd with c
:10 AM Pt. c/o ears tingling, L side of shoulder, face (L side) feeling slightly numb - No c/o difficulty
Y in breathing,
4/17/2009 No 4/17/2009
c/o throat tingling, No c
episode - hit head. Y 5/1/2009 5/1/2009
ceived shots on 4-14-09. Returned to clinic on 4-17-09 with report of swelling in right arm and Y face and itching
4/14/2009 starting
4/14/2009
on Tuesday night.
HONED 5/5 @ 1 pm. Reports that at 3am. Child awakened screaming & banging head. Head Y hot, no fever5/4/2009
& remainder5/5/2009
of body not warm
Y via a GSK representative and described the occurrence
U of diarrhea in a 2-month-old
4/16/2009 male subje
N
ort received on 04 May 2009 from a Y health care professional. This patient, who is a 54-year-oldU male is one8/13/2008
of a cluster
8/14/2008
of five patients who
ACEL, MENACTRA, varicella 3/11/09. Onset 3/20/09 Y - fever, headache,
14 Y lethargy; evaluationNat hospital: 3/11/2009
MRI, LP. Dx 3/20/2009
cerebritis. 5/12/09 VA
n has been received from a consumer concerning her three friends' children, who were vaccinated U with MMR II and became autistic. Upon
n has been received from a consumer concerning her currently 14 year old niece who as a toddler U was vaccinated with a dose of MMRII. C
n has been received from a 21 yearYold femaleYconcerning herself with 7 no medical history orNdrug allergy 1/8/2008
who experienced5/1/2008 seizures the nex
within 1 week change in cognitive abilities & behavior. Within 1st 24-48 hours rash Y over upperN forequarter9/5/2008
resolved within
9/6/2008
2 more days (No
Y concerning
Y a 22 week4 male who on 31-JAN-2007 Y was vaccinated
4/23/2007 with
4/23/2007
a first dose of ROTAT
t injection site of varicella. ER vs 3xYFri-Sun. AdmY hosp Sun 5-1-09 4pm through ER. Culture Ydone at injection4/29/2009
site = staph.
5/1/2009IV antibiotics wh
d 5/1/09, c/o pain. "limping". Temp 103 degrees during the night, shaking, Temp 102 degrees Y am of 5/1/09
4/30/2009
c/o tummy4/30/2009
ache, gagging, 0 vo
5/6/2009
4/29/2009
induration, fever, chills, myalgia, BP stable, No anaphylaxis. 5/4/2009 5/4/2009
n initially & then recurred with deep muscle pain U 4/23/2009
out in bumps all over his body, is in the nurses office @ school. Some are fluid filled. does not have PCP. 4/29/2009
Instructed 5/3/2009
to go to PCP.
ash on R deltoid began 5/4/09 and today 5/6/09 erythema and in eye itchy spread to both forearms U in addition
4/18/2009
3-5m papule
5/4/2009 have appeared
ness, fever, joint pains, headache w/in 24 hours of vaccine. Y 5/6/2009
ministration of L arm erythema & firmness 2-3 cm, Local reaction. Noted 5/7/09. U 5/5/2009 5/6/2009
24 hrs after injection site where administered extremely tender, unable to lift arm. 24 hrs after Y fever began4/23/2009
at 99 degrees,
4/24/2009extreme fatigue,
male was administered VARIVAX onY5/4/09 at Health Unit . On 5/6/09 mother presented to health Y unit with5/4/2009
child to report
5/5/2009
vaccine reaction.
eared 3 days after vaccine, with no Y associated signs or symptoms. Rash consistent with erythema Y multiforme.
4/30/2009 Coincided
5/3/2009with day 7 of AM
hours post vaccination: Fever/chills X 3 days; redness/swelling in large area over injection site, Y generalized3/20/2009
arthrolgias;
3/21/2009
started to resolve
r, painful. 3rd day reaction. Swelling at site of injection. Y 5/4/2009 5/6/2009
(2) SOB, (3) Throat swelling, (4) Stiffness
Y of upper & lower extremities. Oxygen SAT decreased Y 94% on4/30/2009
RA. Rx: 6 lit 4/30/2009
oxygen, EKG, SOLUM
warmth, induration - diffuse tighteningY + pain with touch. Treated with augmentin and will follow U up tomorrow 5/5/2009
05/08/09. 5/6/2009
iven 4/23/09 - Pt began having myoclonicY jerk seizures about 5 hours later. Pt told to go to ER
Y ASAP. LP, 4/23/2009
EEG, MRI, 4/23/2009
CT had all WNL. Curr
U 4/14/2009
meter redness, warmth, swelling, with Y superficial oozing of serum. Y 5/1/2009 5/4/2009
eived Td. - Should have received dTap) 4/11/2009
tool noted 4-29-09 5 days after vaccine Y given. Y 4/24/2009 4/29/2009
t weak, lost balance, became pale, eyes rolled around, pulse and blood pressure went decreased. Y With rest,
5/6/2009
a drink,5/6/2009
and a snack patient s
oid swelling, heat, pain. Large palpable nodule in right axilla. Rx: Augmentin E S 600mg 1 Y 1/2 tsp po BID
4/27/2009
x 10d. Warm4/27/2009compresses to af
seizure activity, brief alteration of consciousness.
Y Y 1/2/2009 1/9/2009
r followed by seizure 24 after vaccine Y Y 3/25/2009 3/26/2009
arm red, swollen and fevered. Mother Y stated used ice packs, ibuprofen and BENADRYL withUno improvement. 5/5/2009
Advised 5/5/2009
to go to ER or child
0-09) - site irritation only through Sunday 5-03-09 - Rash began Monday AM. Covering - Neck U to back of 4/30/2009
thighs. Covering 5/4/2009
torso.
.7 Po since evening after TDAP given until seen in office on day 2. Fatigue + Myalgia X 2 days. U 5/4/2009 5/5/2009
4/29/2009
ling and pain at the site of injection. Y 4/28/2009 5/1/2009
ling & pain at the site of injection. Y 4/7/2009 4/24/2009
st administration child had redness up & down 22 mm left & right 20 mm right thigh upper & slightly Y warm. 4/28/2009
Mom advised 4/30/2009
to watch & use wa
ver 11 days post vaccine 4/24/2009 5/4/2009
noticed behind ears, now on stomach, arms fine red rash behind ear papular rash scattered U on thorax + 4/29/2009
extremities - 5/5/2009
2 hours vaccine on 4/2
throat, difficulty swallowing, stiff neck am of 4/25; and R arm pain Sun am 4/26. Fever blisterYlip. Evaluated 4/24/2009
by Dr and 4/25/2009
started on NAPROSY
tient received immunization at 11:00 and then developed hives that afternoon, no respiratoryYdistress, gave 5/1/2009
patient Benadryl.
5/1/2009Claritin, and O
ed & hot to the touch. Y 4/28/2009
FTER RECIEVING ANTHRAX VACCINE MEMBER HAD A RING OF RAISED BUMPS AROUND U INJECTION
5/1/2009SITE THAT
5/4/2009 ITCHED. MEMB
ed fever (102.0 degrees F) and soreness at injection site (left deltoid region) 24 hours after Y receiving injection.
4/29/2009 Had4/30/2009
stomach discomfort 2
rent says that patient only slept about an hour and a half last night after his immunizations. Says U that he5/11/2009
cried nonstop
5/11/2009
for 3 1/2 hours unco
oticed rash on upper arm and redness size of 50 cent piece. Parents gave Benadryl 1 dose.Y 5/1/2009 5/2/2009
sore, low grade fever, felt tired. Parent unsure which arm was sore. Y 4/29/2009 4/30/2009
low grade fever, fatigue (parent not sure which arm was sore) Y 4/29/2009 4/30/2009
TELY AFTER GIVING MMR SQ ON LT THIGH PT THIGH BECAME RED, SWOLLEN AND Y BLANCHING 5/11/2009
WAS NOTED 5/11/2009
DR NOTIFIED AND
and swelling at injection site. Fatigue. Y 5/8/2009 5/10/2009
the patient called the office to say that as of 1/7/09, her arm from the injection site to the elbow
Y was red, warm,
1/5/2009 and swollen.
1/7/2009
ceived the vaccination on Monday 5/4/2009.
Y Mother called office on 5/5/09 and stated that child's
Y Right arm
5/4/2009
where he 5/5/2009
had received his Dta
eaming in tantrums which would last 15minutes to one hour off an on. Flailing arms, legs, shaking N head. 5/1/2009
Diarhea, vomiting,
5/1/2009 no fever. Initia
hysician varicella rash on back, stomachY and arms with no fever Y 4/30/2009 5/12/2009
pneumococcal vaccine trial, with severe COPD, Y was admitted to the 10 hospital fro severe colitis
Y on 11/8/2008.
9/10/2007
Vaccination
11/8/2008 took place on 9/1
pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 8 11/18/2008 with CHF. Y Vaccination 9/10/2007
took place on 9/10/2007.
### Accordin
d Tdap injection 3/17/09. 3/24/09 reported
Y as walkin to PCP reporting that arm is red and swollen.
Y Per NP3/17/2009
note that3/24/2009
day "left deltoid area ha
d no signs of complicationsY after birth. Shortly after receiving hepatitis vaccination by the nurse U the baby5/11/2009
began experiencing
5/11/2009 stopped bre
ying, sore arms, couldn't move arms; Y temp 105 degrees F; mother gave Tylenol suppository;Ychild projectile 5/6/2009
vomiting.5/7/2009
Tylenol lowered fever
LOPED SIGNS AND SYMPTOMS OF hERPES zOSTER OPHTHALMIC BRANCH OF 5TH YNERVE l SIDE 5/1/2009
4 days after
5/5/2009
receiving Zostavax
d lump the size of a blueberry appearedY behind his right ear (this was diagnosed as lymphadenitis
U by Dr.4/28/2009
Chevez) the 4/29/2009
day after his vaccina
esday May 13th I visited my primary care physician for a routine physical examination. He recommended Y 5/6/2009
that I receive
5/6/2009
both Tetanus and P
ETWEEN 102.5 AND 103.7 FOR 50 HOURS; DIFFICULT TO CONTROL WITH MOTRIN AND Y UNRESPONSIVE4/28/2009TO5/7/2009
TYLENOL // RASH: P
halitis etiology unkonwn.YFive weeksY after administration
Y pt experienced
100 Y stiffnessYof neck. NeckN pain, back 8/16/2007
pain, lethargy,
9/19/2007 no appetite fever
m, I fainted, had possible seizure, unconscious
Y for 1 hour, several months of testings,
Y Dr's can'tN find what's wrong, ###since vaccine
### have sever
warmth & hardness at site, pain at site.Y Y 5/5/2009 5/6/2009
-> Lt scapular pain - gen OXYCONTIN 20mg. ? nerve root. 1/1/09 - shingles --> given FAMVIR N 500mg: PO Q8### hours. ###
elling w/ slight tenderness 12 days after Merck vaccine. Lasted approximately 12-24 hours. YCould move 4/8/2009 neck freely;
4/10/2009
R swollen upper arm
ion , tenderness left upper arm Tylenol or Ibuprofen cold pack to and comfort. U 5/5/2009 5/6/2009
ssible granuloma. Y U 3/19/2009 5/11/2009
nted after administration of yellow fever vaccine, also received IM vaccines for Havrix & Adacel. Y Lasted 5/11/2009
about 30 seconds
5/11/2009 recovered comp
minutes after receiving immunizations Y had syncopal episode and fell onto concrete outside clinics,Y V/s normal,
5/6/2009
hadn't5/6/2009
eaten that day, Dad s
child reports that child had redness, swelling and warmth at injection site within only a few minutes
U (<30).4/13/2009
Site remained
4/13/2009tender to touch un
ped urticaria (generalized) after receiving DTP/aP (TRIPEDIA), PREVNAR & HIB. Per mother Y rash quickly4/24/2009
subsided4/24/2009
within 10 Min & comple
into clinic at 10:00 am on 11-3-08. She reported 4-5 hrs after getting vaccines pt noted redness, Y warmth, soreness
### and itching### on upper le
ine give with expired date Lot 00114 Exp 21 Mar 09 - Saw date as 21 May 09. U 5/12/2009
ately 24 hrs post receiving vaccines, pt reported temp of 102 degrees F. Temp went down inYthe evening 5/5/2009 but next afternoon
5/6/2009(48 hrs later, te
ite {erythema warm sensation pain} with in 4 hrs of shot; then in 24 hrs --> pruritis + (increased) Y redness4/24/2009
5 treatment4/24/2009
(resolved in 1 wk).
ZOSTAVAX injection 5/28/09. Awakened this morning (5-1-09) with a raised, red rash over U "upper chest."
4/28/2009
States the5/1/2009
rash "itches and burn
n, loss of eye sight for 2 weeks. Nerve Y pain. Experience - still being treated for nerve pain in U head. 7/9/2008 ###
apules + pustuls on back + arms. Y ### 5/12/2009
me 1 1/2 hrs post vaccine & stated Y to faint (Dad is a Dr. (cardiologist) and called it a "near syncopal
Y episode
5/11/2009
she also
5/11/2009
felt nauseous & tired.
ain and swelling saw Dr 5/9/09 Y 5/6/2009 5/7/2009
tis left arm s/p Tdap placed on Keflex per clinic & now doing well. 5/8/2009 5/9/2009
developed cough and congestion in lungs, Dr prescribed antibiotic (Amox-clav 500 mg) 3 days N later they gave
4/7/2009
no relief
4/8/2009
or made any differen
ministered @ thigh on 5-3-09. On 5-4-09 in office for eval -- leg pain & refusal to walk since vaccineY administered.
5/3/2009 Are 5/3/2009
firm. Are on L thigh
ma, pain, redness. Y 4/30/2009 4/30/2009
secondary transmission of vaccinia:YPatient is not vaccinee. VAERS filed on vaccinee. 26 year U old female 4/16/2009
patient whose
4/30/2009boyfriend received
n has been received from a pharmacist Y reported that a 25 year old female Y with no allergies received
U PNEUMOVAX
1/31/2009 1/31/2009
(Lot# 662742/1117X), u
s a PNA vaccine on 5-2-09 on her left deltoid. Develop a big red mark on the injection site c/o pain and feels 5/2/2009
swollen5/2/2009
then put a marking on
around 2100 on 5/2/09; spoke with one RH to report that her (L) arm where they injected Pneumococcal vaccine 5/4/2009 started
5/5/2009
to get swollen. Pt w
ingling and respiratory symptoms 4/15/2009
ates awoke to arm red swollen tender to touch. Noted hard spot near tender arm size of prune. Y Patient able 5/8/2009
to use arm5/9/2009
c/o area itchy. Wil
back itchy, especially on ABD. Trunk/Buttocks
Y groups of vesicular/ papules/few tiny pustules U on erythem. base.
6/7/1999 Clinically - varicella (status
ve hep B (peds) on 5-1-09 vac exp date 4-28-09 5/1/2009
dministered to pt on 4-1-09 after she Y denied any allergies about 6pm. Client states on 4-2-09 Y a red slightly
4/1/2009
raised rash 4/2/2009
developed on neck,
length area of redness + local temp - started ? 2cm x 2 in and elevated to 5cm X 5cm overnight. Y Fever 4/29/2009
> 99.8 (A)
m area of erythema + warmth -> L biceps.Y U 5/6/2009 5/7/2009
Y Y 4/13/2009 4/22/2009
on, some lost of vision. ###
Y of joint pain0 in a male subject of unspecified
N age 8/1/1999
who was vaccinated
11/1/1999 with LYMER
o hve severe joint pain Y U 5/11/2009 5/11/2009
as given a Zostavax vaccine as opposed to a varicella vaccine. Contacted patient's mother. Patient is having 5/11/2009
no symptoms.
hospital on May 11, 2009 Y with bilious
Y emesis, Y and low grade fever. 2She was sent home with the diagnosis 4/3/2009
of acute5/10/2009
gastritis. The patient pr
received 2nd dose of Hep A/B TwinRix Y on 5/11/09.She had no problems with 1st dose on 1/12/09. U Within
5/11/2009
an hour of 5/11/2009
receiving the shot, he
tions administered at 12:40pm, 12:45pm face red, hives noted on face. Benadryl administered. Y 2:40pm face 5/11/2009
no longer5/11/2009
red, hives gone.
N AS THE VARICELLA AND MMR WAS GIVEN LOCAL REACTION OCCURRED IN THE FORM Y OF WHEAL,
5/13/2009TWO5/13/2009
OF THEM AND SOME
ped a raised red area on back of Left Y arm on Sunday, 4/26 after immunization on 4/16. AreaYwas hot and 4/16/2009
itchy when 4/26/2009
noticed. Presented @
that a couple of hours after taking 1st
Y typhoid pill developed rash on wrists with swelling of one eye. No 5/8/2009difficulty breathing.
5/9/2009 After taking
ated she had received a MMR vaccine Y and later that night her jaw appeared swollen and painful. Y She stated
4/14/2009
that she 4/14/2009
felt feverish. She cam
n a 102 fever, breathing very fast and Y red cheeks and a very congested nose. Pediatric emergency N number
5/8/2009
advised 5/8/2009
us to go the hospital w
to clinic 4/21/2009 with swollen cheeks,
Y upper lip and left periorbital areas. Hives on trunk and Y arms since4/6/2009
4/6/2009 when4/7/2009
he had his vaccin
S MOTHER REFERS RASH IN ARMS, LEGS, BACK AND IN THE BACK OF THE NECK. Y 3/9/2009 3/9/2009
s and swelling at site of Varivax and Hep A vaccine, persisting swelling at site for 2 weeks. Y 4/27/2009 4/27/2009
DEVELOPED ITCHY HIVES SIMILAR Y TO VARICELLA LESIONS ON HER FACE AND BODY. U 4/9/2009 5/9/2009
eveloping warts on inside of vagina which had never occured before. Three weeks later they N were still there
4/24/2009
and getting
4/28/2009
uncomfortable so i w
CP on 2/4/09 for GYN/PAP and received #1 GARDASIL Y that day. Urine2 HCG on 2/4/09 was negative.
N Pt subsequently
2/4/2009 2/4/2009had (+) pg test 2/16/0
on 1 week prior to abnormal labs, cough x 1 week, Y nasal congestion1 x 1 week, croup 2 months Y prior to admission
2/24/2009- 3/16/2009
3/16 plts 12,000 receive
wing day, noted increased fever, increased rash to chest & arms (red pimples). 3-5Y days later,Ndecreased speech, 1/3/2008clumsiness,
1/4/2008 huge dilated
by MD 5-12-09 in Dermatology - note enclosure. Y 4/10/2009 5/8/2009
uration with redness R lateral thigh Y 4/29/2009 5/1/2009
ook child across street to groc store. She was crying when suddenly went limp + eyes rolled Yback in her head. 5/8/2009 She had
5/8/2009
mild inflammation o
onds after injection became diophoretic, lightheaded, passed out for 15-20 seconds. C/o swelling Y in throat
5/12/2009
and throat5/12/2009
soreness, no SOB or
days vomiting X 2 days U 5/5/2009 5/5/2009
ness approximately 10mm. Vesicles. U 5/12/2009 5/13/2009
d immediately to VAR + MMR with redness + swelling @ sites, generalized urticaria on legs, Y arms, + back5/13/2009
+ abdomen. 5/13/2009
Given 0.2cc of Bena
30mm area of induration on L lateralYthigh. Y 5/1/2009 5/2/2009
se event of symptoms, wrong vaccine given. In clinic 1hr. Past injection with no problems. Y 5/13/2009
dache, fatigue, tremors, arm swelling, myalgias, weakness. U 5/11/2009 5/12/2009
h "milk protein allergy" atY1 month ofYage, developed
Y diarrhea about 3003Y weeks after getting only
N dose of ROTATEQ.
10/8/2008 Found
11/5/2008
to have rotavirus
hing pain in Rt arm, very tender to the Y touch, very red and very hot. Dr put her on antibiotics. U 4/26/2009 4/28/2009
plaint was neck arm stiffness of left side,
Y which continued, confustion (goofy like she was drunk), N conti complaints
5/11/2009of5/11/2009
neck arm, then exhaus
Y concerning
Y her 18 year4 old daughterY who on 29-AUG-2007
N 8/29/2007
with her first dos
n has been received from a consumer concerning Y her approximately1 12 month old son with N allergic reaction to antibiotics who in 2001 was
n has been received from a consumer concerning, the patient's mother, her son (a twin, whoYalso had the same experiences reported in W
n has been received from a consumer, the patient's mother, concerning her son (a twin, whoUalso had the same experiences reported in W
n has been received from a Registered Y Nurse concerning a 2 month old male who on 30-APR-2009 Y was4/30/2009
vaccinated 5/4/2009
orally with the first 2 m
d with rotavirus on 4/30/09 at 6:38. Was taken to Y hospital by mother1after vomiting & diarrheaYfor 2 days. Was 7/2/2008
admitted
4/29/2009
to hosp & tested for
ospitalization for IVIG - extreme weight
Y loss. Tripping,
Y falling, loss of5 muscle mass, inability to
N walk without11/5/2008
assistance. Now ###is in a wheelch
ient seen for F/U s/p hospitalizationY4-5thMay09 Y @ hospital for Acute 2 Myopericarditis following
Y receipt of4/22/2009
primary Smallpox
5/2/2009and Anthrax #1
p with CP and SOB in the early morning Y hours Yon 1/22/09 and got tachycardic
1 and SOB tryingY to climb stairs
1/11/2009
later that
1/22/2009
day. Went to health
e on lower lip within 48 hours of injection."
Y Upper
Y chest pain waking 2 pt. @ 0300 1 wk after injection.
Y No cause
4/15/2009
or change
4/22/2009
of routine other tha
d, slightly warm to touch, area was Y 1 1/2 inches wide x 3 inches in length. Y 5/5/2009 5/6/2009
o fever 102,less of appetite, and fussiness.
Y Y 5/12/2009 5/12/2009
ven Rotarix vaccine. On first dose of Rotarix, my baby had symptoms of vomiting, blood in stools. N These 5/13/2009
symptoms 5/14/2009
stopped after giving ant
5/16/2009 Y Y Y 4 N 5/11/2009 5/12/2009
vaccination on Friday, by Saturday Y evening developed rash at site of injection. Two days later U reaction (rash,
5/1/2009
swelling)5/3/2009
was appro 2" x 2". A
d, hard 2.5 X 3 inch cellulitis, left upper deltoid with left arm pit lymph node involvement. Father U is a MD and 5/12/2009
put child5/13/2009
on Keflex. Child has fe
9 mom called and spoke to nurse, statedY that son got imm on 5-6-09 and now has a swollenYarea on this 5/6/2009 left thigh that
5/10/2009
is the size of a tenn
hours of taking the vaccine, headache,lowY body temperature.next morning, low blood pressure, N nausea, 5/11/2009
body ache, 5/11/2009
stiffness in right arm, th
Varicella and Hepatitis A vaccines on Y 5/13/09 at 1500 hr. Around 1830 hr., developed urticaria, Y swelling 5/13/2009
on eyes and 5/13/2009
mouth. He began cou
n 786.5 (5-000008) 5/19/09 medical records received Y DOS 1/27/09 to 2/5/09. FINAL DIAGNOSIS: U Atypical
1/6/2009
chest pain,
1/27/2009
Hypertension (Sys
nistered Tdap, no previous allergy toY Td, was being Y worked up for allergy
13 - tested + seafood N and almond;4/15/2009
approx 154/15/2009
minutes after vaccine d
m, red, bruised spot on the left arm at Y injection site. Prednisone given orally. Y 5/12/2009 5/13/2009
er arm redden and swollen. Child complains of pain. Mother Bendryl. Applied ice. Y 5/7/2009 5/7/2009
esented to the emergency department Y complaining of generalized rash and itching. Patient was Y treated with 4/6/2009
benadryl4/9/2009
and released home a
ite red and swollen x 1 day, diagnosed with cellulitis at injection site, treated with Sulfatrim xU10 days 5/12/2009 5/13/2003
e series of 3 injections and after the Ypatient developed
Y utis, uris, strep
3 throat 3 times, joint pains,
N muscle weakness, ### numbness, ### insomnia, m
ports that after receiving shot of gardasil abd menectra on 02/25/2009 she became very sleepy Y but not lethargic
5/13/2009 and5/13/2009
experienced a severe
SEEMED TO HAVE PROFOUND HEARING LOSS FOR 2 DAYS AFTER HER VACCINATIONS. Y SHE DID2/26/2009
NOT RESPOND
5/13/2009 TO HER NAM
en hpv vaccine pt was then found to be pregnant Y 6/8/2007
Y and described the occurrence of shoulder pain inNa 40-year-old 4/14/2009
female subject
4/19/2009 who was vaccina
ations. - Fever, chills. - Local cellulitis. 5/15/09 YMedical records received2 (hosp discharge summary
Y included)
4/29/2009
DOS 4/29
4/29/2009
and 5/1/09 to 5/3/0
nd decreased appetite started
Y after he
Y receivedY5/1 immunizations - developed night sweats,Ncold symptoms, 5/1/2009
bruising5/3/2009
- hospitalized 5/11/09
esented to hospital with 1-day history of bleeding, Y bruising and low platelets.
3 History includedY epistaxis, left
4/20/2009
elbow bruise
5/11/2009
and a platelet coun
elling, redness within 48 of receivingYDTAP R deltoid. Y 5/9/2009 5/9/2009
d redness, swelling locally in Rt. deltoid
Y where administered. Systemic chills without fever, myalgias. Y 5/6/2009 5/7/2009
d Varicella vaccine (lot #0336Y) SCYin L lateral thigh on 5/4/09, as well as Hep A vaccine IM.YSeparate areas 5/4/2009
of induration
5/4/2009found on L thigh
ed vaccines TDAP, Hep A + VARIVAX @ 2:30 pm, Pt waited 15 min after vaccines. Pt was fine. U It was around
5/13/2009
3:07 5/13/2009
pm when Pt came to Do
redness, pain, warmth at injection site. Patient seen at clinic and back in primary physician'sYoffice. 5/11/2009 5/13/2009
1/4 inch upper arm redness, blanches, not warm, no streaking c/w immunization reaction Y 5/12/2009 5/14/2009
Erythematous Wheals all over bodyY+ itchiness TX: Benadryl 25mg to tabs PO 4-6 Hrs for itchiness. Y 5/11/2009 5/11/2009
d redness, heat and swelling yesterday. Area red hot, 0 induration noted, minimal swelling toYsite. Approx 5/11/2009
12cm across.
5/10/2009
No itching or pain.
Mother noticed L arm red @ injection site. 5/4/09 blisters on L upper arm with redness + tenderness Y at the
4/21/2009
base. Mom 5/3/2009
called child's Dr + h
gnant female, ADSM, reports receiving Flu Mist vaccine on 17 October 2008 despite being 38 U weeks gestation. ###
The service ###member decid
rgic reaction at site of injection. Y Y 4/25/2009 4/25/2009
female presents for walk-in appt, with "itchy, little red bumps that look like mosquito bites" on Y arms, chest,3/10/2009
abdomen3/16/2009
and back 10-days s/p
ale, ADSM, is referred to the Transition Y Unit for several day h/o nausea and vomiting associated U with his receipt ###of Flu Mist ###
vaccine on 28 O
linic (06May09) re 22 y/o AD WM SM Y w/ 10-12 tiny vesicular lesions surrounding primary SPV Y injection site
4/29/2009
RUE. SM5/6/2009
received primary SP
h left arm, swelling, no fever or vomit. Pt was seen today Doctor 5-22-09. U 5/12/2009 5/13/2009
tchiness, redness at site of injection (L deltoid) 5 - 6 cm reaction - round - slightly erythematous U lesion. Slight
5/1/2009
induration,
5/3/2009
no fluctuance.
s down on R side of face when crying or drinking. Began 1 week ago (approximately 4/30) ?Nmild Bells Palsy. 4/28/2009 4/30/2009
2" urticarial patch over injection sites on right thigh - started at the MMR site - enlarged to cover Y both sites. 4/24/2009 4/24/2009
ination on way home mom said lips got swollen and child broke out in fine whelps. Gave TYLENOL Y and BENADRYL.
5/7/2009 5/7/2009
On 5-7-09 left arm at
swollen lymph nodes under jaw on April 30. N 4/21/2009 4/30/2009
ptoms 2 wk recovery complete physical breakdown felt as if hit by a truck" weak, chills, pain back Y + ribs; chills;
4/2/2009
nausea;
4/24/2009
loss of appetite; che
d rash on 1 thigh, warm to touch Y 5/6/2009 5/7/2009
njection given - HEPA. HEPB & INFLUENZA given 0845 - Patient feeling weak, dizzy, chestYtightness, HR60 5/14/2009
blood5/14/2009
pressure 60/40 0850 -
vaccination: Next few days had increased swelling hardness, heat (hot) Redness cont to spread Y also itching 5/4/2009
+ aching5/4/2009
+ soreness - spoke w
erythema - mom described as the size of a baseball tx with BENADRYL 5/13/2009 5/15/2009
Feverish, C/o "feeling sick" 5-15-09 Employee came to Employee health with pea sized knotYleft upper inner 5/11/2009
arm. lymph
5/12/2009
node also red blot
tion (KINRIX) given on 5/12/2009; mom noticed and reported localized swelling of L arm on 5/14/09, U arm5/12/2009
swollen to 5/14/2009
twice the normal size fr
hives occurred that pm or next am. Patient has DX of urticaria Dermatitis. HX of local reaction Y to latex band
4/29/2009
aids- only
4/29/2009
RX for this incidence
Rt arm inflamed and swollen from shoulderY to elbow - no pain, no fever - when picked up from U day care. 4/28/2009
4/30/09 - Arm 4/29/2009
unchanged - still no
blisters up both arms. Treated with BENADRYL 25mg x 2 doses and antibiotic cream to blisters. 4/30/2009 4/30/2009
treated with BENADRYL 6.25mg Q4hr prn. Y 5/6/2009 5/6/2009
reaction at IM injection site left deltoid. + redness, swelling and warm to touch. Treated with YTYLENOL, BENADRYL 5/8/2009 5/9/2009
and warm compresses
e fever (101), diarrhea, mild irritability starting 48 hours after vaccination. Y 3/19/2009
ness and swelling in L arm 24 hours after injection at site of Sub Q injection of VARIVAX. Y 4/29/2009 4/30/2009
nset one hour after vaccination, at site. Treated with 25 mg Diphenhydramine P.O. . Y 4/29/2009 4/29/2009
Tdap around 9:00-9:30 am at school; Y felt drowsy all day afterwards. Later that evening felt tired,
Y weak, dizzy, 5/5/2009
chills and
5/5/2009
fever of 102.6. com
ministered 0.5 cc of Tdap to client. Expiration date was checked before administration of vaccine U but still was
5/4/2009
not realized til entered into gr
IZ's 4.29.09 - 5-1-09 pale, fever by evening was in Reno all day that day. 5-1-09 Fever increased- Y unknown temp as no thermometer. W
->72 hours : 5 x 7 cm erythematous raised area with small papules (no vesicles). RecoveredYwith Rx. Sl.4/27/2009 increased 4/28/2009
color. Afebrile.
an at injection sites on right arm. Patient received Varicella and Hep A vaccines in right arm.YHives spread5/6/2009 to legs, groin
5/6/2009
and upper arms. N
creased temperature. Seen in Hospital Y emergency room. Y 5/7/2009
- red and swollen with small hard lump. Y 5/5/2009 5/6/2009
ay 8- joint and muscle pain, fatigue Y and lymph node swelling. 2/28/09 Day 9- symptoms became severe,2/20/2009 site painful.2/28/2009
3/3/09 Day 12- evalua
site red and swollen x 1 day, diagnosed with cellulitis. Treated with a 7 day course of amoxicillinU 5/12/2009 5/13/2003
brought in for office visit two days after
Y immunizations d/t fever and localized rash to L thigh.YDescribed 4/13/2009
by NP as tennis4/14/2009
ball sized, raised,
brought in for an office visit six daysY after immunizations were given for localized rash of R armY around injection(s)
4/7/2009 site.4/12/2009
Was treated for dia
vaccine on may 12,2009 at 4:19pm. Later in evening developed body aches, chills and "fever in side". Left 5/12/2009
arm became 5/12/2009
swollen and red.
esented to our office on 5/14/09 with a 2.5in circular swelling @ the injection site. She was diagnosed
Y with
5/11/2009
either cellulitis
5/14/2009
of the injection si
, swollen, hot area on left upper thigh, no discomfort and gait problems Y 5/12/2009 5/14/2009
d her first rabies vaccine on 3/25/09Yand 2 days later had flu-like symptoms, sore throat, "bad" N cough, fever,
3/25/2009
chills, excessive
3/27/2009 tiredness and
er aspect of arm extending light redness 100mm radiating from injection site with darker redness N extending 5/13/2009
50mm from 5/15/2009
injection site radially
d chest pain and palpations after second Y gardasil vaccine. Cardiac evaluation is underway. 5/26/09
N Medical records### received ### DOS 12/30/0
ythamatous, tender lesion at injection Y site U 5/13/2009 5/14/2009
ollen and knot the size of a quarter Y at first on5/13/09 pm. Arm s/s increased and pt seen in Y ER and tx with5/13/2009
Benadryl. 5/13/2009
Mom reported on 5/1
5 yo vaccines today, kinrix, MMR and Y var.ÿ Rash developed about 20 minutes after they leftYthe clinic.ÿ Very 5/14/2009
itchy.ÿ5/14/2009
Started on neck and w
as given Gardisil instead of Menactra Y 5/12/2009
n (786.59) 5-000009 6/10/09 Medical records Yreceived DOS 1/21/09 to 2/3/09. CLINICAL IMPRESSION: U 1/13/2009
Palpitations 2/3/2009
resolved. Post vacci
ew days of receiving Menactra vaccine, Dylan developed Y toe numbness
10 then headache, nausia, Y followed3/19/2009
by foot dragging,
3/20/2009impaired joint po
esented 24 hours later with redness about the size of a half dollar, with tenderness to the touch. U Recommended
5/14/2009 cool
5/15/2009
compresses and trea
ELTS" ON LT ARM TOWARDS THE OUTSIDE-MENACTRA GIVEN IM ON OUTER ASPECT Y OF DELTOID 5/14/2009
MUSCLE 5/15/2009
& HEP A GIVEN TO
month old male presents with c/o Skin Check: for 4 days had Immunizations on 4/17/09 and now Y has a red, 4/17/2009
hard, warm 4/19/2009
to touch area below
ssion from E.R.,recieved Pneumovax in ER, c/o R tricep swelling, pain, itching, observed swelling, Y edema,4/16/2009
warmth,redness,
4/16/2009notified Dr. Ea
ame in to my office 5/15/09 1350 to report neck stiffness and head pressure that started 5/15/09 U PM. 5/13/2009 5/14/2009
as given MCV4 and Var #2 in her left arm. Mom stated that patient had a history of feeling light Y headed with 5/15/2009
any type 5/15/2009
of procedure/lab test.
experienced a short duration of minor pain and redness at injection site each time the vaccine Y was administered.
5/8/2008I was 1/22/2009
pregnant during my
lt with swelling and redness within 4-6 hours after immunization Y 5/12/2009 5/12/2009
arm injection site swelling but not painful, with some redness. Y 5/2/2009 5/15/2009
d erythematous rash at site of vaccine. Y 5/15/2009 5/15/2009
day after shot with a rash widespread over the body and some puffiness to her eyes. Urticaria. U 5/11/2009 5/12/2009
ss Criteria: Other- Medically Significant.
Y Initial report received from another manufacturer
Y (other manufacturer's
4/21/2009 control
4/22/2009
number: WAES 090
9 cm, warm, erythematous area @ previous injection site. Mom states area doubled since injection. N 5/11/2009 5/12/2009
d reaction right thigh. Y 5/5/2009 5/6/2009
Y and described the occurrence of fainting in a 13-year-old
Y female
5/12/2009
subject 5/12/2009
who was vaccinated wi
ceived vaccine 5-8-09; noticed erythema,Y tenderness and warmth 5-9-09 (10x10 cm area at Y injection site).5/8/2009
Doctor visit 5/9/2009
5-11-09. Prescription
ced redness @ swelling to right deltoid area this morning. Y 5/14/2009 5/15/2009
of inflammation occurred immediately after injection given at injection site. Red are had pin point Y areas and5/13/2009
facial areas
5/13/2009
also flushed. MD n
red skin in roughly rectangular shape over left anterior thigh surrounding the injection site. About
Y 9cm x 5cm.5/5/2009
Emerged5/11/2009
6 days after vaccina
mplaints of dizziness, Pt put head on desk. At 1:38 pt vomited small amt, color pale, clammy, Y alert oriented
5/15/2009
B/P 100/72
5/15/2009
- Pt states she is h
urs after receiving injection size 2X2 inch in circumference pruritus, pain + Erythema Tx Benadryl Y + Cold compress.
5/8/2009 5/9/2009
d 4.5mm x 5mm areas + redness, swelling Y and tenderness at site of injection L upper thigh. No
Y significant 5/13/2009
systemic 5/13/2009
reactions due to vaccine
ction Left deltoid; erythema/ edema Y and pain. U 5/13/2009 5/14/2009
red and swollen. Y 4/28/2009 4/29/2009
ves over entire body, headache, itchy throat. Y 5/15/2009 5/15/2009
ed vaccinia with diffuse rash, myalgias,
Y fever, and robust take. Treatment with indocin and benadryl..
Y 4/29/2009 5/4/2009
y of the shot, the injection site had minamal
Y swelling; however the following starting occuringUthe day after 5/11/2009
the shot, 5/12/2009
Severe swelling of lymp
Mom reports body rash for 9-10 days and vomiting 1-2 times daily from 11-28-08 until 12-2-08; Y also "change of### attitude" screams
### loudly at t
n has been received from a consumer Y concerning her 24 month old nephew who was vaccinated U with MMR II when he was 18 months old.
n has been received from a consumer Y concerning her 2 years old son with a history of cross-eyes
N operation
11/1/2005
who in November
4/1/2007 2005, was v
Y a 16 month0 old male with Down's syndrome
N and7/1/2008
cardiac issues,
5/8/2009
and a history of a
n has been received from a registered nurse for the Pregnancy Registry for GARDASIL concerning Y a 2512/4/2006
year old female
8/30/2007who is a Guillain B
n has been received from a nurse, for Y the Pregnancy Registry for GARDASIL concerning a 22 Y year old patient
9/20/2006 who 9/20/2006
on 20-SEP-2006 was v
n has been received from a nurse concerning aY14 month old female 0 who was vaccinated with U all three doses of ROTATEQ (dates, route a
n has been received from authors of a published Y literature article concerning
Y an 11 year old N male patient who was vaccinated with PNEUM
vaccines rec'd 10/18/07 and 11/20/07. Y 3 mos later
Y developed Guillain-Barre
5 syndrome/was hospitalizsed
Y for acute
### lower
2/5/2008
extr. weakness. 5
4/28/09 after sx has resolved. Stated that 12 hr after Td-had arm soreness, faint pain in knees, Y felt like fever,
4/24/2009
enlarged4/24/2009
lymph node under (L
ches erythematous area on left arm, Mildly elevated. Still present 72 hours after vaccination. U 5/15/2009
@ injection site edema pain. Y Y 5/11/2009 5/12/2009
c received HPV, MENACTRA, Hep A, Tdap - observed pt. 15 min. after vaccinations. Pt. later Y reported she5/13/2009
couldn't 5/13/2009
quite hear several hour
ceived VARIVAX immunization 5/11/09, mom noticed rash on arms, legs and trunk 5/13/09. Y 8-10 small slightly
5/11/2009 raised5/13/2009
lesions on arm, leg an
Y U 4/28/2009 5/15/2009
vaccination, (hours later) redness andY swelling developed around injection site. At ER, patient U was given 5/13/2009
ibuprophen 5/13/2009
and benadryl. 2 day
alergic reaction to left thigh Y 5/12/2009 5/15/2009
apular rash post auricular nodes U 4/24/2009 5/3/2009
esented to the Emergency Room approximately
Y 27 hours post vaccination with injection site Ycellulitis. Symptoms
5/13/2009 included
5/14/2009 reddness, heat
ven Menningicoccal vaccine at approx. 9 am. at 930 am she started to feel dizzy and was beginning U to get
5/18/2009
a headache. 5/18/2009
Her father was calle
9 Adriana returned to have a TST read. PHN observed right arm triceps area reddened, firmYand warm 5/12/2009 to touch in an 5/13/2009
area 3 1/2 by 2 inche
plained swollen area about size baseball
Y noted under left arm noticed soreness under arm to U chest area5/14/2009
. This was5/16/2009
first noted on 05162009
erated vaccine well, but upon leaving office (within 5 minutes) was "not feeling well" per mom. Y While in car,
5/14/2009
continued 5/14/2009
to complain of not fee
E OUT WITH PIMPLES ON FACE. SLIGHT REDNESS Y 5/18/2009 5/18/2009
slight fever and flu like symptoms and a base ball size knot that was warm and tender and decreased
Y ROM5/8/2009
2 days 5/10/2009
post shot. When pt repo
baby on 5/11/09. Got MMR while still Y in hospital on 5/13/09. 2 hours later c/o numbness of tongue.
N Later5/13/2009
c/o pain and 5/13/2009
tingling of l neck and
d localized swelling at injection site which lasted 48 hrs. Y 5/15/2009 5/16/2009
d hard bump in arm that grew in size. She felt itching in the arm of injection that spread over Yentire body.5/18/2009
She had the 5/18/2009
previous two hepatitis
s administered vaccines, before giving Y vaccine client said he had taken some Benadryl recently Y for allergies.
5/14/2009After receiving
5/14/2009 vaccines client
as given Vaccines and 48 hours later began having Y fevers and resultant 3 febrile seizure. HadYan ear infection 5/13/2009noted 5/16/2009
at the appointment whe
9 the patient was given the meningitis vaccine: Meningococcal (MENACTRA) Polysaccharide Y accination4/28/2009
injection given
4/29/2009
in the left deltoid b
atigue, migraines, nose bleeds, muscle Y & joint pain, sensitivity to light, mood swings, irritable,Nbrain fog, dizzy
5/10/2007spells,6/11/2007
trembles, numbness, b
where the vaccine was adminstered, which is the left shoulder, has been extremely sore and N I am unable 4/25/2009
to lift my arm 4/28/2009
up over my head, ne
hing began less tan 12 hours after first
Y hepatitis B vaccine; no hives/blisters; mother treated Y today for poison
5/11/2009
ivy exposure
5/18/2009
eltoid from Prevnar administered on 05/13/2009. left deltoid 5x4 erythemetous lesion, not indurated,
Y nontender.
5/13/2009 ice 5/14/2009
and 12.5mg benadryl tw
e of vaccine(prevnar) left deltoid 7x7 indurated erythemetous tender macualar eruption Ice, benadryl
Y and5/13/2009
motrin 5/14/2009
e weak and dizzy while walking outside to car. Pt had syncopal episode and fell on sidewalkYoutside clinic. 4/27/2009
Her sister
4/27/2009
reports seeing her st
eived Zostavax in am on 05/14/2009. The visit was uneventful. On 05/15/2009 she came back Y to the HD 5/14/2009
stating her 5/15/2009
r. lower arm was sore
1.9), achiness, headache, throwing Y up the morning after the shots, feeling week Y 5/12/2009 5/12/2009
NDURATED AND ERYTHEMATOUS. AREA 5CM BY 10CM STARTING AT INJECTION SITE U AND EXTENDING
5/12/2009DISALY
CINE WAS INJECTED ON HER UPPER LEFT LEG. THE AREA WHERE SHE HAD THE VACCINE Y GOT5/4/2009
INFECTED. 5/11/2009
IT WAS PURPLE AN
ted 4/15/09, chicken pox. Elevated IGG 1550 on 4/16/09. Transmitted to 9 mon old sib whoUalso tested IGG 4/7/2000
positive.
4/15/2009
after vaccines Y 5/18/2009 5/18/2009
d raised, reddened, approx 4 1/4 in x 3 1/2 in area painful and warm to touch. Left arm Posterior Y subqutaneous
5/4/2009 area 5/7/2009
has reddened area ap
ed in clinic Td and Pneumovax injection. Pt states that evening she was ambulanced to ER with U severe body 5/15/2009aches,5/15/2009
chills, and diaphoresis
sh all over body, no urticaria, feels sandpapery
Y 5/18/2009
er her first shot patient started having
Y episods of what we thought were panic attacks. She had N a hard time 6/11/2008
breathing,
6/12/2008
her heart would race
ad dizziness, nausea and vomiting Y on and off since HPV was given 3/16/09, associated withUbody malaise. 3/16/2009
There was4/2/2009
no reported fever.
rst booster injection given (April 8, 2009
Y I think) I experienced left arm itchiness with small bumps
U 1 week5/15/2009
post the injection.
5/16/2009The injection si
p at injection site. Sore arm. Achey muscles. Y 5/12/2009
hing, unresponsive. Fussiness, fever, Y decreased Y appetite. 6/3/09 Hospital
1 records receivedYDOS 5/15/09 5/15/2009
to 5/16/09.5/15/2009
FINAL DIAGNOSIS:
d swollen with redness and pain. Y 5/13/2009 5/13/2009
was reported by a pharmacist and described the Y occurrence of decreased
0 oxygen saturationY in a neonate4/6/2009
male subject
4/6/2009
who was inadverte
-104 X 2 days Y 5/12/2009 5/14/2009
en/red 2 days after vaccine administeredY (left thigh). Y 5/15/2009 5/17/2009
A and Influenza shot on 4/14/09 and SPV 4/16/09. She returned to the Imm Clinic on 4/23/09 for evaluation 4/14/2009
of SPV4/23/2009
(major take); pt reques
g of day of shots - She developed chills vertigo, nausea (still able to drink.) confined to bed - Ymissed school 5/12/2009
next day.5/12/2009
Mom states " this sens
given in R thigh- 48 hours later, thighY with edema + splotchy erythema. R thigh 33 cm diameter, Y L thigh 29 5/13/2009
cm. At 72 5/12/2009
hours, rash worsened
S B #2 (accelerated schedule) given Y 4/15/09 - later on 4/14/09 pt called with "arm burning". YNo other symptoms
4/13/2009advised
4/14/2009
ADVIL/cold comp
nflammation 3 cm Rx for Benadryl given. Y 4/21/2009
systemically see clinical data report.Y Y 5/5/2009 5/6/2009
swelling-hard and warm to touch . LeftY upper thigh 8"x5" (redness). Seen at hospital. DX: cellulitis.
Y RX: BACTRIM.
5/8/2009 5/9/2009
5/11/2009
Y Y 5/8/2009 5/9/2009
tous, swollen, large local reaction greater then 30cm 1 week after vaccine for DTAP. Y 4/16/2009 4/21/2009
4/14/2009
h red, indurated 1 1/2 - 2" area Y 5/5/2009 5/6/2009
which began a couple of hours after receiving vaccine. U 5/12/2009 5/12/2009
per right arm appeared red, swollen and hard with a measurement of 60mm induration. Patient N denied any itching or difficulty breathing.
called back 2 days after ER visit to notify
Y us that patient was very weak + had drowsiness, a Y "knot on the4/15/2009
left arm". The
4/15/2009
was patient last dos
was reported in a literature article and described the occurrence of hepatitis B antigenemia in Y a 111-day-old subject of unspecified gender
me in for Flu vaccine, Right and TDAP, Left. Complaint of pain and swelling next day- c/o very painful. Called 5/1/2009
PMD today-appointment
5/2/2009 mad
injection site, right arm. Erythema right
Y arm. Taking BENADRYL about every 8 hours. Y 5/8/2009 5/9/2009
d 13X14 CM Swollen, Redness, warm Y to touch. Apply cold compress (ice) every 2 hrs for 15Umin. Then warm. 5/5/2009 5/5/2009
ould have received a Tdap patient was administered a DTaP. No adverse event reported. Patient Y notified
5/11/2009
of mistake.
orts that after HPV vaccine given on 2/27/09 she went home, started feeling dizzy, had chestYpain, rapid 2/27/2009
heart rate and2/27/2009
vomiting for 3-4 day
en lump L thigh. Y 5/7/2009 5/7/2009
esicles at injection site, followed by patch
Y of erythema & induration expanding to 8 X 10 cm by 5/13/09. Borders
4/28/2009 slightly
4/30/2009
raised, mildly tende
ceived VARIVAX vaccine on 12/19/97 and 6/27/08. Exposed to chicken pox vaccine 2 weeksY ago. Developed 6/27/2008
chicken
5/10/2009
pox rash on 5/10/09.
iven 5/1/09 pri 5/1 - 5/09 Redness + swelling at site 5/5 - 8/09 no fever/chills. No antibiotics Ygiven. 5/1/2009 5/1/2009
receiving vaccine, mild swelling and tenderness of left upper arm / L axilla. Y 5/6/2009 5/8/2009
generalized. Benadryl 6.25 BID X 5 days ; weak 2y in Y 5/6/2009 5/11/2009

M ADSM is referred from a study for evaluation of previous local reaction to AVA #2. Symptoms:Y Edema8/12/2007
@ injection8/12/2007
site 50-120mm, Pain,
tion to the pertussis in DTAP #5. Became pale approx 15-30 minutes after imm in peds. Returned
Y to peds5/5/2009
at Dr.'s direction.
5/5/2009Place on exam
9 1150/AM.- MMR #2 given. 730/PM. Y Pt had seizure taken to ER s+s unknown. Y 4/28/2009 4/28/2009
received first GARDASIL shot in June 2008. She passed out and hit her head getting a concussion
N -the Dr
6/1/2008
believed-. She had to stay in be
y MD on 3/13/09. Pt c/o rash in dermatome pattern from right lower flank which extends down U and wraps2/20/2009
around to ant3/6/2009
thigh. Sx started 7 d
n has been received through the Merck pregnancy registry, from a registered nurse concerning Y an approximately
1/20/200818 year old female with n
Y nurse for the Pregnancy Registry for GARDASIL, concerning
N a 222/22/2008
year old female
2/22/2008
who on 22-FEB-2
n has been received from Merck Pregnancy
Y Registry for GARDASIL from a health care worker Y concerning2/7/2008
a her 15 year
7/1/2008
old daughter with
n has been received from a physicianY and a registered nurse concerning a 10 years old femaleY patient who 3/6/2008
on 06-MAR-2008, was vaccina
n has been received from a physician's nurse concerning a female who in 01 July 2008, wasYvaccinated with 7/1/2008
GARDASIL 7/1/2008
vaccine (Lot# and
Y nurse and a 26 year old female with no pertinent medical
N history and2/17/2009
no history of known drug react
n has been received from a 20 yearYold female patient with no relative medical history, drug N
3/1/2009who 3/1/2009
was vaccinated with
n has been received from a physicianY concerning a 21 year old female who on 18-MAR-2009 Y was vaccinated
3/18/2009
intramuscularly
3/18/2009 with a first do
n has been received from a 28 yearYold female patient with irregular heartbeat and no allergies
N who in June 9/1/2007
2007, was
10/1/2007
vaccinated with the
n hs been received from a physicianY concerning a 15 year old female who was vaccinated with U GARDASIL. The patient developed genital
n has been received from a physician concerning a either 15 or 16 year old female who wasYvaccinated with a dose of GARDASIL (lot num
n has been received from a nurse concerning a 9 year old female with sore throat on 23-FEB-2009
N who 2/23/2009
was vaccinated with her first dose
n has been received from a 30 year old female with no medical history reported, who on 24-JAN-2009
N was
1/24/2009
vaccinated
1/24/2009
with a 0.5 mL dose o
n has been received from a nurse concerning a 23 year old female with a penicillin allergy whoY on 02-APR-2009
4/2/2009was4/2/2009
vaccinated with GAR
n has been received from a nurse practitioner concerning a 19 year old female patient with no Y previous medical
3/27/2009 history
3/27/2009
reported who on 27
Y concerning a 13 year old female with a history of cancer N who was vaccinated with a first and second
n has been received from a mother concerning her 14 year old daughter, with inflammatory N bowel disease 9/29/2008
and not known drug reactions/al
n has been received from a Nurse Practitioner (N.P) concerning a 20 year old female patientNwith no pertinent
3/16/2009medical
3/26/2009
history and no know
n has been received from a registered nurse concerning a female patient who on 30-JAN-2009 U was vaccinated
1/30/2009 with1/30/2009
the first dose of GARD
n has been received from an office manager concerning a female who was vaccinated in theUphysician's office with a second dose of GARD
n has been received from a consumer who in January 2008, was vaccinated first dose of with U GARDASIL1/1/2008
(dose, route 1/1/2009
and lot number not p
n has been received from a registered nurse concerning a 16 year old female with no knownYdrug reaction/allergies
4/3/2009 and 4/3/2009
no pertinent medic
n has been received from a nurse practitioner concerning a female patient with allergy to Ceclor,
U who on3/31/2009
31-MAR-2009 4/1/2009
was vaccinated wit
Y concerning a 19 year old female patient with noY pertinent medical
2/4/2009 history
2/7/2009
or no known drug a
n has been received from a 27 yearYold female with sulfonamide allergy who "about a year ago",Y in approximately
1/1/2008 2008 1/1/2008
was vaccinated wit
Y concerning a female who on 22-DEC-2008 was vaccinated Y with the
2/18/2009
first dose2/18/2009
of GARDASIL vaccine.
n has been received from a physician concerning a 20 year old female who on 30-MAR-2009 N was vaccinated
3/30/2009
with her4/3/2009
first dose of GARDA
Y concerning a 21 year old female patient who on 25-SEP-2007
N was9/25/2007
vaccinated with ### the first dose of G
n has been received from a physician concerning a 20 year old female who on 02-APR-2009, U was vaccinated
4/2/2009
intramuscularly
4/2/2009 with third 0.5
Y concerning a 19 year old female who on 13-NOV-2008 U was vaccinated with ### first dose of GARDASIL
Y nurse, for the GARDASIL vaccine a Pregnancy Registry U concerning 3/30/2009
a 17 year old female with sulfa
Y pharmacist concerning her 17 year old daughter with Nno pertinent4/29/2008
medical history,
5/5/2008
who on an unspe
n has been received from a registered nurse concerning a female who on an unknown date,Uwas vaccinated with GARDASIL (lot # not repo
n has been received from a licensed practical nurse concerning a female with no drug reaction/allergies
Y who was vaccinated with the first 0
n has been received from a Pharm. T. concerning a 23 year old female with sulfonamide allergy N and a 3/16/2009
history of birth
3/21/2009
control who on 16-M
n has been received from a female staff member in a physician's office but not healthcare professional
U concerning
5/16/2008 her 14 year old daughte
Y a 15 year old female patient with no relative medical
N history,
3/25/2009
drug reactions
3/27/2009or allergies who i
n has been received from a consumer concerning her daughter, a female patient, who on anUunspecified date was vaccinated with a dose
n has been received from a practiceYmanager concerning a 22 year old female patient who on Y 06-FEB-2009 2/6/2009
was vaccinated
2/6/2009with her first d
n has been received from a bachelorY of science in nursing concerning a female who on 03-APR-2009
Y was4/3/2009
vaccinated 4/3/2009
with the second dose
n has been received from a registered nurse concerning a 19 year old female patient with anemia,
Y herpes type### 1 since July###2005 and sulfa
n has been received from a registered nurse concerning a 17 year old female who on an unknown N date, received her 3/31/2009
second dose of GAR
n has been received from a licensedY vocational nurse concerning a female who on 04-OCT-2007 N was vaccinated
10/4/2007intramuscularly
10/4/2007 with a firs
Y concerning a female who was already being treated for U vulvar Condyloma (genital wart) and was vac
n has been received from a Registered Nurse (R.N.) reported that in February 2009 an unknown U number 2/1/2009
of patient may2/1/2009
had received a dos
n has been received from a Registered Nurse (R.N.) concerning an 18 year old female who Y on 02-APR-2009 4/2/2009
was vaccinated
4/2/2009 intramuscular
n has been received from a physician concerning an approximately 15 year old female patient Y who was vaccinated
3/1/2009 with 3/1/2009
her first dose of GA
n was received from a nurse practitioner
Y concerning a 22 year old with a needle phobia and Uadmitted to 3/21/2009
passing out3/21/2009
with piercings and tatto
Y concerning a 26 year old female at a high risk to allergies,
U with penicillin
3/23/2009allergy
3/24/2009
and a history of hosp
n has been received from a licensedY visiting nurse concerning a female with no pertinent medical
N history10/4/2007
or drug allergies
10/4/2007who on 04-OCT-
n has been received from a physician concerning two 17 year old female who on an unspecified Y date were vaccinated with a 0.5 ml second
n has been received from a consumerY concerning her daughter, a 17 year old female patientYwith no relevant 3/27/2009
medical
3/27/2009
history, drug reaction
n has been received from a pharmacist concerning a patient who was vaccinated with a second U and third4/8/2009
dose of GARDASIL
4/8/2009 (lot # not rep
n has been received from a physician concerning an unknown number of female patients with U no pertinent medical history or drug allergies
n has been received from a Registered Nurse concerning a female who on an unspecified date U was vaccinated with GARDASIL and exper
n has been received from a 46 yearYold female with allergies to sulfa and ATARAX and no pertinent
N medical
3/30/2009
history3/30/2009
who on 30-MAR-2009
n has been received from a physician concerning a 14 year old patient who on 05-MAR-2009 Y was vaccinated
3/5/2009
with the3/5/2009
first dose of GARDA
n has been received from a physician concerning a patient who experienced heavy menstrual U bleeding about a year ago after receiving a d
Y concerning a 19 year old female with no medical history N and drugs 3/6/2008
allergies, who
3/21/2009
on 06-AUG-2007 w
n has been received from a consumer concerning her daughter, a 15 year old patient with no N pertinent medical
4/7/2009 history
4/7/2009
and no known drug
n has been received from a consumer concerning his 22 year old female wife who on 16-APR-2008
N was vaccinated with the first 0.5 mL do
n has been received from a medical assistant concerning her 12 year old daughter with no pertinent
N medical
4/6/2009
history reported
4/6/2009and no known
n hs been received from a physician concerning a patient who on an unspecified date was vaccinated
U with a dose of GARDAIL (dose, route
n has been received from a dentist concerning her 13 year old daughter who on 08-APR-2009 N was vaccinated4/8/2009with the
4/9/2009
first dose of GARDA
Y concerning a 15 year old female patient with no known N drug allergies/drug
2/5/2009reactions
3/31/2009 who on 05-FEB-
Y concerning a 17 year old female who on 13-AUG-2007
U was
8/20/2008
vaccinated8/20/2008
Y worker concerning a 12 or 13 year old female patientYwith no relative 1/22/2009
medical1/22/2009
history, drug reactions
n has been received from a physician concerning a 25 year old female teacher with no knowNdrug allergy 4/1/2009
who on 01-APR-2009
4/5/2009 was vaccin
n has been received from a medicalYassistant, for GARDASIL, a Pregnancy Registry product, U concerning 2/26/2009
her daughter, an approximately 1
Y and a registered nurse concerning a 19 years old femaleN patient who 1/7/2009
was vaccinated
3/1/2009 with a complete
Y and a registered nurse concerning a 27 years old femaleY patient who 6/13/2007
was vaccinated
12/5/2007 with a complete
Y concerning a female patient who was vaccinated with Na complete series of GARDASIL. It was reporte
n has been received from a 25 year old female with no medical history and drug allergy whoUwas vaccinated with her second dose of GARD
n hs been received from a consumer concerning a 10 year old female who was vaccinated with U GARDASIL. Then the patient started to fee
n has been received from a female patient who was a medical assistant and a physician concerning
Y the 2/18/2009
patient who2/19/2009
was vaccinated with h
Y nurse concerning her daughter who 02-FEB-2009 was N vaccinated10/3/2008
with her third dose ###of GARDASIL
n has been received from a physician assistant concerning a 21 year old female with no medical
N history 1/27/2009
or drug allergies
4/1/2009
who was vaccinat
Y nurse concerning an 18 year old female with a historyNof cardiac murmur4/7/2009 who 4/9/2009
on 07-APR-2009 was
n has been received from a registered nurse concerning an 18 year old female with asthma Y and no known 4/13/2009
drug allergies
4/14/2009who on 27-JUN-2
n has been received from a registered nurse concerning a 27 year old female who on an unspecified
N dates was vaccinated with the three d
n has been received from a nurse concerning a 17 year old female patient who in approximately
Y January 2009 (reported as about 3 months
Y reported that he received a call from a mother concerning
N a 14 female ###daughter who was vaccinate
rmation was received from a physician, and follow up information from a nurse concerning a Y female patient who was vaccinated with her se
n has been received from a Licensed Visiting Nurse concerning a 12 year old patient who onU03-APR-2009 8/6/2008
was vaccinated
n has been received from a physician concerning a female patient who "last year" in 2008 wasY vaccinated with her second dose of GARDA
Y nurse, for the Pregnancy Registry for GARDASIL, concerning
Y a 19
11/4/2008
year old female
11/4/2008 with no relevant
n has been received from a physician assistant concerning a 16 year old female with negativeY medical history
4/13/2009
who on
4/13/2009
13-APR-2009 receiv
Y assistant concerning a 29 year old female patient whoNon 13-APR-2009 4/14/2009
was vaccinated
4/15/2009 with GARDA
Y nurse, for GARDASIL, a pregnancy registry product, Y concerning a 6/3/2008
16 year old3/25/2009
female who on 03-JU
n has been received from an office Ymanager who stated that she received this report from the
U patient's mother. The patient's mother had re
Y assistant and nurse concerning a 17 year old female whoY on 25-DEC-2008 ###was vaccinated
### with the f
n has been received from a nurse practitioner concerning a 24 year old female with KEFLEXYallergy and3/30/2009
irregular heartbeat
4/6/2009 who on 30-MA
n has been received from consumerY concerning her 17 year old daughter who"2 or 3 months U ago" was 4/13/2009
with the first dose of GA
n has been received from a physician and his office manager concerning a 25 year old female N with a history
4/11/2009
of bladder
4/13/2009
repair in July 2007 d
n has been received via medical record
Y from a registered nurse concerning a 16 year old femaleY with heavy
3/20/2009
menstrual
3/22/2009
periods (last menstr
n has been received from an office assistant and a female patient who on 19-MAR-2009 was N vaccinated3/19/2009
the first dose
3/26/2009
of GARDASIL. Conc
Y nurse and a licensed practical nurse from patient's report
Y and emergency2/16/2009 room
2/16/2009
(ER) records concer
Y from a licensed nurse practitioner concerning a female
U patient who on an unknown date was vacc
Y and a licensed visiting nurse, concerning a 11 year oldNfemale patient, who ###on12/1/2008
13-AUG-2008 was va
n has been received from a Allergy YTechnician concerning a 14 year old female patient with Nno pertinent medical ###history
12/5/2008
and no drug reacti
n has been received from a medical assistant concerning an unknown number of patients whom U were vaccinated with a dose of GARDASI
Y concerning a 16 year old female who was vaccinated Y with three doses of GARDASIL (Lot # not repo
n has been received for the Merck pregnancy
Y registry of GARDASIL from a 22 year old femaleN patient with 2/16/2009
iodine allergy
2/16/2009and a history of "p
n has been received from a physician concerning a female patient who on unspecified datesYwas vaccinated with the first, second and third
n has been received from a physician concerning a female who on an unspecified date was U vaccinated with first 0.5mL dose of GARDASIL
n has been received from a medicalYcoordinator concerning an 18 year old female who on 25-MAR-2009
Y 3/25/2009
was vaccinated
follow-up information has been received from a physician and the physician's office manager Y concerning3/23/2009
a 19 year 3/23/2009
old female who on 23-M
n has been received from a nurse practitioner concerning a 25 year old female who on an unspecified
N date was vaccinated with first 0.5 mL
n has been received from a physician concerning a female patient who was vaccinated with a dose of GARDASIL IM. On an unspecified da
n has been received from a Registered Nurse concerning a 25 year old female who in 2006 Y("3 years ago") was vaccinated with her first an
Y nurse, for the Pregnancy registry for GARDASIL, concerning
U a 22 year old female
4/22/2008with no pertinent
n has been received from a physician concerning an 18 year old female patient who on 22-JAN-2009
Y was vaccinated4/1/2009
with her first dose of
n has been received from a physicianY concerning a 26 year old female with no drug reactions N or allergies who in 2008 4/21/2009
was vaccinated with
n has been received from a physician concerning three patient who were vaccinated with GARDASIL
U and tested positive for a high risk stra
n hs been received from a nurse practitioner concerning a 14 year old female student with no Y pertinent medical
9/22/2008 history
9/23/2008
and no known drug
n has been received from a physicianY concerning a 11 year old female with bronchospasm exercise
Y induced
4/21/2009
who n 4/21/2009
21-APR-2009 was vacc
Y nurse, concerning a female who was vaccinated withUGARDASIL that was stored improperly at 32 F
Y nurse (R.N.) concerning a 19 year old sexually activeNfemale who from 10-JUL-2007 3/27/2009 was vaccinated
n has been received from a consumer Y concerning her 17 year old daughter with no medical N history and allergies,
4/17/2009who 4/20/2009
on 17-APR-2009 wa
n has been received from a physician concerning a patient who unspecified date was vaccinated U with GARDASIL (lot # not reported). On u
Y concerning a 24 year old female who vaccinatedY the first dose of GARDASIL 7/1/2008 on an unspecifi
n has been received from a physician concerning a patient who was vaccinated with a dose Uof GARDASIL and experienced a vasovagal re
n has been received from a consumer concerning her daughter, a 16 year old female who on Y unspecified dates was vaccinated with a first
n has been received from a physicianY concerning a 40 year old female who experienced pain U on her shoulders, knees and sometime in her
n has been received from a physicianY concerning a 19-20 year old female who was vaccinated N with the first 0.5 ml dose of GARDASIL (no
n has been received from a physician's assistant concerning a female patient who on unspecified
U dates was vaccinated with the first, secon
n has been received from a nurse practitioner concerning a female patient, who was vaccinated U with the3/18/2009
third dose 3/25/2009
of GARDASIL, 0.5ml. N
n has been received from a consumer a 28 year old nurse with latex allergy and a history of Yparoxysmal supraventricular 2/23/2009
Tachycardia (PSV
n has been received from a licensed Y practical nurse concerning a 22 year old female with a Nmedical history
3/26/2009
of knee operation
4/8/2009 in 2004 who
n has been received from a the doctor's nurse concerning a 25 year old female who on 21-APR-2009,
U was
4/21/2009
vaccinated
4/23/2009
intramuscularly with
n has been received from a registered nurse concerning that her son's several female friends U developed muscle twitches and tingling sens
n has been received from a consumer concerning her 18 year old daughter who was vaccinated U with the first dose of GARDASIL (lot#, rou
n has been received from LicensedYPractical Nurse (LPN) concerning a 19 year old sexuallyNactive female 11/1/2008
who in April4/9/2009
2008, an unspecifie
n has been received from a medical assistant concerning a 17 year old female who on 26-FEB-2009
N was2/26/2009
vaccinated3/5/2009
n has been received from an office manager concerning a female who was vaccinated with the U first, the 5/11/2007
second and the third dose of GARD
n has been received from a licensed practical nurse concerning a 16 year old female who inYSeptember 2/27/2008
2008, was 2/27/2008
vaccinated with GARDA
n has been received from a physicianY concerning an 18 year old female who was vaccinatedNwith the first 7/19/2007
dose of GARDASIL
3/13/2009 on 12-JAN-2
n has been received from a physicianY concerning an 18 year old female who was vaccinatedUwith GARDASIL. 6/19/2007The 9/19/2008
patient had a negative p
n has been received from a physicianY concerning a 21 year old female who had a negative pap U smear test 1/15/2008
on 09-JAN-2006.
4/9/2009Patient then re
n has been received from a registered nurse concerning a 33 year old female with on pertinent U medical history and no allergies who in app
n has been received from a consumer concerning her 21 year old daughter who was vaccinated Y with the first dose of GARDASIL (lot #, rou
Y nurse and a patient care coordinator concerning a 19Nyear old female 7/8/2008
who in June 2007, was vaccin
n has been received from a certifiedYmedical assistant concerning a 21 year old female with N amoxicillin allergy and no 2/1/2009
pertinent medical his
n has been received from certified medical
Y assistant concerning a 3 year old female patient N
with no drug reaction
7/1/2008or10/1/2008
allergies and no pertin
Y an "about 20 year old" female who on an unspecified
U date was vaccinated 2/1/2009
with third 0.5mL d
n has been received from a physician concerning his daughter who on an unknown date was U vaccinated with a dose of GARDASIL and the
or no known
2/10/2009drug/allergy reac
n has been received from a consumer concerning her 15 year old daughter with no pertinentNmedical history and no known drug allergies/d
n has been received from a physicianY concerning a 21 year old female with sulfonamide allergy who on 1/18/2008
18-JAN-2008 1/19/2008
n has been received from a physician concerning an 18 year old female who was vaccinatedUwith GARDASIL. The physician reported that
rmation was received from a physician and follow up from a licensed practical nurse concerning Y a 20 year old female ### 11/1/2008
n has been received from a certified nurse practitioner concerning a female who on an unspecified
U date was vaccinated with first dose of G
Y (N.P.), for the Pregnancy Registry for GARDASIL,
Y concerning
4/30/2008
a 23 year
6/19/2008
old female with no p
n has been received from a 52 yearYold licensed visiting nurse who was splashedYwhile she N was withdrawing
11/1/2008
a dose11/1/2008
of PNEUMOVAX 23 in
n has been received from a 69 yearYold femaleYpatient who "2 or 3 years
0 ago" was vaccinatedY with a dose of PNEUMOVAX (manufacturer
n has been received from a physicianY concerning his 54 year old wife with allergy to sulfa drugs
Y like Bactrim8/20/1998
and no8/20/1998
pertinent medical histo
n has been received from a physician concerning Y an approximately 117 week old male who was U vaccinated 5/7/2009
orally with
5/11/2009
a 2 ml second dose o
n has been received from a physicianY concerningY a patient who on an 1 unspecified dates wasUvaccinated7/14/2008
orally with 5/11/2009
three doses of ROTATE
n has been received from a physicianY concerningY a 12 month old male 3 who on 07-JUL-2008Ywas vaccinated with ###the first dose of ROTATE
solated IgA deficiency, administered pneumococcalY vaccine. 4 days 2before admit she developed
Y swelling, 4/20/2009
redness &4/20/2009
fever within 24 hrs of i
ort received from a consumer on 08 May 2009, Y who is also the patient's
0 parent. A 37-year-oldUfemale patient4/21/2009
with an unknown medical histo
was received on 13 May 2009 fromYa consumer. A 41 year old female patient received ACAM2000 N (lot number
5/2/2009unknown)
5/11/2009in her left arm an
ped pain, swelling and redness at site of vaccine LD after receiving it. Y 5/8/2009 5/9/2009
ates pt received vaccine then had some blood work in office. After ten minutes pt complained Y of dizziness
7/14/2008
accompanied7/14/2008
with numbness in
ng by 8 cm wide erythema & warmth ant/lad @ thigh. 5/13/2009 5/13/2009
set (10-12 hours) post vaccine fever. Y 104 T max. Fever lasted 48 hours, then abruptly stopped, and a lacy 5/13/2009
red rash5/13/2009
appeared head to toe.
ven Adacel, Menactra + PPD. Began feeling light headed, sat in chair and became faint. Y 4/20/2009 4/20/2009
er, I awoke with a 3 inch red, hot, itchy, swollen circular patch on my upper right arm. I called Y pharmacist 5/1/2009
and saw my5/4/2009
doctor. Benadryl pre
ven MENACTRA 0.5 ml @ deltoid on 5/12/09. On 5/13/09 at approx 7pm pt & parent noted large Y localized
5/12/2009
reaction.5/13/2009
Redness & warmth 5x
hours- Left arm (between elbow andY deltoid) became swollen 3x normal size at site of varicella Y vaccine. 5/12/2009
Within 48 hours
5/13/2009
red welted rash d
ately 24 post Kinrix vaccination patient had marked non-pitting edema to his right upper leg with Y redness that extended from his right greate
IVEN 4-14-09 AND PATIENT REPORTS ONSET OF SEVERE HEADACHE ON 4-15-09. Y 4/14/2009 4/15/2009
02 degrees Body aches.chills,fever, red swollen left arm. Applied ice to left arm, Tylenol Y 5/12/2009 5/12/2009
cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol
5/11/2009
in Sterile Water. Patient does
ceived MCV4 in Left deltoid and Tdap in Right deltoid on 5/12/09. She came in 5/18/09 c/o left Y upper arm 5/12/2009
itching for5/15/2009
a few days (approx sta
5/13/2009
ide effects include: diarrhea, stomach pain, discomfort, cranky behavior, problems with sleep, Y excessive5/14/2009
crying, but 5/15/2009
no fever. The adverse e
Y 5/18/2009
5/14/2009
5/12/2009
5/11/2009
d baseball size knot with redness, swelling and fever noted. Pt taking benadryl. Y 5/18/2009 5/18/2009
5/12/2009
in Sterile
5/19/2009
Water. Patient does
5/11/2009
in Sterile
5/19/2009
Water. Patient does
y administered an expired Hep A vaccine to patient. She did not have any adverse symptomsYat the time.5/19/2009 No treatment 5/19/2009
given.
5/11/2009
in Sterile
5/19/2009
Water. Patient does
er second gardasil, pt went to ER for Y dizziness, ataxia and severe headache. Skull x ray, ct headY and lab4/18/2008
work all negative.
4/18/2008 7/2/09 Receive
ht immigration form from civil surgeon Y with need for Td, PPV, Varicella (due to neg blood titer) and Zoster. 5/13/2009
I said Zostavax
5/17/2009not needed beca
5/11/2009
in Sterile
5/19/2009
Water. Patient does
5/11/2009
in Sterile
5/19/2009
Water. Patient does
5/13/2009
in Sterile
5/19/2009
Water. Patient does
cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and U 0.25% phenol
5/13/2009
er receiving vaccines, he had left upper extremity Y swelling, redness,2and warmth. His left thumb
U base was 5/13/2009
itching. There
5/18/2009
was left thumb pai
ling of nausia. Sycope within minutes of the injections. Fell and hit head. Regained consciousness U within
5/19/2009
a few minutes
5/19/2009under care of the
PLAINING OF VOMITING AFTER VACCINES WERE ADMINISTERED. HE WAS SEEN BY U ANOTHER 5/19/2009
PROVIDER5/19/2009LATER THE SAME EV
pain in arm of injection, inability to move/lift
Y arm, extreme stiffness and pain in neck, enlargedYand painful/tender
5/13/2009 touch
5/14/2009
glands in neck. Could
hema, vesicular rash in dermatome Y distribution (L/arm). Rx : ACYCLOVIR 800 5x/d. LYRICAU50. tid and 5/13/2009
VICODIN. 5/17/2009
ely post immunizations baby became very pale & lethargic HR 100 initially - increased 120s with Y stimuli pulse
5/13/20090 X 965/13/2009
arousable but sleepy g
turned 30 min after immunization with hives. Lungs CTA Heart Reg Benadryl 12.5mg given-Ypt observed5/13/2009 x 20 min still
5/13/2009
with hives but active.
warmth, erythema approx 10 cm around Y injection site. Y 5/12/2009 5/14/2009
se effects noted per patients father - 5-13-09. Y 5/12/2009
stated that his "arm is sore." No other adverse effects noted, 5-13-09. Y 5/12/2009
ns were given at 2:30 pm; Pt waited in the room for 15 minutes. Waiting then to have lab drawn Y noticed5/12/2009
her right hand5/12/2009
swelling on the dors
was reported by a physician via a GSK representative, and described the occurrence of bloody U diarrhea in a subject of unspecified age and
was reported by a physician via a GSK representative, and described the occurrence of bloody U diarrhea in a subject of unspecified age and
n muscles, joints. Felt hot all over, pressure
Y in chest. Given IV fluids DILAUDID, ZOFRAN inY ER. 5/6/09 5/5/2009
6 am D/C with 5/6/2009
VICODIN for pain.
.5 within 24 hrs of vaccine administration. 5/13/2009 5/14/2009
ack ache in mid + lower back muscles which woke me from sleep. Restlessness + achey thatY night. Gradually 3/30/2009 decreased
3/31/2009over next 3 days.
ruised at injection site - high fever - Paleness, Weak, dizzy - Sore throat, ear ache, sore eyesY - chills 3 days2/27/2009
MOTRIN 2/27/2009
& TYLENOT given
upper pain with 3" swelling, redness, Y heat, hardness. 5-12-09 Went to place @ 6-7 pm.- was Y told "reaction
5/11/2009
to tetanus
5/12/2009
but not bad enough
swelling, 6" down arm, 3-4" wide, with heat. No fever. Pain in arm as well. Diagnosis cellulitis Y secondary 4/27/2009
to injection.
4/29/2009
Tx with AUGMENTI
hargy, rash started 6 days following vaccination. Some rhinorrhea started 5/8/09 with slight cough Y Fever4/29/2009
> 104 degrees. 5/5/2009
ters branching out / popping up on noseY area - 7 total so far, patient was contacting doctor. U 5/12/2009 5/15/2009
ped rash behind his leg, forearms and Y few spots on trunk. Describes as itchy, appears dry, Y Flat. Began4/29/2009
approx. 244/30/2009
hours post 2nd dose H
y - few hrs. after Gardasil #3. Y 8/18/2008 8/18/2008
en and red at injection site. 5/13/2009
epared for older sister & accidently given to younger child. Y 5/14/2009
ess, malaise, swelling of lymph nodes Y day of injection. Involuntary muscle twitching seizureYon Saturday. 4/30/2009 5/2/2009
ceived Hep A on right arm and HPV on Left arm a few seconds later while nurse in room hadYdazed look5/18/2009 and feeling5/18/2009
a heavy feeling lay bac
d Tdap, HPV and Menactra and then slumped over into mother's arms motionless, then jerked Y involuntarily5/19/2009
and was5/19/2009
layed down with eyes
as fatigued a few hours after the injection. About 6 hrs after injections, there was a small rash U around area. 5/14/2009
Fever started
5/14/2009 @ 10:pm, patien
m swelling, leg and back - pain. Y Y 5/13/2009 5/13/2009
dizziness, pulse rate 100, low grade fever, sore arm w/hot to touch + tired. These symptomsUstarted about 4/30/2009
12 hrs after 4/30/2009
vaccine was given a
nted about 10 minutes after the last shot, falling off the table. ? L.O.C for about 3 minutes. Y 5/18/2009 5/18/2009
t. Extreme fussiness trouble sleeping. only when carried. Y 5/11/2009 5/13/2009
len, warm, painful area to upper right Y thigh 24 hours post vaccination. Approx 24 cm X 19cm. U Also noted 5/12/2009
several fluid5/13/2009
- filled vesicles at in
d high fever to 104 with lethargy on day of vaccinations, after they were given. 2 days later she Y developed5/5/2009hives that5/5/2009
lasted for 2-3 days. P
STAVAX administered; pain at injection site 5/5/09 redness/hardness 3 inches wide & 6 inches U long extending5/4/2009 from injection
5/5/2009site & down th
5/13/2009
reaction with redness & swelling @ injection site, radiating heat. check non-sotp crying > 3 hours (or more) 5/18/2009
post injection.
5/18/2009
esented shortly after receiving the vaccine
Y with slight red rash to all body parts. Benadryl Administered.
Y 5/18/2009 5/18/2009
d #2 Hep A vaccine. 3 min. later became dizzy & fell. ? loss of consciousness x few seconds. Y BP- 80/60 3/18/2009
Pulse- regular.
3/18/2009 Skin warm/dry.
f 5-8-09. Mom noticed a rash on child. Child has had low grade fever. Decreased appetite U and fluid intake.
5/7/2009
Fussy more5/8/2009 than usual. Pin h
y weekend, use bandages slides off. Y Reaction occurs progressively starting around original vaccination
U point
3/10/2009
to upper 4/25/2009
arm. Exam reveals c
5/9/2009 N 5/4/2009 5/9/2009
N
vaccine 3/1/09, developed fever chills,Y rigor, malaise,
Y pain @ injection
4 site, admitted to hospital
Y for cellulitis3/1/2009
at TD injection
3/2/2009 site. Treated wit
ale presented to the office for routine follow up of chronic medical problems. She had a routine physical examination5/1/2009 5/1/2009on 8/8/08 at which tim
ter - chills - increased pulse - about 15 next 2 days - fever, weakness, sweating. Also noticed Y lower blood 4/14/2009
pressure,4/14/2009
about 20 points. Only
d with bruise @ site of immunization + swelling + erythema. Pt very fussy and difficult to console. Y 5/7/2009 5/7/2009
ct identified himself as a cardio-vascular surgeon, Y 22 years in Army.5He was deployed Y to a foreign
N country in 1991, at which time he receive
Herpes Zoster - began 5-3-09. Y U 11/4/2008
sh "hives" x 3 days; improving after 3 days per mother. Rash started 7 days after vaccinations U in same place 5/4/2009
as administered
5/11/2009VARIVAX. Mo
n has been received from a registered Y nurse concerning an approximately 14 year old female U patient who3/7/2008
on 22-AUG-2007, 19-OCT-2007
n has been received from a physician concerning a 15 year old female patient who was vaccinated U with 1/26/2009
the first dose of GARDASIL IM, 0.5
n has been received from a physician concerning a 19 year old female Y with no known medicalY history, allergies
5/17/2007 or drug reactions
### who in Ma
Y concerning a 4 year old male patient with no pertinent
N medical history ###and no known drug allerg
Menactra on 5/13/09 and developed fever, myalgia, and headache on 5/14/09. Seen at office Y and instructed
5/13/2009
to take 5/14/2009
ibuprofen.
ceived a Hepatitis B vaccine on May 18th @ 1:37 PM. She recieved a second dose of the vaccine Y on May 5/19/2009
18th @ 12:45 5/19/2009
AM. No known com
ceived the HPV vaccine in the late afternoon
Y of Wednesday, May 6, 2009. Early on ThursdayU morning she5/6/2009 woke up with 5/7/2009
pain in her right leg
er receiving VZV#2, felt cold and had Y sore throat, day 8 or 9 post vaccination, noticed rash to back of neck 5/5/2009
with itching;
5/17/2009
15 days post vaccin
ports they were awakened in the middle Y of the night with patient screaming. When they wentYto him, he was 5/19/2009
very hot, 5/20/2009
then he immediately s
ported that child's entire left thigh was reddened, swollen, and warm to touch within 25 hoursYof receipt of4/22/2009 vaccines. 4/23/2009
Mom gave motrin and b
oyee PE 11/10/08. Received flu vaccine,Y TB test and Hep B vaccine 11/10/08 during employee PE. Then was sent ### to health ###Dept. for Tdap
P and IPV vaccines on 4/29/09, came in to office on 5/1/09 with R leg red, swollen, hot and painful Y to touch.
4/29/2009
Diagnosed with cellulitis and tr
ection site, difficulty breathing and nausea.
Y Y 5/17/2009 5/17/2009
ew months of the vaccination on 12/05/06, I became less stable on my feet, and experiencedY Nsymptoms 12/5/2006
of neuropathy 4/15/2007
including foot drop, l
11, 2009, I went in for aYcheck-up, Y and referralYfor neurological evaluation
1 and saw Dr. I hadYbeen previously
3/11/2008
ill since
3/14/2008
April 2005, and had b
perienced chest pain and flushing. EKG was done. Pt felt better. Had subsequent ECHO and Y HOLTER and 4/23/2009
work up4/23/2009
by cardiology.
as immunized with Yellow Fever vaccine and dose #2 of Twinrix (HepA/HepB) vaccine on 4/28/2009. U The4/28/2009
patient reports
4/29/2009that she develope
red spot at injection site; size of baseball;
Y red area is hard; Provided Motrin and Tylenol as has U had a fever 5/18/2009
since date 5/19/2009
of shot (Monday, Ma
scribed a tightness in chest with difficulty breathing
Y within 5 minutes2of getting the vaccine. U Patient was 5/18/2009
given an injection
5/19/2009 of epinephrine s
rs after injection, patient developed red, inflamed, warm to the touch, 2" radius reaction at injection
Y site. 48 hours after injection site not as
Y ###
RM NUMBNESS AFTER RECEIVING VACCINATIONS, THEN 2.5 MINUTES AFTER C/O BECOMING Y LIGHTHEADED
5/20/2009 5/20/2009 AND DIZZY
cieved smallpox vaccine that was reconstituted with sterile water instead of 50% glycerin, and Y 0.25% phenol 5/11/2009
in Sterile
5/20/2009
Water. Patient does
B Vaccine, Dose 2 administered on 5/18/09 @ 3 PM. On 5/19/09 upon awakening in morning, Y patient describes
5/18/2009 itching
5/19/2009
hives over upper ch
KIN;CC swelling and redness left upper arm;site of the pneumonia shot ;was given 11/12/08Yin clinic. The patient ###return here ###11/13/08 arm
d herpes simplex in the eye, April, 2009. Was treated by Dr. for it. Y 1/14/2009 4/16/2009
ave no known allergies (especially neomycin
Y or gelatin which are contraindications for Zostavax)
Y patient 5/15/2009
had a significant
5/16/2009reaction to shingle
PED HIGH-PITCHED SCREAMING WHEN LAYED DOWN, ARCHING OF BACK TREMOR AND Y OPEN,1/23/2008
GLAZED EYES 1/23/2009WITHIN AN HOU
equiring 2 doses of IV medication.
Y 6/29/09
Y Hospital
Y ER records received2 DOS 6/17/09. Assessment: Y Second5/19/2009
afebrile5/19/2009
seizure. Patient presen
jection administered. Immediately after PEDIARIX given body stiffened, eyes rolled back in head Y and stopped
5/19/2009
breathing
5/19/2009
x 2-3 seconds. Re
d swollen, hard, hot & red where vaccine given. 6 cm / 5 1/2 cm. Circ. 23 cm. Y 5/12/2009 5/13/2009
lls, muscle aches. Y 5/14/2009 5/14/2009
5/18/2009
ace, trunk and extremities 5/18/2009
utes after vaccine administered Pt began
Y c/o dizziness and weakness in upper extremities. Pt. U then began 5/19/2009
c/o weakness
5/19/2009in lower extremitie
(R) arm- swollen, unable to move. Numbness in fingers, swollen hand. Y 5/19/2009 5/19/2009
t after receiving ADACEL, MENACTRA and GARDASIL. She then became opisthotonic, began Y salivating, 5/19/2009
eyes rolled5/19/2009
back. Episode lasted
wollen, Eye lid, decreased appetite.Y Y 5/19/2009 5/19/2009
vaccinated with SPV around 09 AprY09, approx 24 Apr wife developed a lesion near her eye,Yher arm and4/9/2009 multiple lesions
4/24/2009 on vaginal area.
in erythema edema and pruritic sx.Y5/10/09. U 5/18/2009 5/19/2009
accine onset redness @ vaccine site Y 5/11/2009 5/12/2009
R upper extremity treated with oral LEVAQUIN.
Y Y 5/14/2009 5/15/2009
lness. - Generalized skin rash (topical Y chicken pox rash). - Bilateral Otitis Media. U 5/5/2009 5/10/2009
n: the day after receiving his first anthrax
Y shot, SM developed hives and was seen at the local Y ER x2 because9/30/2007
hives did not resolve despite
panic male, PVT, ADSM reports eruption Y of skin skin rash some 3 weeks after his receipt of U primary SPV4/16/2009
and TYPHOID 5/7/2009
vaccines. Sympto
5 cm slightly tender red swelling on the left thigh. Y 5/19/2009 5/19/2009
Y 4/24/2009 4/24/2009
accine administered - no adverse event Y during 15 min wait. 5/6/09 -Courtesy call follow-up - Y Pt reports rash5/1/2009
and bumps 5/6/2009
under right breast a
red, warm, and swollen crying uncontrollably
Y Y 5/20/2009 5/20/2009
me down with shingles anyway, diagnosedY 5/19/09. Rash and blisters on face...lip and below lip and in eye.1/14/2009
Spent 5/16/2009
$300.00 on vaccine and
ine red rash on both her arms and thighs. Itchy. states started the next day after recieving Tdap. U 5/16/2009 5/17/2009
ped a rash thought to be Shingles approx Y 3 weeks s/p Zostavax administration. Pt treated with U valacyclovir. 2/9/2009 3/4/2009
s were administered to this chld. Immediately after the 5th vaccine, the pt. displayed mild seizure Y activity5/19/2009
lasting about 5/19/2009
5 seconds. She awo
HAV and Depo Provera at doctor visit Y on a.m. In p.m. state symptoms of back pain, epigastric Y pain, temp. 2/26/2009
high 105 2/26/2009
degrees ache all over,
ur office on 5/12/09 for 4 year old boosters.
Y Two days later developed red, swollen left arm. YDiagnose with 5/12/2009
cellulits 5/14/2009
secondary to vaccine a
eft deltoid to elbow redness and swelling-fever,headache,and
Y aches all over especially legs-relief
Y with tylenol-denies
5/15/2009 5/16/2009
rash,hives,shortness
pneumococcal vaccine trial, with severe COPD, Y was hospitalized on2 1/29/09 with enterococcalY prostatitis. 4/14/2008
Vaccination1/29/2009
pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 2/25/09 with Urinary tractY infection 4/14/2008
- bacteremia. 2/25/2009
Vaccination took plac
call from Mom 5/21/2009 R/T patients Left thigh. DTaP injection admininstered 5/18/2009.Red feverish area 5/18/2009
measuring5/19/2009
7 1/2 x 4 1/2 on Le
ped myocarditis. Symptoms developed Y on 27 April.
Y Smallpox vaccination
8 given on 19 Apr 09 U 5/28/09 Medical
4/19/2009records
4/27/2009
received DOS 4/27
red vaccines at 11:40; promptly fainted;Y as she fainted she fell from the chair to the floor; had
Y approx 2-35/21/2009
second duration
5/21/2009 seizure with twitc
Zoster- Appeared on patient's left armY extending linearly from the left clavicle to the left wristY two weeks4/22/2009
after vaccine 4/30/2009
administration. The v
SHES, JOINT PAIN , MUSCLE PAIN, U 11/4/2003 11/5/2003
iving vaccinations, patient felt faint lightheaded Y 5/20/2009 5/20/2009
days after receiving Zostavax vaccination, client had painful blisters on her scalp and top of the Y head with 5/12/2009
severe headaches.
5/19/2009 Saw her HCP
of rash and swollen on both thighs after MMR and Varicella vaccines. U 5/11/2009 5/11/2009
action - itching - immediate with hives and rash developing over a 3 day time period. Treated Y with 50mg q6h 5/8/2009
benadryl 5/8/2009
and 10mg claritin - r
me in on 8/12/08 for Gardasil and Varivax. Patient Y was counseled for
8 pregnancy. Patient calledY on 5/21/09
8/12/2008
and stated
4/27/2009
that she had been
turned to clinic two days post vaccination with a red, slightly swollen area to Right upper arm.U Area is circular 5/19/2009
in shape5/21/2009
and the size of a ha
rovider pt seen in ER 5/13/09 pm - 30hr Y after vaccine gen rash + 102 fever. 5/14/09 still has fever + gen 5/12/2009
rash. Given5/13/2009
antibiotics in ER 5/13/2
ated she had localized swelling in left upper arm (injection site) within 24 hours. Been on 5/15/09 U no redness.
5/11/2009
C/o pain
5/12/2009
from left shoulder to
ever 101.8, eating ok, not acting sick, no rash, given TYLENOL for fever. Recommended if not Y better in a4/28/2009
few days or 5/21/2009
if worse to be seen
given at about 12:30pm. By 7PM, arm ached - pain in (L) elbow- Daily pain increase in all joints Y and pain 5/12/2009
has continued5/12/2009
even now.
multiforme 4 days after administration. N 5/14/2009 5/19/2009
and tenderness with local swelling at Y injection site; painful to raise arm. Tx'd with NSAIDS. Pt U reports had 5/18/2009
sweats &5/18/2009
chills the evening of im
rash, hives around injection site not sure when it started per patient Y 5/11/2009
d (+) erythema and edema - warm Y to touch measuring 3 X 2 inch oval area. 5/18/2009 5/19/2009
Y 5/21/2009
nt fainted immediately (30 secs) after the vaccine, she twitched for 15-20 secs then staring forwards, U and5/18/2009
then started5/18/2009
crying. PR = 72/min,
DASIL injected into left deltoid. Pt became dizzy, visual disturbances, severe stomach crampsY and R hand 5/15/2009
cramped 5/15/2009
up and "felt dead" It too
nt turned pale, felt tingling all over, pupil dilated and was blurring over. PR = 80 / mier Bp = 90/60.U 5/18/2009 5/18/2009
is red, swollen, tingling felt in hands and fingers. No fever. Also felt numbness sharp pain when U making 5/20/2009
a fist. No oozing
5/20/2009
or bleeding presen
meter erythema/induration at site of VARIVAX - Treated with KEFLEX, ibuprofen Y 5/19/2009 5/21/2009
n (L) deltoid area began promptly, pain peaked at the 1-3 wk period gradually improved beginning Y in May3/20/2009
1 '09. 3/20/2009
ine number 1 given . Syncope 5 minutes Y after vaccine. Fell to floor hit head laceration required
Y sutures broken
5/20/2009
incisor
5/20/2009
# 1 Rt upper.
upper arm-hot to touch- VARIVAX given 5-13-09. Patient presented with symptoms 5-14-09. Y Treatment:5/13/2009
BENADRYL 5/14/2009
PRN.
lled 2 1/2 hours after shot stating she has what look like broken blood vessels all over her body. U 5/15/2006 5/15/2005
a PNEUMOVAX shot on Monday afternoon 4/27 and was well until approx. midnight (8hrs after shot). I woke 4/27/2009
during4/27/2009
the night with a very p
pells X 5 lasting approx 3 seconds, each. Y 5/18/2009 5/18/2009
ven varivax 5/8/9. On 5/14/2009 developed pain left lower extremity. On exam today findings U consistent with
5/8/2009
shingles
5/14/2009
in dermatomal distrib
iven Approx 6pm on 5/12/09 on 5/13/09 Y L arm has area 3x3cm redness, swelling. 5/12/2009 5/13/2009
d our office on 5-21-09 to report that child received typhoid vaccine at health department 1-2Yminutes after 5/13/2009
vaccine given child fainted. Bec
and induration (R) thigh. 5/19/2009 5/21/2009
Q oral vaccine administered. Approx 10 minutes later child's lips noted to be swollen as well as Y the soft tissue
5/21/2009
surrounding
5/21/2009the lips. Oral muc
n has been received from a pharmacist Y concerning a female in her "early 20s" who on an unspecifiedY date was vaccinated with third dose o
n has been received through a Merck Y Pregnancy registry from a 38-year-old female with no Y medical history8/16/2004
or allergies
9/13/2004
who on 16-AUG-20
n has been received from a physician and a 35 year old female concerning herself with no pertinent Y medical
6/14/2007
history6/14/2007
and no known drug rea
Y registry for VARIVAX (Oka/Merck) from a physician'sY assistant
5/1/2007
concerning 5/1/2007
a 34 year old femal
n has been received through the Merck Y pregnancy registry and from a male consumer concerning Y his 226/18/2007
year old wife
6/18/2007
with no known allerg
n has been received through the Pregnancy
Y registry from a registered nurse concerning a 16 U year old female
10/3/2007
with no6/1/2007
medical history or alle
n has been received from a registered Y nurse concerning a 14-year-old female with no pertinent Y medical history
5/1/2001and no drug reactions/allerg
n has been received from a physician concerning a patient who on 17-MAR-2008 was inadvertently U vaccinated
3/17/2008with3/17/2008
VARIVAX (Oka/Merck)
n has been received from a physician Y concerning an 11 year old male who was vaccinated with U VARIVAX (Oka/Merck). The patient reporte
n has been received from a physician concerning a 9 year old male who on 21-FEB-2008 was Y vaccinated 2/21/2008
(subcutaneous)
2/22/2008 with a second do
n has been received from a health department registered nurse who was told by an unspecified U school nurse 4/14/2000
that a3/11/2008
9 year old male on the
n has been received from the parent of an approximately 19 month old male patient with a history Y of seizure
3/13/2008
who on3/13/2008
13-MAR-2008 was vac
follow-up information has been received from a registered nurse concerning a 11 year old female Y consumer with ###a history
2/22/2008 of asthma. Who
n has been received from a pharmacist concerning a male who on approximately 14-MAR-2008 U (reported 3/14/2008
as on an 3/14/2008
unspecified date about
n has been received from a physician's assistant concerning a male who was vaccinated with Y a first dose of VARIVAX (Oka/Merck). The pa
n has been received from an 89 (also reported as 79 years old) year old retired physician. He U reported that3/18/2008
he was 3/18/2008
vaccinated with VARIVA
n has been received from a physician Y concerning a 36 month old male with an allergy to REGLAN Y who on3/30/2007
30-MAR-2007
3/30/2007
was vaccinated w
n has been received from a physician Y concerning a 21 month old male who, at 12 months ofUage, was vaccinated with a dose of VARIVAX
n has been received from a registered Y pharmacist concerning a female who on 24-MAR-2008 U was vaccinated
3/24/2008
with a
3/24/2008
dose of VARIVAX (Ok
n has been received from a motherYconcerning her 12 months old son with possibly allergy to N eggs and 5/16/2008
a history of 5/18/2008
febrile seizures and ear
n has been received from a mother concerning her 11 year old daughter who"at the age of 1" Y (approximately 1997),3/10/2008
was vaccinated with V
n has been received from a physician concerning a patient (age and gender unknown) who,Uon an unspecified date, was vaccinated with a
n has been received from a physician Y concerning Y a patient who on an 0 unknown date was vaccinated
U with a second dose of VARIVAX (Oka
n has been received from a nurse concerning a female patient who was vaccinated with a dose Y of VARIVAX 3/7/2008
(Oka/Merck)
3/17/2008(lot number, dose
n has been received from a licensed Y practical nurse concerning her 8 year old son Y with no known
Y allergies, diabetes,
### 4/23/2008
asthma and a history
Y concerning a 14 month old 20lb. 15oz. 29 in.Yfemale with 3/3/2008
no known 3/11/2008
pre-existing allergies, b
n has been received from a consumer concerning her 9 year old granddaughter with Y no pertinent
N medical history or drug4/7/2008
allergies/reaction
n has been received from a physician concerning Y a female between012 and 15 years of ageYwith a history of obesity 2/1/2008 who was vaccinated S
n has been received from a physician concerning an 8 year old female who was vaccinated U with VARIVAX (Oka/Merck). The patient report
n has been received from a physicianY concerning a 12-month-old patient who was vaccinated U with a dose of VARIVAX (Oka/Merck) and ei
n has been received from a physicianY concerning a 12 year old 104 lb. 55 in. female who onY03-Oct-1996 10/3/1996
at the age2/29/2008
of 12 months, was vac
n has been received from a physicianY concerning a 12 month old male who on 26-Feb-2008Ywas vaccinated 2/26/2008
subcutaneously
3/14/2008with 0.5ml of
n has been received from a nurse concerning a 45 year old, non-pregnant female physician U with probable3/26/2008
recurrent exposures to wild type
n has been received from a health department
Y registered nurse who received information from
U the patient's mother
### 3/17/2008
concerning a 7 year old
n has been received from a physicianY concerning an approximately 5 year old female patientUwith no medical history who was vaccinated w
n has been received from a licensed Y practical nurse concerning a 9 year old male child with N
no known allergies### or pertinent
n has been received from a nurse concerning a 3 year old boy with no pertinent medical historyN and no history
3/1/2006of drug
3/20/2008
n has been received from a consumer Y concerning her daughter with no known drug allergiesYor pertinent2/19/2008
medical history
2/21/2008
who "sometime du
n has been received from a licensed Y vocational nurse concerning a 13 month old patient who N on 17-MAR-2008
3/17/2008 was3/25/2008
vaccinated with VARIV
n has been received from a consumer concerning a 12 year old male with Penicillin allergy and N a history of chickenpox 3/14/2008
who on 11-March-2
n has been received from a nurse concerning a female who in 2002 was vaccinated with one U dose of VARIVAX (Merck). The patient's moth
n has been received from a licensed vocational nurse concerning a 39 month old female who Y on 25-FEB-2008
2/25/2008was3/11/2008
vaccinated with the firs
n has been received from an advanced practice registered nurse concerning a 78 year old postmenopausal
U 1/29/2008
female,1/29/2008
weight 142lb, height 59
n has been received from a physician concerning a 18 month old male who on 08-OCT-2007 N was vaccinated
10/8/2007
in right
4/23/2008
arm subcutaneously w
n has been received from a physician concerning a 15 month old patient who was vaccinated Y IM with a first dose of VARIVAX. Concomitan
n has been received from a licensed practical nurse concerning a 9 year old female patient whoN on 24-MAR-2008
3/24/2008 was 3/24/2008
vaccinated SQ with
n has been received from a physicianY concerning a 17 month old female who two months ago, Y in March 2008,
3/1/2008
was vaccinated with VARIVA
n has been received from a nurse concerning a 13 year old female who on 21-FEB-2008 was Y vaccinated2/21/2008
with the second
2/28/2008dose of VARIVAX
n has been received from a certifiedYmedical assistant (CMA) concerning a patient who on unspecified
Y dates was vaccinated with two dose
n has been received from a physicianY concerning a 12 month old female with no pertinent medical
N history
3/16/2008
reactions/allergies, w
n has been received from a consumer Y concerning her daughter, a 9 year old girl with no knownN allergies4/25/2008
or pertinent4/25/2008
medical history who w
n has been received from a physician concerning a male who's son on 16-MAR-2008 was vaccinatedU with a dose of VARIVAX (Merck). Th
n has been received from a physician concerning a male patient who developed varicella and U secondary transmission from his son, who ha
n has been received from a consumer concerning a 12 year old male with penicillin allergy and N a history3/11/2008
of chickenpox3/11/2008
who on 11-MAR-20
n has been received from a nurse practitioner (N.P.) concerning a 5 year old male with a soyNallergy and no 5/8/2008
pertinent5/9/2008
medical history who o
n has been received from a grandmother
Y concerning her 21 month old grandson with eczema N who was vaccinated 5/10/2008
with a second dose of V
n has been received from a physician concerning a 7 year old female who on approximatelyY14-MAR-2008 3/14/2008
was vaccinated
3/14/2008 with a second d
n has been received from a registered nurse (R.N.) through a Merck pregnancy registry concerning
Y a 31 year
5/5/2008
old female
5/5/2008
with no pertinent m
n has been received from a health professional concerning a 16 year old female with asthmaUwho on 12-MAR-2008
3/12/2008 3/14/2008
was vaccinated subcut
n has been received from a 34 yearYold female who was accidentally exposed to VARIVAX (Oka/Merck).
N Concomitant5/12/2008
therapy included al
Y concerning a male who was vaccinated with aUfirst dose of VARIVAX (Merck). The nurse rep
n has been received from a physicianY concerning an approximately 5 year old female who was Y vaccinated with a dose a VARIVAX (Oka/M
n has been received from a registered nurse concerning a 15 month old male with no pertinent N medical history
5/8/2008or allergies
5/12/2008 who on 08-MAY
n has been received from a registered nurse concerning a 12 month old female who in the morning
Y of 17-FEB-2006
2/17/2006 3/22/2008
n has been received from a public health
Y nurse concerning a 15 year old female child who inU1999 was vaccinated
10/1/2008 with 1/1/2009
her first dose of VA
Y nurse concerning a 7 year old male child who in 2002U was vaccinated
10/1/2008 with 1/1/2009
her first dose of VARIV
Y nurse concerning a 5 year old female child who in U 2004 was vaccinated with 1/1/2009
her first dose of VAR
n has been received from a Registered Nurse concerning a patient who was vaccinated withUVARIVAX (Merck) (Lot # not reported) instead
n has been received from a registered nurse (R.N.) concerning a patient who on 30-JAN-2009 U was vaccinated
1/30/2009with 1/30/2009
a dose of VARIVAX (M
n has been received from a consumer concerning her son with reaction to all vaccines and medications
Y he has received that contain gelatin
n has been received from a physicianY concerning a 10 year old male with no medical historyUwho on 14-APR-2000
4/14/2000 was 1/28/2009
vaccinated with a fi
n has been received from a doctor's front desk employee concerning a friend who had a reactionU to VARIVAX (Merck) (lot# not reported). I
Y nurse concerning a 4 year old female with no known N medical history
9/8/2008
and drugs 2/4/2009
allergies, who on 08-
Y concerning a 5 year old female patient, with no
N known drug 1/28/2009
reactions/allergies
1/31/2009and no pertine
n has been received from a 17 year old female, for the Pregnancy Registry for VARIVAX (Merck),U with asthma
1/23/2009and 1/23/2009
no drug reaction who on
Y nurse, via health department, concerning a patient who U was vaccinated with VARIVAX (Merck). "Wit
n has been received from a medical assistant concerning a 72 year old patient who was inadvertently
U vaccinated with VARIVAX (Merck) in
n has been received from a female registered nurse (R.N.). It was reported that a drop of VARIVAX
U (Oka/Merck) (lot 2/2/2009
# not reported) splash
n has been received from a physicianY concerning a 11 year old female patient who on 27-AUG-2007
U was6/2/2008
with her first dose of V
n has been received from a physician concerning an 8 year old patient who on 11-AUG-2001 U was vaccinated
8/11/2001
with the
1/22/2009
first dose of VARIVA
n has been received from a registered nurse concerning a female junior volunteer who on 19-OCT-1995
U was vaccinated
### with a first dose o
n has been received from a nurse practitioner (N.P.) concerning her 9 year old daughter withYno pertinent2/3/2009
medical history
2/7/2009and drug allergie
Y concerning an 8 year old female who on 31-MAY-2001 U was vaccinated
5/31/2001
with her
1/30/2009
n has been received from a physician via in a published article, concerning a 11 year old patient
Y with a seizure disorder and a history of mil
Y nurse, via health department, concerning a patient who U was vaccinated with VARIVAX 1/1/2009 (Merck). "Wit
Y nurse concerning a 46 month old female with no pertinent
Y medical 6/19/2006
history and2/4/2009
no drug reactions/alle
Y nurse, via health department, concerning a patient who U was vaccinated with VARIVAX 1/1/2009 (Merck). "Wi
n has been received from a licensed practical nurse concerning a female who on an unspecified
U date was 1/19/2009
vaccinated1/19/2009
with the second dose
Y concerning a female who on 10-FEB-2009 was vaccinated N with her
2/10/2009
first dose
2/10/2009
of VARIVAX (Merck)
n has been received from a consumer concerning her approximately 20 month old son with Y no pertinent 7/25/2008
medical history and no drug reactio
Y nurse concerning a female who on approximately 30-JAN-2009,
U "about
1/30/2009two weeks
2/5/2009ago" was vaccina
Y concerning an approximately 12 year old female withUno medical history or allergy who on 11-SEP-1
n has been received from a physician assistant concerning a 13 month old female child whoNwas vaccinated with VARIVAX (Merck). The ch
n has been received from a nurse concerning a 12 to 15 month old male who in 2009 was vaccinated
U with a 0.5 ml dose
2/1/2009
of VARIVAX (Mer
Y concerning a 4 year old male patient who on 11-FEB-2009N was vaccinated
2/11/2009with 2/12/2009
the second 0.5ml do
n has been received from a licensedY visiting nurse concerning a 12 month old female patientYwith no known 2/10/2006
3/24/2006 and a
Y concerning a 15 year old female with no pertinent medical
Y history 7/28/2003
and no drug1/16/2009
reactions or allergies w
n has been received from a licensedY practical nurse concerning two patients who on 16-FEB-2009
N was vaccinated
2/16/2009 subcutaneously with the
n has been received from a consumer concerning her 4 year old son with no drug reactions N or allergies who, "about2/17/2009
3 years ago", in approx
Y assistant concerning a 13 year old male patient with noY drug reactions/allergies
4/4/2007 2/15/2009
who was vaccinated
n has been received from a consumerY concerning her 13 month old daughter with no pertinent N medical history ### or drug
2/15/2009
Y nurse concerning a 14 year male with no relevant medical
U history1/26/2009
reported and 2/2/2009
no allergies reported
n has been received from a nurse concerning a 11 year old male patient with autoimmune disorder
U who about 5 years ago, in approximate
n has been received from a licensedY practical nurse concerning a 13 year old female patientUwho on 16-FEB-2009
2/16/2009 was vaccinated subcuta
n has been received from a consumer concerning her 24 month old granddaughter. The caller U reported that she had 1/23/2009
shingles about a mon
n has been received from a consumerY concerning her almost 15 month old daughter with noNknown medical 2/5/2009
history who on 05-FEB-2009 w
Y nurse concerning 9 year old female patient with no previous
N medical
8/21/2000
history and
2/23/2009
allergies reported, w
n has been received from a health professional concerning a 10 year old female patient withYno allergies at 9/7/1999
time of vaccination and allergic
n has been received from a physician concerning a patient who on 05-Mar-1997 was vaccinated Y with the 3/5/1997
first dose of1/5/2004
VARIVAX (Oka/Merc
n has been received from a licensedY practical nurse concerning a 12 year old female patientNwith no previous medical
### 2/23/2009
history and allergies
n has been received from a Licensed Practical Nurse concerning a 4 year old male patient whoU on 08-JUN-20056/8/2005was2/1/2009
vaccinated with first d
Y nurse (school nurse) concerning a 7 year old male who N in approximately 2008, about 1 year ago, wa
n has been received from a registered nurse concerning a child who on an unspecified date Uwas vaccinated with the first dose of VARIVAX
n has been received from a registered nurse concerning a child who on an unspecified date Uwas vaccinated with a second dose of VARIVA
n has been received from a consumer concerning her 4 year old son with no drug reactions N or allergies who, "about2/17/2009
3 years ago", in approx
Y concerning a 29 year old female with no medical historyN who in her teens, was vaccinated with two d
n has been received from a pharm D. concerning a 46 year old male with HIV, penicillin allergy
N and drug hypersensitivity 2/23/2009
to sulfa and a hist
n has been received from a doctor of pharmacy concerning an over 60 year old male physician U with a history
2/25/2009
of chickenpox
2/25/2009 who on 25-FEB
n has been received fro a nurse practitioner concerning a 6 year old male who on 15-SEP-2003U was vaccinated
9/15/2003 with
1/31/2009
a dose of VARIVAX (O
n has been received from a medicalYassistant concerning 38 year old female with no pertinentY medical history
2/12/2009and no
2/21/2009
known allergies, who
Y concerning a 13 month old male with no medical history Y or drug allergy who ### on
1/16/2009
31-DEC-2008 was va
n has been received from a consumerY concerning her 25 month old son with allergy to eggsYand oatmeal, 1/21/2009
patient's 1/28/2009
mother with Sjoren's sy
n has been received from a office secretary concerning 36 year old mother female who on 27-FEB-2009
U 2/27/2009
was splashed 2/27/2009
in the eye with VAR
n has been received from a registered nurse concerning a patient with egg allergy and a history
U of chickenpox who on an unspecified date
Y concerning a 47 month old (age estimated) female
N who in July
7/1/2007
2007, was
2/1/2009
vaccinated with on
n has been received from a physician concerning a 17 year old female who on 13-FEB-2009Ywas vaccinated 2/13/2009
with a 0.5mL dose of VARIVA
n has been received from a physician concerning a female between 30 and 40 years old who Y on an unknown2/11/2009
date was
2/20/2009
vaccinated with a 0
n has been received from a nurse practitioner concerning her 6 year old grand daughter whoNin Summer 2008 6/1/2008(approximately
2/28/2009 June 2008),
n has been received from a registered nurse concerning a female in her late 30's who four toY five weeks1/27/2009
ago was vaccinated
n has been received from a registered nurse concerning a patient who a couple years ago was U vaccinated with the first and second doses
Y concerning a patient who on unspecified dates was vaccinated
Y with first and second dose of VARIVA
Y concerning a 5 year old male who was vaccinated withY a second dose of VARIVAX (Merck). The pat
n has been received from a nurse practitioner concerning a number of patient who were vaccinated
U with VARIVAX (Oka/Merck). The patien
Y nurse concerning a 27 month old female with no pre-existing
Y allergies,
2/21/2008
birth defects,
2/25/2009medical conditio
n has been received from a registered nurse concerning an 8 year old female who on an unspecified
Y date was vaccinated with a second of
n has been received from a physician concerning an approximately 17 year old female with Y penicillin allergy and clindamycin allergy who o
n has been received from a registered nurse concerning a patient (gender not specified) who U on an unspecified date, was inadvertently vac
n has been received from an immunization program officer, concerning an unknown numberYof patients who 7/8/2008
on an unspecified
7/8/2008 date, were v
n has been received from a physician and other health professional concerning a 17 month Y old (previously
6/10/2008
reported9/14/2008
at 18) female patient w
Y assistant concerning a 44 year old male who on 05-SEP-2008
N was9/5/2008
vaccinated9/7/2008
with a first dose of VA
Y nurse concerning a 16 year old female with no previous N medical history
9/18/2008reported
9/18/2008
and an allergic rea
n has been received from a health care
Y professional concerning a 14 year old female who on U 23-AUG-1999 9/19/2008
was vaccinated
9/20/2008with the first do
Y concerning a female physician who on an unspecified U date was vaccinated with VARIVAX (Oka/Me
n has been received from a physician concerning a 11 year old patient with no pertinent medical
Y history,11/7/2001
allergies or9/18/2008
drugs reactions, who o
n has been received from a patient who on an unknown date was vaccinated with VARIVAXU(Oka/Merck). On an unknown date, the patien
n has been received from a pharmacist concerning an adult patient who received the first doseU of VARIVAX (Oka/Merck). Subsequently the
n has been received from a registered nurse concerning a 24 year old female who was vaccinated
U with 2 doses of of VARIVAX (Oka/Merck
n has been received from a physician concerning a 10 year old male with no pertinent medical Y history or9/11/2008
drug reactions/allergies,
9/11/2008 who on 1
n has been received from a health professional concerning a 12 month old male who at 11:00 U am, on 12-SEP-2008
9/12/2008 9/18/2008
was vaccinated SC wit
Y and a health
Y care worker concerning
2 a 16 year old male
Y patient who 12/2/2008
on 02-DEC-2008
n has been received from a physician concerning a little over 12 month old patient who was Yvaccinated with a dose of VARIVAX (Oka/Merc
n has been received from a health care worker concerning a 15 month old patient who was vaccinated
U with a first dose of VARIVAX on an
n has been received from a medicalYassistant concerning a three elementary school aged patient
Y about the age of 8 or 9 who received the
Y from aYphysician and a nurse0 concerning a 5 year old
N male patient,
11/3/2008
who on11/4/2008
03-NOV-2008 was vac
n has been received from a medical assistant concerning three patients who between June U 2008 and August 6/1/2008
2008 were vaccinated with th
n has been received from a physician concerning a 14 month old female with no drug allergies N or reactions a history
### of reactive
### airways an
n has been received fromY a physician who heard that an adult female who was vaccinated with U VARIVAX (Oka/Merck) (route and site was
Y from a registered nurse concerning a 41 year old female
Y with no9/23/2008
pertinent 9/24/2008
medical history and no
Y concerningY a newborn baby (DOB 20-Mar-2008) who Y was a sibling of a patient 4/15/2008
vaccinated with VARI
n has been received from a registered nurse concerning a female who was vaccinated with U a dose of VARIVAX (Oka/Merck) subcutaneous
n has been received from a physician and a medical assistant concerning a female who on an N unspecified date was vaccinated with a dose
n has been received from a physician who was told by another physician, that a patient whoUin the past was vaccinated with VARIVAX (Ok
Y concerning a 14 month old male with no relevant medical N history or 6/19/2008
allergies who
7/15/2008
on 19-JUN-2008 w
n has been received from a licensedY practical nurse concerning a 13 month old patient who N on 09-SEP-2008 9/9/2008
was vaccinated with VARIVA
n has been received from a physician concerning a 24 year old male who on an unspecifiedYdate was vaccinated with VARIVAX. About ten
n has been received from a 60 yearYold femaleYwith penicillin allergy0and
Y sulfonamide allergyYand a history 8/1/2001
of liver transplant,
8/1/2001 arthritis and g
n has been received fromY a physician
Y concerningY a male with positive1 skin test for egg and soy
Y (physician stated ###not a clinical
### allergy to so
Y nurse concerning a 40 month old boy without medicalNhistory and1/23/2007
no allergy 9/20/2008
who on 23-JAN-2007 w
Y a 7 year old female who on 03-MAR-2003 wasNvaccinated SC 3/3/2003
with VARIVAX
9/24/2008(lot number 643
manager concerning a 13 month old female with no medical N history or 9/23/2008
allergies who
10/1/2008
on 23-SEP-2008 w
Y nurse concerning a patient who was vaccinated with U VARIVAX (Oka/Merck) instead of ZOSTAVAX
n has been received from a physician concerning a 15 month old male with no pertinent medicalY history and3/5/2009
no allergies
3/5/2009
who on 05-MAR-2
n has been received from a physician concerning a 15 month old female with no pertinent medical
Y history3/5/2009
and no allergies
3/5/2009
who on 05-MAR
n has been received from a physician concerning a 14 month old patient who on 02-MAR-2009 N was vaccinated3/2/2009with3/12/2009
a dose of VARIVAX (d
n has been received from a registered pharmacist concerning a 21 year old patient who wasNvaccinated with one or two doses of VARIVAX
n has been received from a consumerY concerning a 72 year old male who was supposed to U received ZOSTAVAX
3/10/2009 (Oka/Merck)
3/10/2009 on 10-MAR
n has been received from a pharmacist concerning a child who on an unspecified date was vaccinated
U with a dose of VARIVAX (Oka/Merc
n has been received from a bachelor of science in nursing concerning her 5 year old daughter Y who in 1995 was vaccinated with VARIVAX.
Y concerning an 8 year old male with unknown drug reactions,
Y asthma
3/12/2009
and a history
3/12/2009
of hives (develope
n has been received from a bachelor of science in nursing concerning her 1 year old son who U in 1998 was vaccinated with VARIVAX (Merc
Y concerning a 9 year old female who on 09-JUL-1999 was Y vaccinated with ###a first dose
###of VARIVAX (O
n has been received from a physician concerning a 9 year old male who on 01-MAY-2000 was Y vaccinated 9/26/2008
with a first
9/27/2008
dose of VARIVAX. At
n has been received from a physician concerning a 9 year old male with rhinitis allergic whoYon 08-OCT-19996/30/2008
was vaccinated
7/1/2008 with a first do
n has been received from a physician concerning a child (age unknown) who was vaccinated U with the first
9/28/2007
and second 6/13/2008
0.5 ml doses of VAR
n has been received from a nurse practitioner concerning a female with allergy to "6MP" andUCHRON'S 10/2/2008
disease who on 02-OCT-2008 rece
n has been received from consumer, for the Pregnancy Registry for VARIVAX (Oka/Merck), Yconcerning a2/1/2007 34 year old5/1/2007
female who in Janua
n hs been received from a physician and a licensed practical nurse concerning a female patient
Y who was recently vaccinated with the seco
n hs been received from a physician and a licensed practical nurse, concerning a 14 year old Y female patient
9/18/2008
with no pertinent
9/9/2008 medical histo
n has been received from a registered medical assistant concerning a 4 year old male who was Y vaccinated with VARIVAX (route not report
n has been received from a registered nurse concerning a patient who on 16-OCT-2008 wasUvaccinated with VARIVAX ### (Merck)
### (LOT# 660
n has been received from a pharmacist concerning a 9 year old female who on an unspecified Y date was9/17/2008
vaccinated10/8/2008
with a dose of VARIVA
follow-up Information has been received
Y from a nurse practitioner, concerning a 15-month-oldU male infant with### eczema, who ###on 20-OCT-20
follow up information has been received from a nurse concerning a 43 year old female with Y history of fever
8/15/2008
with previously
8/22/2008
vaccinations wit
Y nurse (R.N.) concerning a patient who was vaccinated N with a dose of VARIVAX (Merck) (lot # not re
n has been received from a nurse concerning a 24 month old patient with no pertinent medical Y history who 4/3/2007
on 03-APR-2007
Y concerning a 11 year old male with no past medical history
N of immunocompromise
### or
###immunosuppre
follow-up information have been received
Y from a register nurse concerning a 7 year old female
Y student with5/17/2002
no allergies and
###no pertinent m
Y nurse concerning a 9 year old female who was vaccinated N with VARIVAX (Oka/Merck) intradermally
n has been received from a healthcare professional concerning her daughter who in 1996 was Y vaccinated with VARIVAX (Merck). The pati
n has been received from a nurse concerning a male who on 07-MAR-2001 was vaccinatedUwith a first dose 7/7/2008
of VARIVAX ###(Merck) 0.5 mL s
Y worker concerning a 12 year old male with no relevant Y medical history
6/28/2007
or allergies,###
who on 22-APR-
n has been received from a allergistYconcerning a patient who in 2007. also reported as last U
year, was vaccinated with a dose of VARIVAX
n has been received from a healthcare professional concerning a 12 month old female who U on 16-OCT-2008 was ### vaccinated
### subcutaneou
follow-up information has been received from a registered nurse and a physician concerningUa 73 year old 10/7/2008
female patient
10/7/2008
who on 05-SEP-2
n has been received from a caller concerning her 12 month daughter with food allergies andYno pertinent 5/1/2008
medical history,
5/1/2008
on 03-JUL-2007
Y a 22 month old male who on 06-MAY-2008 was N vaccinated5/6/2008
with a dose of VARIVAX
### (Merck)
n has been received from a pharmacist and nurse midwife concerning an adult female who was U vaccinated with a dose of VARIVAX (Merc
n has been received from a physician concerning a 33 year old female pregnant (17 weeks)Npatient with a history of VARICELLA ### at age of
Y concerning a 7 year old male with hypersensitivity andUasthma and a history ### of eczema who on 11-O
n has been received from a registered nurse concerning a female patient who in April 2007, Nwas vaccinated 4/1/2007
with a dose of VARIVAX (Merc
n has been received from a licensed practical nurse concerning a 5 year old male patient, with
U no known6/18/1997
pertinent medical
6/18/1997history, or no kn
n hs been received from a registered nurse concerning a 64 year old patient who on approximately
U 01-NOV-2008
11/1/2008 was vaccinated with VAR
n has been received from a physician concerning a patient who on an unspecified date was U vaccinated with the first dose of VARIVAX (Ok
Y school nurse concerning an 8 year old female patientNwith a history7/2/2001
of shingles (2006)
###and lesions o
Y concerning a 7 year old female who on 03-NOV-2008Nwas vaccinated 11/3/2008
with the11/4/2008
second dose of VARIV
Y concerning a 16 year old male with no pertinent medical Y history who 11/3/2008
on 03-JUN-1998
n has not been received from a nurse
Y concerning a 24 month old female who on 15-OCT-2007 N was vaccinated### with VARIVAX
### (Oka/Merck)
Y in litigation from a registered nurse concerning a 9 year
N old female 9/25/2008
who on 25-SEP-2008 was vaccin
n has been received concerning a 7 year old female with no concurrent conditions or pertinentU medical history ### who on 28-OCT-2008
### receiv
n has been received form a registered nurse concerning a 12 year old female with ZITHROMAX Y allergy 7/18/2008
(total body swelling)###and no illness
n has been received form a physician
Y concerning a 14 year old male with a history of attention
Y deficit/hyperactivity
10/7/2008 disorder
10/8/2008 and possibly ha
n has been received from a registered nurse concerning a 39 month old female with no medical Y history, no known ### allergies###who on 10-OCT
n has been received from a registered pharmacist concerning a patient who on 07-OCT-2008 U was vaccinated
10/7/2008
subcutaneously
10/7/2008 with a 0.5 m
Y pharmacist concerning of a 66 years old white femaleUwho on 10-Nov-2008 ### was vaccinated
### with VA
n has been received from nurse concerning a patient who came into office to receive a doseUof ZOSTAVAX (Merck) (MSD) but was given a
n has been received from a physician concerning a 3 year old male who at the age of 7 months U (in approximately 2005) was ###vaccinated wi
n has been received from a pharmacist concerning a 16 year old female with penicillin allergyN and a history 4/8/2008
of Guillain-Barre
4/18/2008syndrome and
n has been received from a Registered Nurse with no known drug reactions or allergies, whoN on 14-MAY-2008 6/16/2008 was vaccinated
### with first do
n has been received from a physician concerning her 12 month old daughter who on an unspecified
Y date was vaccinated subcutaneously w
Y nurse (RN) concerning a 13 month old female with eczema Y who on 31-Oct-2008
### 11/1/2008
was vaccinated sub
n has been received from a physician concerning her 2 year and 9 month old daughter who U was "previously" vaccinated with a dose of VAR
n has been received from a registered nurse concerning a 20 year old female patient with noYknow drug8/28/2008
allergies, no8/29/2008
seasonal/environmen
n has been received from a pharmacist concerning his granddaughter (14 month old female)Nwho at about8/1/2008 age 12 months
8/8/2008
(approximately A
n has been received from a nurse concerning a 5 year old female who received her first dose Y of VARIVAX 6/13/2007
(Oka/Merck) (lot####647719/1248N
n has been received from a nurse concerning a patient who was vaccinated with VARIVAX (Oka/Merck)
U instead of ZOSTAVAX (Oka/Merck
n has been received from a medical assistant concerning a 68 year old male who on 15-OCT-2008
U was vaccinated### with VARIVAX
### (Oka/Me
n has been received from a licensed Y nurse concerning a 12 month old male patient with no known
N pertinent medical
### history, and no known
n has been received from a licensed Y nurse concerning a 12 month old male patient with no known
N pertinent
10/8/2008
medical history,
###and no known
n has been received from a physician concerning an adult patient who was vaccinated with VARIVAX
U (Oka/Merck) instead of ZOSTAVAX (
n has been received from a licensed visiting nurse concerning a 4 year old female who on 23-OCT-2008
N was vaccinated
### with
### (lot # not rep
w-up information has been receivedYfrom a physician concerning a 10 year old male studentYwith no pre-existing
8/5/2008allergies,
8/25/2008
birth defects or m
n has been received from a physicianY concerning a boy who was vaccinated with VARIVAX Y(Oka/Merck) 0.5ml (therapy started date, route
n has been received from a physician concerning his daughter, a 13 year old female who onN18-SEP-2008 4/18/1997
was vaccinated
4/18/1997with the second
n has been received from a physician and a licensed practical nurse concerning a female who Y was recently vaccinated with the second dos
Y a patient who was vaccinated with VARIVAX (Oka/Merck)
Y (therapy started date, route, site u
n has been received from a pharmacist concerning a patient who on an unspecified date was U vaccinated with VARIVAX (Oka/Merck) when
n has been received from a physician assistant concerning a male patient who on 17-NOV-2008 U was vaccinated ###with VARIVAX
### (Oka/Merc
n has been received from a healthcare worker concerning a 63 year old male patient, who was U scheduled9/1/2008
to receive 9/1/2008
ZOSTAVAX (Oka/Mer
Y a patient who was vaccinated with VARIVAX (Oka/Merck)
Y (therapy started date, route, site u
n has been received from a physicianY concerning a female patient who on 03-NOV-2008 was U vaccinated11/3/2008
with a 0.5 ml dose ###of VARIVAX (O
n has been received from a nurse via a sales representative concerning an approximately 4 Nyear old male1/1/2005
who in 2005
10/6/2008
was vaccinated with
n has been received from a 35 yearYold female pharmacist concerning herself with no pertinent
N medical 8/15/2008
on 15-AUG-2008 was
n has been received from a patient who "a week ago" was vaccinated with VARIVAX (Oka/Merck).U The patient### reported that
###she went to a
n has been received from a medicalYassistant concerning a three elementary school aged patient
Y about the age of 8 or 9 who received the
n has been received from a consumer concerning his daughter, a 5 year old female who in October
U 2007 10/1/2007
was vaccinated with VARIVAX (M
n has been received from a physicianY concerning her son who was vaccinated with VARIVAX Y vaccine (Oka/Merck) (lot # not provided). Sub
n has been received from a certifiedYmedical assistant concerning a 26 month female with drug
Y hypersensitivity
9/22/2007 to CEFTIN### and no illness a
n has been received from a physicianY concerning a 10 year old female with asthma who on N 22-OCT-1999 9/17/2008
received 10/7/2008
her first dose of VARIV
n has been received from a physicianY concerning a 24 month old female who on 23-MAY-2008 Y was vaccinated
5/23/2008 with11/6/2008
her first dose of 0.5 mL
n has been received from a physicianY concerning a 11 year old female who on 24-JUN-1998Nreceived her 10/2/2008
first dose10/3/2008
of VARIVAX (Merck) (l
Y nurse concerning an elementary school aged child patient
U with medical history and allergy unspecifi
n has been received from a patient'sY mother concerning her 3 year old son, with no pertinentYmedical history
5/16/2007
and no drug ###
allergies / drug re
U history and5/1/2008
no drug 5/1/2008
reactions/allergies wh
n has been received from a health professional concerning an 8 year old female who on 21-OCT-2008
U received ###the second###dose of VARIV
n has been received from a physicianY concerning a 28 month old male (child) who was vaccinated
Y with VARIVAX (Merck). Subsequently th
n has been received from a Registered Nurse concerning a 38 year old female patient with penicillin
N allergy and ###medical history
### unknown,
n has been received from a physicianY concerning a 37 year old male who on 10-SEP-2008 received
Y the10/9/2008
first dose of VARIVAX### vaccine (Ok
n has been received from a license practical nurse concerning a 12 year old female who on Y 08-SEP-20089/8/2008
received the9/9/2008
second dose of VAR
n has been received from a physicianY concerning a 10 year old female who was vaccinated N with a dose of VARIVAX (lot #### not reported) wh
n has been received from a registered nurse (R.N.) concerning a patient who on 28-OCT-2008 U was vaccinated### with a dose###of VARIVAX (M
Y nurse concerning a 22 month old male with no known allergies who on an unspecified ### date was vac
n has been received from a physicianY concerning a 15 month old male who on 02-JUL-2008Nwas vaccinated 7/2/2008
subcutaneously### with a first 0.5
follow-up information has been received from a physician concerning a 13 year old male patient
Y who on5/22/2007
29-JUN-1998 3/1/2008
was vaccinated subc
n has been received from a medicalYassistant concerning an elementary school aged patientYabout the age of 8 or 9 who received the seco
n has been received from nurse practitioner
Y concerning a 49 year old female patient with hypertension
N who
9/11/2008
on 11-SEP-2008
n has been received from a physicianY concerning a 4 year old male patient (his nephew) who U in approximately
8/1/2008
August
11/1/2008
2008, was vaccinate
n has been received from a physicianY concerning a female patient who at the age of 12 months
Y (date unspecified) was vaccinated with a d
Y Nurse concerning an 18 year old female patient withUno pertinent 9/1/1998
medical history or drug reactions
Y Nurse concerning a 13 year old white male with unknownY medical 1/22/1997
history and no known
### drug allerg
n has been received from a certified medical assistant concerning a patient who on 12-DEC-2008
U was inadvertently
### vaccinated
### with a dose
n has been received from a certified medical assistant concerning a patient who on 15-DEC-2008
U was inadvertently
### vaccinated
### with a dose
n has been received from a registered nurse concerning a 4 year old male patient with asthmaY intermittent 4/3/2008
who on 13-APR-2008
### was vacc
n has been received from a physicianY concerning a patient who on an unknown date, received U 2 doses of VARIVAX (Oka/Merck) (lot # not
n has been received from a physicianY concerning of his daughter a 25 year old who on an unspecified
U date was vaccinated with a dose of V
Y concerning a patient (a friend at school of his nephew)Uwho on unspecified date was vaccinated with
n has been received from a consumerY concerning a 28 year old daughter who 13 years ago U(1993) was vaccinated
1/1/1998 with 1/1/2008
a dose of VARIVA
n has been received from a female Ylicensed practical nurse, with asthma, who on 18-Dec-2008,U splashed a VARIVAX ### (Oka/Merck)
### in her e
n has been received from a nurse concerning her daughter with environmental allergy. In 1999-2001
Y when her daughter was 4-6 year old,
n has been received from a nurse concerning a 24 month old female with a history of liver transplant
Y who was vaccinated with a dose of VA
n has been received from a pharmacist concerning a 75 year old patient who on 29-DEC-2008 U was vaccinated### with VARIVAX ### (Oka/Merck)
n has been received from a physician concerningY a 2 year old female with steroid therapy, absence
U of corpus callosum
### and
###pan-hypopituita
n has been received from a health professional concerning a 10 year old female student who U on 03-SEP-1999
9/3/1999was 11/6/2008
vaccinated subcutaneo
Y nurse concerning a 14 month old male patient with noUpertinent medical
10/1/2008 history and### known allergies
n has been received from a nurse and
Y a medical assistant concerning a 44 month old female N who on 03-MAY-2006
5/3/2006 was 1/1/2009
vaccinated with he
n has been received from a nurse concerning a 12 year old female who on 09-JUN-1997 was N vaccination
12/1/2008
with the first
12/1/2008
dose of VARIVAX (O
n has been received from a physician a 39 year old male with no drug reactions or allergies Uwho on 20-Nov-2008 ###was12/1/2008
vaccinated subcutan
Y nurse concerning a 43 year old female employee whoUon 01-DEC-2008 12/1/2008 was 12/3/2008
vaccinated with the firs
n has been received from a 31 yearYold female patient for the pregnancy Registry for VARIVAX.Y Some time 2/1/2007
in February,
2/10/2007
2007 was vaccina
Y from a registered nurse who while working part timeN at a high school heard12/3/2008
from an acquaintance
Y and a nurse supervisor concerning an 7 year old female U with asthma,
4/15/2008
eczema and allergic
### rhinitis wh
Y concerning an 8 year old female patient who on 03-Dec-2008
Y was12/3/2008
vaccinated12/5/2008
with the second dose o
Y nurse concerning a 10 year old female patient who onN29-OCT-1999 was ### vaccinated
n has been received from a registered nurse concerning an employee who was vaccinated with U the first dose of VARIVAR (Oka/Merck). Th
n has been received from a registered nurse concerning a female employee who was vaccinated U with her second dose of VARIVAX. The p
n was been received from a medicalY assistant concerning an approximately 60 year old maleU patient who 12/8/2008
on 08-DEC-2008
Y concerning a 6 year old female patient who either 2003 N or 2004 was vaccinated with the first dose of
n has been received from an office manager concerning a 76 year old female who on 03-DEC-2008U was12/3/2008
vaccinated12/3/2008
Y nurse concerning a 26 year old female patient with noNpertinent medical### history and### no known drug a
n has been received from a licensedY practical nurse (L.P.N.) concerning an 8 year old femaleY who was vaccinated
7/14/2008 with 1/5/2009
a first and second d
n has been received from a healthcare worker concerning a female patient, who on unspecified U dates, was vaccinated with two doses of VA
Y and licensed practical nurse concerning a 5 year old female
Y patient
3/25/2004
who on 25-MAR-2004
5/31/2008 was vacci
n has been received from a licensedY practical nurse concerning a 51 year old male patient with
N Bacitracin and ### Sulfonamide
1/2/2009 allergy and no
n has been received from a physician concerning a 7 year old female twin on 02-JAN-2009 was U vaccinated 1/2/2009
subcutaneously
1/2/2009with a 0.5ml do
Y concerning a 24-month-old female who was vaccinated Y with a 0.5ml dose of VERIVAX (Oka/Merck) (
n has been received from a physician concerning a male child with no pertinent medical history
N and no drug allergies
### 1/1/2009
who on 29-DEC-2008
Y another nurse who in 1990 was vaccinated with U VARIVAX (Oka/Merck) (unsure if 1 or 2 dose
n has been received from a physician concerning a 8 year old female who on 02-JAN-2009 U was vaccinated1/2/2009
subsequently
1/2/2009with a 0.5ml dose
n has been received from a physician concerning a 7 year old female twin who on 02-Jan-2009 U was vaccinated
1/2/2009 with a 0.5m
Y and certified medical assistant concerning an 8 year oldU patient who was vaccinated with two doses
n has been received from a health educator
Y concerning a male teenager who on 30-DEC-2008 N was vaccinated### with1/11/2009
VARIVAX (Oka/Merck
n has been received from a registered nurse concerning a 43 month old male child who on 05-SEP-2006
Y 9/5/2006
subcutaneously i
n has been received from a physician concerning an 10 year old patient who was vaccinatedUwith a dose of VARIVAX (Oka/Merck) (no lot#
Y an 8 year old male with no medical history, noNknown drug9/18/2001
on 18-SEP-2001 wa
Y a 28 year old female with no allergy who on 22-DEC-2008
Y was vaccinated
### with
### her first dose
n has been received from a nurse practitioner concerning a female who was intended to receiveU ZOSTAVAX 1/13/2009
(Oka/Merck),
1/13/2009 was inadvertent
Y a 50 year old female who in 1995 was vaccinated
U with one dose of VARIVAX (Oka/Merck) (lo
n has been received from a nurse practitioner concerning an unspecified number of patientsUwho on an unspecified date were vaccinated w
n has been received from a physician concerning an 88 year old male who on an unknown date, Y was vaccinated ###with1/5/2009
the first dose of VAR
n has been received from a school registered nurse who heard of a case concerning a child Ywho was vaccinated with one dose of VARIVA
Y a 12 month old female who on 22-DEC-2008 was Y vaccinated with ###a first dose###of VARIVAX (O
Y nurse concerning a 7 year old female patient with no Y previous medical
4/24/2007history
4/27/2007
reported, who on 04-A
n has been received from a licensed visiting nurse concerning a patient who on 10-MAR-1999 U was vaccinated
3/10/1999 with 3/14/1999
a dose of VARIVAX (Ok
n has been received from a consumerY concerning a her 12 month old son with no pertinent medical
N history
9/11/2007
and known 9/15/2007
drug reactions or all
n has been received from a bachelor of sciences in nursing concerning a patient who on an U unspecified date was inadvertently vaccinated
n has been received from a physician concerning her ex-husband who was vaccinated IM with U VARIVAX (Oka/Merck) (Lot # 659722/1877U
n has been received from a physician assistant concerning a 27 year old male with amoxicillinY allergy who on 13-NOV-2008
### ###was vaccinate
Y concerning a male patient under the age of four yearsYwho was vaccinated wit 1/19/2009
ha dose of VARIVAX
n has been received from a registered pharmacist concerning a patient who was vaccinatedUwith a dose of VARIVAX (Oka/Merck). It was
n has been received from a certified medical assistant concerning a patient who "one week ago"
U was vaccinated
1/16/2009with1/16/2009
a dose of VARIVAX (
Y nurse concerning a 6 year old male patient with no knownY drug reaction/allergies
4/11/2008 1/21/2009 and no pertinent m
n has been received from a physician concerning a patient who was intended to receive ZOSTAVAX
U (Oka/Merck) (MSD), was inadvertently
n has been received from a nurse practitioner concerning a male with no pertinent medical history,
Y allergies
10/5/1998
or drug reactions who on 05-O
Y concerning a 13 year old male patient with noYpertinent medical
10/2/1996
history1/9/2009
and no known allergi
n has been received from a health professional concerning a 5 year old female patient, who Non 18-OCT-2007 was ### vaccinated with a dose o
Y concerning an 8 year old male with food allergies
Y including 7/21/2001
peanuts and no past medical hist
n has been received from a nurse practitioner concerning a 4 year old female who on an unknown
Y date was vaccinated with a dose of VAR
Y concerning a patient who was vaccinated with a dose Uof VARIVAX 1/8/2009
(Oka/Merck)1/20/2009
(lot#661008/1317X).
n has been received from a registered nurse concerning a 7 year old male patient with asthma N who on 19-AUG-2002
8/19/2002 1/24/2009
was vaccinated with o
Y concerning a patient who was vaccinated with a dose Uof VARIVAX (lot# 661008/1317X). Concomitan
n has been received from a registered nurse concerning a 4 year old male patient who in approximately
Y 2005 was vaccinated
Y nurse concerning a 16 year old female child who inU2004 was vaccinated
10/1/2008 with 1/1/2009
her first dose of VA
Y nurse concerning a 43 year old male with no pertinentNmedical history1/23/2009
and no1/25/2009
drug reactions/allergie
n has been received from a physician concerning a 9 year old female who at few years ago N was vaccinated injection with VARIVAX (Merck
n has been received from a registered nurse concerning a patient who was vaccinated with U a dose of VARIVAX (Merck). Subsequently the
n has been received from a registered nurse concerning a patient who was vaccinated with U a dose of VARIVAX (Merck). Subsequently the
Y nurse concerning a 13 year old female with no knownNallergies or7/15/2008
medical history,
7/17/2008
who on 07-AUG-1
n has been received from a licensed practical nurse concerning a 9 year old white female who Y on 25-Aug-2004
6/8/2008 SQ with VA
n has been received from a physician concerning a male patient, who was vaccinated with the N first dose of VARIVAX (Oka/Merck) on an un
n has been received from a medicalYtechnician concerning her 18 month old female daughter, Y with no pertinent
7/16/2008 medical
7/17/2008
history and no drug
Y nurse concerning a 13 month old male with no relevant N medical history
7/16/2008
and no
7/17/2008
drug allergy who on 1
n has been received from a physician concerning a 35 year old female who 15-Mar-2005 was N vaccinated 3/15/2005
with a first dose of VARIVAX (Ok
n has been received from a healthcare worker concerning a 19 year old female with no pertinent
N medical4/25/1996
history who on 25-APR-1996 was
n has been received from a physician concerning a female teenage patient who on an unspecified
U date was vaccinated with the second do
n has been received from an office Ymanager, in physician's office, concerning an office nurse's
U child who on an unspecified date was vacci
Y an 8 year old male who on 18-JUN-2008 was Yvaccinated with 6/18/2008
the second
6/19/2008
dose of VARIVAX
n has been received from a physician concerning a female patient, who was vaccinated withNthe first dose of VARIVAX (Merck) on an unsp
n has been received from a physician concerning an 18 year old female who on 19-JAN-1998 N was vaccinated
7/3/2008
with the
7/3/2008
n has been received from a physician concerning a patient who on 23-Jul-2008 was vaccinated U with VARIVAX
7/23/2008(Oka/Merck).
7/23/2008The physician
n has been received from a licensed practical nurse concerning a 40 month old male, weightU29.5lb height 2/28/2006
35 inches,
6/23/2008
who on 28-Feb-2006
n has been received from a physician concerning an 8 year old male with no know allergies N who on 01-JUL-2008
7/1/2008at6/30/2008
2 PM was vaccinated s
n has been received from a physician concerning a 9 year old female with no know drug allergies
U who at6/24/2008
11 AM on 6/25/2008
24-JUN-2008 was vacc
n has been received from a physician concerning a pediatric patient who was vaccinated subcutaneously
U 2/5/1999
with the second 0.5ml dose of VA
n has been received from a physician concerning a child with no reactions after the first dose
N of VARIVAX 7/10/2008
(Oka/Merck) who on approximat
Y concerning a child with no reactions after the first dose
U with the second 0.5ml dose of VA
n has been received from a physician concerning a child with no reactions after the first dose
Y assistant concerning her approximately 24 month old N son with no pertinent medical
7/23/2008history nor drug a
U with the second 0.5 ml dose of V
U with the second 0.5 ml dose VAR
n has been received from a physician concerning an 8 year old male who on 23-JUN-1998 was U vaccinated 6/23/1998
with a first
6/17/2005
dose of VARIVAX (O
n has been received from a registered nurse concerning a patient who was vaccinated with U a dose of VARIVAX (Oka/Merck). Subsequentl
n has been received from a medical assistant concerning a female who on 08-JUL-2008 was U vaccinated subcutaneously
7/8/2008 7/15/2008 with a 0.5 ml dose
n has been received from a registered nurse concerning her daughter, a 3 year old female who Y in approximately 2006 (2 years ago) was va
n has been received from a nurse practitioner concerning
Y a 12 month old male with eczemaNand egg allergy 7/11/2008
who on7/13/2008
11-JUL-2008 was vacc
n has been received from a certified medical assistant concerning a 14 month old female who Y on 29-JUN-2005
8/3/2005 with a first
n has been received from a physician concerning his 4 year old son who "at age of 1", in 2005N was vaccinated with a7/1/2008
dose of VARIVAX (O
n has been received from a registered nurse concerning a patient who was vaccinated with U a dose of VARIVAX (Oka/Merck). Subsequentl
n has been received from a medicalYassistant concerning a 5 year old patient who on 19-JUL-2004
Y was vaccinated 8/14/2006
with VARIVAX (Oka/Me
n has been received from a physician concerning an about 7 year old male who on an unspecifiedU date was vaccinated with VARIVAX (Ok
Y from a nurse concerning a 17 year old female with Y asthma and 7/17/2008
no allergy who 7/25/2008
on 17-JUL-2008 wa
follow-up information has been received from a medical assistant concerning a 12 month oldY male with no 7/18/2008
relevant medical history or allerg
n has been received from a consumer concerning her 12 year old daughter with sulfonamideNallergy who7/23/2008 on 23-JUL-2008
7/24/2008was vaccinated w
n has been received from a licensed practical nurse and a consumer concerning a 12 year old Y female twin 8/6/2008
who on an8/7/2008
unspecified date was
n has been received from a nurse practitioner concerning a 6 year old female patient who was Y vaccinated with a second dose of VARIVAX
n has been received from a healthcare worker concerning an adult female who on 23-JUL-2008 U was vaccinated
7/23/2008 inadvertently
n has been received from a licensed practical nurse and a consumer concerning a 11 year old Y white female 8/6/2008
twin who8/7/2008
on 06-AUG-2008 was
n has been received from a nurse concerning a 12 month old healthy patient who on 17-JUL-2008 Y was vaccinated
7/17/2008 with 7/23/2008
a first dose of VAR
n has been received from a healthcare worker and the nurse concerning a 63 year old female U who on 02-AUG-2008
8/2/2008 8/2/2008
n has been received from a physician concerning a 7 year old female with allergic rhinitis andY a history of7/16/2008
"HAO" who 7/17/2008
on 16-JUL-2008 at 11
n has been received from a company representative concerning her daughter a 7 year old female Y with pollen
7/1/2007
allergy 7/1/2008
who in approximately
follow-up information has been received from a nurse concerning a 10 year old male who onU13-AUG-2008 8/13/2008
was vaccinated
8/15/2008 subcutaneousl
n has been received from a registered nurse concerning her daughter, a 14 year old female Ywho at 4:008/21/2007
pm on 21-AUG-2007
8/23/2007 was vaccinat
Y nurse concerning a 4 year old female with no known U pertinent medical
8/13/2008
history8/15/2008
or drug reactions/aller
Y nurse, concerning her 5 year old son, who on 12-MAY-2004 N was 5/12/2004
with VARIVAX (Oka/Me
follow-up information has been received from a nurse concerning a 10 year old male with mold U allergy and 8/13/2008
reactive8/15/2008
airway disease who on
n has been received from a physician concerning a 3 year old male who on 27-FEB-2006 was N vaccinated 2/27/2006
subcutaneously with one 0.5 ml d
n has been received from a physician concerning a 15 year old female patient who on 16-AUG-2008,
U was8/16/2008
subcutaneously into
Y concerning a 15 year old female patient who on 24-MAR-2008,
Y was
3/24/2008
with a dose of VARIV
n has been received from a nursing student concerning her 4 year old daughter who on 22-JUL-2005
Y was
8/21/2008
subcutaneously with
Y concerning a 5 year old female who on 07-AUG-2008,Nwas vaccinated 8/7/2008
with her8/9/2008
first dose of VARIVAX
n has been received from a female who "last week" (on approximately 15-AUG-2008) was vaccinated
U with
8/15/2008
one dose of VARIVAX (Merck) 0
Y nurse concerning a 5 year old female with no illnesses Y at the time8/11/2008
of vaccination,
8/11/2008
who on 04-FEB-20
Y a 14 year old patient with allergy to unspecified
Y medication who ### on 12-DEC-1999
Y concerning a 16 year old male who in 1996 was vaccinated Y with VARIVAX
6/27/2008(Oka/Merck).
6/27/2008 On 27-JUN
n has been received from a nurse concerning a 10 year old patient with allergy to unspecified Y medication who ### on 28-Dec-1999
n has been received from a nurse practitioner, concerning to "couple of youngsters", who were Y vaccinated with the second dose of VARIVA
n has been received from a female who a year ago was suppose to get ZOSTAVAX (Merck),U but by mistake 8/1/2007
the prescription
8/1/2007was written fo
n has been received from a consumer concerning a 10 year old male son with no previous medicalN history
8/19/2008
reported,8/20/2008
who on 19-AUG-2008
n has been received from a physician concerning three patients who on an unspecified date,Ywere vaccinated with a dose of VARIVAX (Me
Y a 7 year (estimated, age unit was not provided) Y old patient with an ###allergy
7/1/2008
to unspecified med
n has been received from a pharmacist concerning an adult patient who was vaccinated withUVARIVAX (Oka/Merck). Subsequently the pat
n has been received from a pharmacist, concerning a 67 year old male patient who was vaccinated
U with a dose of VARIVAX (Oka/Merck) i
Y nurse concerning a 14 year old male with no pertinentNmedical history 9/10/1997
who on 10-SEP-1997 was vac
Y concerning her son who was vaccinated with VARIVAX Y (Oka/Merck) a while ago. The patient deve
Y concerning a 36 month old female with no pertinent medicalN history8/16/2006
who on 16-AUG-2006
follow-up information has been received from a registered nurse concerning her 18 year oldYdaughter with 8/13/2008
no known 8/13/2008
allergies or pertinent m
n has been received from a registered nurse; concerning a friend of hers who developed shingles
N 3 days after her children received a boos
Y nurse (R.N.) concerning a 12 year old female who onN18-DEC-1998 was### vaccinated
Y nurse (R.N.) concerning a 13 year old male who on 25-AUG-2008
U 8/25/2008
was vaccinated
8/25/2008
subcutaneously w
n has been received from a nurse concerning a female grandmother of a child who receivedUthe second6/18/2008dose of VARIVAX (Merck) (Lot # 6
n has been received from a physician concerning an "almost 5 years old" male who in November U 2007, 11/1/2007
was vaccinated 8/22/2008
with his second do
Y a 13 year old female who was vaccinated withYa second dose 8/26/2008
of VARIVAX
8/26/2008
(Merck). One day
n has been received from a physician concerning a child who was vaccinated with VARIVAXU(Merck). Subsequently the patient developed
n has been received from a consumer concerning her 6 year old son, who on 13-AUG-2008Nwas vaccinated 8/13/2008
with VARIVAX
8/23/2008 (Merck), 0.5 mL
n has been received from a pharmacist, concerning a 67 year old female patient who was vaccinated
U with a dose of VARIVAX (Oka/Merck
n has been received from a physician concerning a child who was vaccinated with VARIVAXU(Oka/Merck). Subsequently the patient devel
n has been received from a nurse at the health care department who received a faxed reportUfrom a registered12/3/2007 nurse,
8/20/2008
concerning a case of
Y concerning a patient who on an unspecified date was Yvaccinated with a first dose of VARIVAX (Merc
n has been received from a physician concerning a patient who on an unspecified date, wasUvaccinated with a dose of VARIVAX (Merck). T
Y from a nurse and a consumer concerning her 10 year Y old daughter 8/4/2008
who is a8/5/2008
student with an amox
Y concerning a male who on 28-JUN-2008 was vaccinated U with a dose6/28/2008
of VARIVAX8/6/2008
(Oka/Merck) (Lot n
n has been received from a physician concerning a male patient with Crohn's disease who on N an unspecified date was vaccinated with VAR
Y from a physician concerning a 9 year old male whoNin 1999, also re was vaccinated with a 0.5 ml d
n has been received from a physician concerning a 10 year old female with no known allergies U who on 05-AUG-2008
8/5/2008 8/5/2008
was vaccinated with
n has been received from a licensed practical nurse concerning an approximately 12 year old N male patient
8/11/1997
who on 11-AUG-1997
8/18/1997 was vacc
Y concerning a 4 year old female patient who on 20-AUG-2005,
N was8/23/2008
vaccinated8/25/2008
with the first dose of V
Y concerning a 5 year old female who on 19-AUG-2004Nwas vaccinated 8/19/2008
with a first
8/21/2008
dose of VARIVAX (
n has been received from a registered nurse (R.N.) concerning two or three patients who were Y vaccinated8/8/2008
with VARIVAX
8/10/2008(Merck) that was
Y concerning a 12 month old female with no known pertinentU medical8/16/2008
history or8/18/2008
Y concerning an 8 year old female with no pertinent medical
U history and no history 7/12/2008
of drug reactions or
n has been received from a physician's assistant concerning a 4 year old female who on 20-DEC-2004
U was
8/4/2008
vaccinated8/4/2008
n has been received from a registered nurse (R.N.) concerning a 9 year old male who on 14-FEB-2000
N was
2/14/2000
vaccinated
8/16/2008
subcutaneously wit
Y from a physician concerning a female patient whose U son in 1999 was vaccinated7/28/2008 with a dose of VA
rmation has been received from a registered
Y nurse concerning her 5 year old daughter who on N 27-AUG-20088/27/2008
was vaccinated
Y concerning a 5 year old female with no allergies
Y and no medical
2/7/2006 history
9/1/2006
reported, who on 0
n has been received from a pharmacist concerning a patient who an unspecified date was vaccinated with a dose of VARIVAX (Oka/Merck
Y a 5 year old male with dextromethorphan hypersensitivity
Y 10/8/1996
who on 08-OCT-1996 was vaccina
n has been received from a physician concerning an 11-15 year old female who was vaccinated U with a second dose of VARIVAX (Oka/Mer
n has been received from an allergist/
Y immunologist concerning a 7-9 year old male "sometime N in mid-July7/15/2008
2008", on approximately 15-Jul-
Y from a physician concerning a 16 month old femaleNwith a history6/1/2008
of allergic6/1/2008
atopic dermatitis who
n has been received from a licensedY practical nurse (L.P.N.) concerning a 12 month old female
Y with no pertinent
8/29/2008medical9/1/2008
history or allergie
Y from a physician concerning a 5 year old male patient
Y (birth weight9/8/2008
was 7 pounds,
9/9/2008 11 ounces) with
n has been received from a physician concerning a 12 year old female who on an unspecified N date was vaccinated with a second dose of V
Y from a nurse concerning a 16 year old male who onN22-JUL-1997 8/18/2008
was vaccinated
n has been received from a physician concerning an 11-15 year female who was vaccinatedUwith a second dose of VARIVAX (Oka/Merck).
Y concerning a 6 year old female with a history of otitis media
Y in February
2/7/2004
20048/11/2008
(treated with amoxicillin
Y concerning a 15 year old male patient with AMOXICILLIN U allergy 9/8/2008
who on 08-SEP-2008
Y from a physician concerning a 11 year old female whoU on 20-AUG-2008
8/20/2008was 8/20/2008
vaccinated with the f
Y concerning a 9 year old female who was vaccinated with Y VARIVAX vaccine (Oka/Merck) (route, lot n
Y concerning a 29 year old female who on 09-Sep-2008 U was vaccinated
9/9/2008
IM with9/9/2008
VARIVAX (Oka/Merc
n has been received form a physician's
Y assistant student concerning an 11 year old male with N no known5/23/2007
allergies, who9/4/2008
on 18-APR-2000 wa
Y from a nurse practitioner concerning a 7 year old female
Y with allergy
8/4/1998
to OMNICEF ###(rash) and no p
Y concerning a 7 year old male patient who on 21-AUG-2008 U was vaccinated
8/21/2008 with 9/9/2008
a second dose of VA
n has been received from a consumer her 12 months daughter with allergy to gelatin, who on N 04-Sep-2008 9/4/2008
was vaccinated
9/4/2008 with VARIVAX
Y assistant concerning a female patient who received U two doses two of VARIVAX 9/3/2008
(Merck) at unstated
Y nurse concerning a 4 year old male with no pertinent N medical history
8/4/2008
and no history
8/6/2008 of drug reaction
n has been received from a physician concerning a patient who on an unspecified date was U vaccinated subcutaneously with a 0.5ml dose o
Y concerning a 5 year old patient who had been vaccinated Y with a dose of VARIVAX (Merck) in the pas
follow-up information has been received from a nurse concerning her 6 year old male grandson U with no 8/16/2008
pertinent medical
9/6/2008history and no dr
n has been received from a Certified
Y Medical Assistant concerning a 9 year old female who N on 10-SEP-2008
9/10/2008
was vaccinated
9/10/2008 with a booste
Y a 9-year-old female patient who on 30-AUG-2008N received8/30/2008
the second dose of 0.5ml VARIVA
Y concerning a 16 month old female with no pertinent medical
N history8/8/2008
reactions/allergies, w
n has been received from a physician concerning an 8 year old male who on 23-JAN-2001 was vaccinated 1/23/2001
with the first
9/7/2008
dose of VARIVAX
n has been received from a physician concerning a patient who on an unspecified date was U vaccinated subcutaneously with a 0.5 ml dose
Y concerning a 11 year old male patient who on 21-AUG-2008U was 8/21/2008
vaccinated with9/9/2008
a second dose of V
Y concerning a 9 year old male patient who on 21-AUG-2008 U was vaccinated
8/21/2008 with 9/9/2008
a second dose of VA
Y concerning a 11 year old female patient who on 21-AUG-2008
U was
8/21/2008
vaccinated9/9/2008
with a second dose o
follow-up information has been received from a nurse concerning a 67 year old female with U hypertension9/16/2008
who on 16-SEP-2008
n has been received from a nurse concerning her 7 year old male grandson with no pertinent N medical history and no 9/6/2008
drug reactions/allergie
follow-up information has been received from a nurse concerning a 68 year old male with hyperlipidemia
U 9/16/2008
who on 16-Sep-2008
n has been received from a physician concerning an 11 year old female who on an unknownUdate was vaccinated with a second dose of V
n has been received from a certifiedYmedical assistant (C.M.A) concerning a 20 year old female,Y weight 7/17/2008
168lb, height 7/18/2008
67 inches, with no pe
n has been received via literature article regarding a case in litigation concerning a now 54 year
U old female 3/7/2001
with common variable immunod
n has been received from a physician concerning a 24 year old female who on was vaccinated U with two doses
4/1/2008of VARIVAX (Merck) and fai
n has been received from a registered nurse concerning an over 6 years old male who on approximately
U 7/21/2008
21-JUL-2008 7/21/2008
was vaccinated with
n has been received from a physicianY concerning a 12 month old male with no medical history Y or no drug allergies who was vaccinated with
n has been received from a pharmacist concerning a male who was vaccinated with VARIVAX U (Oka/Merck). The patient failed to SEROCO
n has been received from a physicianY concerning a 12 month old female who on 29-MAY-2008 N was a dose 5/29/2008
of vaccinated with VARIVAX (M
n has been received from a pharmacist concerning a 70 year old male who on 14-MAY-2008Uwas vaccinated 5/14/2008
with VARIVAX
5/14/2008(Merck), 0.5 m
n has been received from a physician concerning a 7 year old male who was vaccinated withU the second dose of VARIVAX (Merck). One y
Y nurse concerning a 4 year old boy who on 06-JAN-2005 N was vaccinated
5/13/2008 into left arm
n has been received from a physician concerning a 60 year old patient who on 30-JUL-2008Uwas inadvertently 7/30/2008vaccinated
7/30/2008
with VARIVAX (O
n has been received from a physicianY concerning an approximately 10 year old patient who N on an unspecified date was vaccinated with a d
n has been received from a physicianY concerning a 13 month old female with no pertinent medical
N history
4/30/2008
and no allergies
5/11/2008who on 30-APR
n has been received from a physician concerning a 16 month old female with no known allergies N or pertinent
4/21/2008
medical5/9/2008
history who on 21-AP
n has been received from a nurse practitioner through a pregnancy registry concerning a 29Yyear old female 4/1/2008
with asthma
4/1/2008
and a possible Ty
n has been received from a consumer's
Y mother concerning her 24 month old daughter with no N pertinent medical ###history or###
drug allergies wh
n has been received from a physicianY concerning a 5 year old male who on 19-Jan-2008 was on 19-Jan-2008 1/19/2008
was vaccinated
7/21/2008 with a secon
Y nurse (R.N.) concerning a 11 year old male with no pertinent
Y medical
5/18/1998
history and
5/8/2008
no allergies who o
n has been received from a physician concerning a male who's 5 year old son was vaccinated U with VARIVAX (Oka/Merck) on an unspecifie
n has been received from a nurse concerning a 55 day old patient who on 16-MAY-2008 was U vaccinated5/16/2008
into the thigh
5/16/2008
with a dose of VARI
n has been received from a physician concerning his 5 year old grandson with a history of eczema
U (outgrew)
5/1/2008
and no 5/1/2008
known allergies who in
n has been received from a consumer concerning her 5 year old grandson who was vaccinated U with at least one dose 4/9/2007
of VARIVAX (Merck)
follow-up information has been received from a nursing student concerning a 19 month old male Y with no7/22/2003
known drug 7/24/2003
reaction/allergies or p
n has been received from a healthcare worker concerning a 75 year old female who on 16-MAY-2008U was
5/13/2008
vaccinated5/16/2008
n has been received from a medicalYassistant concerning a 5 year old male with no pertinentNmedical history 7/30/2008
or allergies
7/30/2008
who on 14-AUG-2
n has been received from a registered nurse (R.N.) concerning a 10 year old patient who was U vaccinated with a dose of VARIVAX (Merck)
n has been received from a nurse practitioner concerning a 37 year old female who on 28-SEP-1998
U was vaccinated
### 8/16/2007
with the first dose of V
n has been received from a registered nurse concerning an 8 year old patient who was vaccinatedU with a dose of VARIVAX (Merck) (dose
n has been received from a registered nurse concerning a patient who on approximately 21-JUL-2008
U was
7/21/2008
vaccinated
7/21/2008
with a second dose
Y concerning a 30 month old female who was vaccinated
U with the first dose of VARIVAX (Merck)
n has been received from a registered nurse concerning one to two female patients betweenNthe ages 15 to 18 months out of 20 who were
n has been received from a registered nurse concerning a patient who on approximately 21-JUL-2008
U was
7/21/2008
vaccinated
7/21/2008
with a second dose
n has been received from a physicianY and a medical assistant concerning a 5 year old boy with Y no pertinent
5/19/2008
medical5/19/2008
history and no history
n has been received from a physicianY concerning a 10 year old female with no related medical Y history and5/13/2008
drug allergy
5/14/2008
who was vaccinated
n has been received from a physicianY concerning a 15 month old patient who was vaccinated Y IM with a first dose of VARIVAX (Merck). At t
n has been received from a medical assistant concerning a 11 year old male who "about oneY month ago", in April 2008, was vaccinated wit
n has been received from medical assistant concerning a 7 year old patient who "about one Ymonth ago" in April 2008, was vaccinated with
n has been received from a male dentist concerning his female friend who on 08-APR-2008 Uwas vaccinated 4/8/2008
with VARIVAX
4/8/2008 (MERCK) inste
n has been received from a consumer concerning a 48 year old male with high blood pressure U whose 5-year-old son4/9/2007
developed bumps on
Y concerning an approximately 16 month old male Y with no known
1/8/2003
allergies
2/1/2003
or pertinent medica
n has been received from a physicianY and a medical assistant concerning a 7 year old female, Y weight 46lb,
12/4/2006
who on 4/27/2008
19-JUL-2001 was vacc
Y a 29 year old female who was vaccinated withUVARIVAX (Merck). The nurse reported that th
n has been received from a physician's office staff member concerning her daughter, a 4 year Y old female5/16/2008
who on 16-MAY-2008
n has been received from a physician concerning a 12 month old patient who on an unspecified U date was vaccinated with a dose of VARIV
n has been received from a physician's office staff member concerning a 4 year old boy whoYon 22-MAY-2008 5/22/2008was 5/22/2008
vaccinated with the sec
n has been received from a physicianY concerning an 8 year old female, weight 39lb, height 48.5Y inches, 8/23/2007
who on 05-DEC-2000
n has been received from a physician and her first office staff member concerning a 4 year old Y patient who5/22/2008
on 22-MAY-2008
n has been received from a physician and her office staff member concerning a 4 year old boy Y who on 22-MAY-2008
5/22/2008 5/22/2008
Y registry from a registered nurse for VARIVAX (Merck)
U concerning
3/25/2008
a 20 3/25/2008
year old female with no
n has been received from a registered nurse concerning a 14 year old male with no allergiesYand with Crohn's 4/28/2008disease
4/29/2008
and who is immunoc
n has been received from a registered Y nurse concerning a female in her 30's year old who on Y 19-MAY-2008 5/19/2008
was vaccinated
5/19/2008with a first dos
n has been received from a registered nurse concerning one to two male patients between the N ages 15 to 18 months out of 20 who were v
n has been received from a registered nurse concerning an 8 year old patient who was vaccinatedU with a dose of VARIVAX (Merck) (dose
n has been received from a physician Y concerning a 30 month old male with no other medicalNproblems who on an unspecified date had bee
n has been received from a physician Y concerning a 13 year old male who was vaccinated with Y the second dose of VARIVAX (Merck) (lot# 6
n has been received from a medicalYassistant and physician concerning a 21 year old female Y with no pertinent
5/13/2008medical
5/23/2008
history and no drug
n has been received from a physician Y concerning a 13 month old male who on 05-MAY-2008 Y was vaccinated
5/5/2008
subcutaneous
5/19/2008with his first do
n has been received from a registered nurse concerning a 57 year old female who on 27-MAY-2008 Y was5/27/2008
intended to 5/27/2008
receive ZOSTAVAX (
n has been received from a physician Y concerning an 8 year old boy who on 12-MAY-2008 was Y vaccinated 5/12/2008
with the second
5/26/2008 dose of VARIVA
n has been received from a physician Y concerning a 12 year old male who was vaccinated with N a first dose of VARIVAX (Merck). The patien
n has been received from a physician concerning a 12 month old female with no known allergies Y and a history
4/23/2008of cellulitis
5/4/2008
in left leg at 6 mo
n has been received from a health professional concerning a patient who was vaccinated with U a dose of VARIVAX (Merck) (lot number, inje
n has been received from a physician concerning an 18 month old female who on 22-MAY-2008 Y was vaccinated
5/22/2008with 5/22/2008
VARIVAX (Merck). Th
n has been received from a physician concerning a 5 year old male with seasonal allergies who N on 24-JUN-2004
5/14/2008was 5/14/2008
vaccinated subcutan
n has been received from a physician concerning a 9 year old male who on 06-SEP-1995 was U vaccinated9/6/1995
with VARIVAX9/1/2004
(Merck) (lot # not
n has been received from a registered nurse, concerning her 13 year old daughter who on 14-JUL-1995
Y 7/14/1995
was vaccinated
5/28/2008
with the first dose
n has been received from a physician Y assistant concerning a 30 year old white female with seasonal allergy,8/1/2008
chronic8/13/2008
sinusitis and anaemia
n has been received from a health professional concerning an 18 year old female who on 20-MAY-2008
U 5/20/2008
was vaccinated
5/22/2008
subcutaneously on
n has been received from a medical assistant and physician concerning a 10 year old female N with no pertinent
8/11/2008medical
8/11/2008
history and no allerg
n has been received from a registered nurse concerning a 12 month old female who in approximately
U 2007, about one year ago, was vacci
n has been received from a registered nurse concerning an 8 year old female who on 02-MAR-2001 Y was9/12/2007
vaccinated 5/9/2008
subcutaneous with a f
n has been received from a physician concerning an 82 year old female patient living in an assisted
U living
8/15/2008
residence8/15/2008
who on 1:30PM, 15-AU
n has been received from a licensed Y practical nurse concerning a 5 year old female with no U
medical history
5/21/2008
or allergies who on 21-MAY-20
n has been received from a physician concerning a patient who was vaccinated with VARIVAX U vaccine (Merck). The physician reported tha
n has been received from a physician concerning a child who was vaccinated with a dose ofUVARIVAX (Merck) in the 4/21/2008
past. Five or six week
n has been received from a registered Y nurse concerning a 12 month old female who on 08-APR-2008
Y was4/8/2008
vaccinated4/17/2008
subcutaneously in th
n has been received from a consumer concerning her daughter, a female who in approximately U 1998 (about 10 years ago) was vaccinated
n has been received from a pharmacist concerning a 25 year old female employee of the hospital U who was vaccinated with two doses of VA
n has been received from a registered pharmacist concerning her son, a 14 month old male Ywith no pertinent 7/1/2008
medical7/1/2008
history and no known
n has been received from a medicalYassistant concerning a 9 year old female, weight 78lb, height
Y 58 inches,
5/22/2008
with attention
6/2/2008 deficit/hyperacti
n has been received from a physician Y concerning an 8 year old male who on 22-AUG-2000 N was vaccinated 9/1/2006
subcutaneously
n has been received from a medical assistant and a nurse concerning a 70 year old female who U on 18-AUG-2008
8/18/2008 was 8/18/2008
vaccinated with VAR
n has been received from a physician concerning an 85 year old male who on 08-APR-2008Uwas vaccinated 4/8/2008
with a "regular
4/8/2008 dose" of VARIV
n has been received from a physician concerning her 8.5 year old daughter who on 24-JUL-2007 U was vaccinated
7/24/2007in7/24/2007
the right arm with a do
n has been received from a registered Y nurse concerning a 6 year old male with no drug allergies
Y who on5/14/2003
14-MAY-2003 5/24/2008
was vaccinated with
n has been received from a registered Y nurse (R.N.) concerning a patient who on 03-JUN-2008 U was inadvertently
6/3/2008vaccinated
6/3/2008subcutaneosly
n has been received from a physician Y concerning a male in his 40's with a past medical history
N significant5/1/2008
for a thyroid5/1/2008
disorder treated with
n has been received from a certified medical assistant concerning a 13 year old white femaleY with no pre-existing
8/7/2008allergies,
8/8/2008 birth defects, or
n has been received from a vaccineYprovider concerning a 9 year old female minor with no pre-existing
Y 5/28/2008
allergies, birth
5/29/2008
defects or medical c
n has been received from a physician Y concerning a 10 year old male with allergy to OMNICEF Y who on 22-APR-1999
4/22/1999 8/10/2008
n has been received from a physician concerning a 4 year old female with no history of recent exposure to 6/5/2005
Chicken pox 6/4/2008
who on 05-JUN-20
n has been received from a licensed practical nurse and a consumer concerning a 12 year old Y male with8/12/2008
atopic dermatitis
8/13/2008 on leg behind kn
n has been received from a registered nurse concerning a 68 year old female patient with noUpertinent medical history 8/8/2008
or known allergies o
t was identified from a line listing obtained
Y on request by the company from the FDA under the U Freedom of Information Act. A patient exper
n has been received from a registered nurse (R.N.) concerning a 69 year old female who onU11-AUG-2008 8/11/2008
was vaccinated
8/11/2008 with a dose of V
n has been received from a nurse practitioner, concerning to "couple of youngsters", who were Y vaccinated with the second dose of VARIVA
n has been received from a physician Y concerning a patient who on an unknown date was vaccinated
U with a second dose of VARIVAX vacc
n has been received from a physician Y concerning a 9 year old male who in approximately 2000,N "8 years ago", was 8/12/2008
vaccinated subcutaneo
n has been received from a licensed practical nurse and a consumer concerning a 12 year old Y male who 8/4/2008
on an unspecified
8/5/2008 date was vaccin
U with a second dose of VARIVAX (Oka
Y nurse concerning a 19 year old female patient with asthma
Y and penicillin
8/4/2008 allergy
8/13/2008
which caused breat
U with a second dose of VARIVAX (Mer
Y pharmacist concerning a patient who on 13-AUG-2008 U was vaccinated
8/13/2008
with a8/13/2008
dose of VARIVAX (Me
U with a second dose of VARIVAX (Mer
n has been received from a physician concerning three patients who on an unspecified date,Ywere vaccinated with a dose of VARIVAX (Me
Y concerning an adult male, without a reported history ofUchickenpox and who was VZV negative, who
Y nurse concerning a 3 year old female with no known N drug allergies7/28/2008
and no pertinent
Y from a licensed practical nurse for the pregnancy registry
Y for VARIVAX
3/7/2008 (Merck)
3/7/2008
concerning a 15 y
n has been received from a physician concerning a male who was vaccinated with a dose ofUVARIVAX (Merck). Subsequently the patient e
n has been received from a licensed practical nurse and a consumer concerning an 11 yearYold female who 6/13/2008
on 13-Aug-2008
n has been received from a nurse concerning a patient who on 04-AUG-2008 was vaccinated U with a dose8/4/2008
of VARIVAX (Merck) (lot # 66144
n has been received from a nurse concerning an 11-12 year old female who was vaccinatedYwith VARIVAX 10/1/2007
(Merck)10/1/2007
(lot no., route and site
n has been received from a physician concerning a female who on an unspecified date was Yvaccinated with a second dose of VARIVAX (M
follow-up information has been received from a nurse concerning an 11-12 year old female Y who was vaccinated
10/1/2007 with
10/1/2007
VARIVAX (Merck) (lo
n has been received from a nurse cornering an 11-12 year old female who was vaccinated with Y VARIVAX 10/1/2007
(Merck) (lot
10/1/2007
no., route and site of
n has been received from a nurse concerning an 11-12 year old female who was vaccinatedYwith VARIVAX 10/1/2007
(Merck)10/1/2007
(lot no., route and site
Y concerning a 6 year old male who on an unspecified date U was vaccinated with a second dose of VAR
n has been received from a physician's assistant (P.A.) concerning a approximately 23 month Y old white male
2/1/2008
with no3/1/2008
other medical history
Y nurse (R.N.) concerning a patient who was vaccinated Y with the first dose of VARIVAX (Merck). Sub
Y concerning a 12 year old male with a historyNof rash for 29/19/2003
days who 6/21/2008
on 19-SEP-2003 was v
Y nurse (R.N.) concerning a patient who was vaccinated Y with the first dose of VARIVAX (Merck). Subs
Y concerning a patient, his child, who was vaccinated withU a dose of VARIVAX (Merck) (lot no., route a
n has been received from a physician concerning a 10 year old male, weight 107.8lb height Y 52.5 inches, who
8/3/2005
on 03-AUG-2005
n has been received from a licensedY practical nurse concerning a 10 year old male with no pertinent
Y medical
6/4/2008
history 6/4/2008
and drug reactions/alle
n has been received from a consumer concerning her son who on 19-JUN-2008 was vaccinated N with his6/19/2008
booster VARIVAX
6/19/2008 (Merck), 0.5 ml
Y concerning a 11 year old male patient with no known allergies
Y or pertinent
6/16/2008medical
6/16/2008
history who on 16
n has been received from a licensedY practical nurse (L.P.N.) concerning a 14 month old male Y on 05-JUN-2008
6/5/2008was vaccinated
6/5/2008 subcutaneo
n has been received from a licensedY practical nurse concerning a 14 month old male patientYwho on 05-JUN-2008
6/5/2008 was 6/5/2008
vaccinated with a d
Y concerning a 11 year old female who in April 2008, was N vaccinated4/1/2008
with second dose of VARIVAX (M
n has been received for a physicianYassistant concerning a 8 year old male patient who on 11-SEP-2001,
Y 9/11/2001
with VARIVAX (M
Y concerning a 9 year old male patient with a history of Useizures who was vaccinated with a dose of VA
Y an approximately 8 year old male who "about Y 10 years ago" in approximately 1998 was vacc
Y worker concerning an approximately 7 year old female Y with no known
5/16/2001
allergies2/1/2007
and a history of strep
n has been received from a physician concerning a 59 year old male patient who on 15-APR-2008U was prescribed
4/15/2008 and 4/15/2008
vaccinated with a fir
n has been received from a nurse concerning a patient who in 1998 was vaccinated with a dose Y of VARIVAX (Merck) (lot no., route and sit
n has been received from a physician concerning a 5 year old female patient with no pertinentY medical history
4/1/2007
and drug reactions/allergies
Y assistant (P.A) concerning a patient who was vaccinated N with a dose of VARIVAX (Merck) years ago
Y concerning a 14 year old female with a history
Y of dermatitis,
3/31/2008
rhinitis 3/31/2008
allergic and latex allerg
n has been received from a 40 yearYold female with hypercholesterolaemia and a history of female
Y genital9/4/2007
operation 9/4/2007
concerning on 04-SEP
n has been received healthcare provider
Y concerning a 9-year-old male who on 16-AUG-2002 Y was vaccinated
8/16/2002
with a dose
6/1/2008
of VARIVAX (Me
n has been received from a licensed practical nurse concerning a 12 year old male who on an Y unspecified8/5/2008
date was vaccinated
8/5/2008 with her firs
n has been received from a registered nurse (R.N.) concerning a patient who on 03-APR-2001, Y 4 day early 4/3/2001
prior to the
4/3/2001
patient's first year b
n has been received from a health professional concerning an 11 year old male who on 05-JUN-2008
U was6/5/2008
vaccinated 6/6/2008
subcutaneously in le
Y concerning a 46 year old female with history of morphineN allergy who
6/9/2008
on 09-JUN-2008
n has been received from a medical assistant concerning a 63 year old patient who on 04-JUN-2008
U was6/4/2008
vaccinated6/4/2008
n has been received from a consumer concerning her son a male patient who on 10-JUN-2008 N at 11:006/10/2008
with VARIVAX (Me
n has been received from a consumer concerning her son who was vaccinated with VARIVAX U (Merck) (Injection site, dose/ frequency and
Y nurse (R.N.) concerning that during the past few months Y a few patient
5/14/2008
who were
5/14/2008
vaccinated with a s
n has been received from a registered nurse (R.N) concerning a patient who on 11-JUN-2008 U was inadvertently
n has been received from a nurse concerning her child, 4 year old male, with a history of prior
N immunizations
6/10/2008
(unspecified)
6/10/2008 who on 10-JUN
n has been received from a nurse concerning a 36 month old male who in approximately 2006 Y was vaccinated with a6/5/2008 single dose of VARIV
n has been received from a certifiedYmedical assistant (C.M.A.) concerning a 12 year old female
N with no6/26/2008
pertinent medical
6/27/2008 history or known
n has been received from a pharmacist concerning a 65 year old patient who on 27-JUN-2008 U was inadvertently
6/27/2008vaccinated
6/27/2008with a single d
n has been received from a registered nurse concerning a patient who on 30-Jan-2008 was U inadvertently6/30/2008
n has been received from a registered nurse concerning a male with no known pertinent medicalU history6/26/2008
who on 26-JUN-2008 was vaccina
n has been received from a nurse concerning a 60 year old male who on approximately 30-MAY-2008
U was
5/30/2008
vaccinated5/30/2008
with a dose of VARI
n has been received from a licensed Y practical nurse (L.P.N.) concerning a 4 year old femaleNwith no medical5/8/2008
history or5/8/2008
drug allergies who o
n has been received from a certified medical assistant (C.M.A.) concerning a patient in his (or
U her) 70's with7/1/2008
no pertinent
7/1/2008
medical history, dr
n has been received from a veterinarian
Y concerning his 24 year old pregnant daughter with aUhistory of chickenpox 6/12/2008
as infant. The patient's
n has been received from a physician concerning her daughter who was vaccinated with a dose Y of VARIVAX (Merck). On an unspecified d
n has been received from a nurse concerning her approximately 12 month old daughter withUallergies who8/1/2005 in August 2005 was vaccinated
n has been received from a physicianY concerning a patient who on unspecified dates was vaccinated
U with the two doses of VARIVAX (Mer
n has been received from a Merck employee
Y concerning a 6 year old female who last week U(between 23-JUN-2008
6/25/2008 6/25/2008
to 29-JUN-2008) was v
n has been received from a certified medical assistant (C.M.A.) concerning a patient in his (or
U her) 70's with7/1/2008
no pertinent
7/1/2008
medical history, dr
n has been received from a licensed practical nurse concerning a 20 year old female patientUwith no pertinent
8/17/2007medical history who on 17-M
n has been received from a nurse concerning a 25 year old female with no pertinent medicalUhistory or history4/1/2008
of drug4/1/2008
allergies or reaction w
n has been received from a nurse concerning a 6 or 7 years old male who was vaccinated with U at least two doses of VARIVAX (Merck). Th
n has been received from a licensed Y practical nurse (L.P.N.) concerning a 13 month old female
U with no medical
5/30/2008 history
6/24/2008
or no drug allergies
n has been received from a pharmacist concerning a patient who on 07-JUL-2008 was vaccinated U with "one
7/2/2008
vial" of VARIVAX
7/2/2008 (Merck) inste
n has been received from a health professional concerning a 4 year old female with no pre-existing
U allergies,
7/1/2008
birth defects
7/3/2008or medical condi
n has been received from a health care professional concerning an 8 year old female with no Y pre-existing6/26/2008
allergies, birth defects or medica
n has been received from a physicianY concerning a patient who on unspecified dates was vaccinated
U with the two doses of VARIVAX (Mer
n has been received from a healthcare worker and a physician concerning an 11 year old white Y female with 8/14/2007
no pertinent
8/14/2007
medical history an
n has been received from an office manager concerning a 63 year old female who on 08-JUL-2008U was vaccinated
7/8/2008 in7/8/2008
her left arm with a do
follow-up information has been received from a registered nurse concerning a 5 year old male U with no relevant
7/2/2008medical7/4/2008
history or allergies
n has been received from a certified medical assistant (C.M.A.) concerning a 4 year old female
N who on 01-JUL-2008
7/1/2008 7/1/2008
n has been received from a registered nurse concerning a 13 year old female with no pre-existing
N drug allergies
4/10/1996 and6/27/2008
medical conditions wh
n has been received from an office staff concerning a female who in June 2008, was vaccinatedU with a dose 6/1/2008
of VARIVAX6/1/2008
(Oka/Merck) (lot
n has been received from a registered nurse concerning a 10 year old female patient who inYapproximately 8/1/1998
August 1998,6/6/2008
when she was 12
n has been received from a licensed practical nurse concerning a 10 year old male who on 02-FEB-1997
Y 4/10/2007
was vaccinated with the first dose
n has been received from a licensed practical nurse concerning an 8 year old female patientYwho on 17-JAN-2001,
4/10/2007 was 7/1/2008
vaccinated with the
n has been received from a pediatrics office and a nurse concerning a 12 month old female Y who on 27-JUN-2008
6/27/2008at6/27/2008
1545 was subcutaneo
n has been received from a Licensed Practitioner Nurse, concerning a 15 year old female patient,
U whose5/27/2008
mother told the LPN that she had
Y concerning a male patient who received VARIVAX (Merck) Y (Lot #557099/0453U)
6/5/2007 7/11/2008 0.5 mL SQ on 05-J
n has been received from a physicianY concerning a 13 year old female patient who on 24-Mar-2008,
Y was3/24/2008
vaccinated3/24/2008
n has been received from a physician concerning a 12 year old female who on 24-Mar-2008Ywas vaccinated 3/24/2008
SC with 3/25/2008
a second 0.5ml dose
n has been received from a physician and a registered nurse concerning a patient who overUthe last one or two weeks 6/1/2008
was vaccinated with
n has been received from a medicalYassistant concerning a her 7 year old daughter with history
Y of asthma and### no drug
3/13/2008
reactions/allergies,
Y concerning a patient who on an unspecified Ydate, was vaccinated with a first dose of VARV
n has been received from a physician concerning a female with a history of obesity who wasYvaccinated SC with a second 2/1/2008dose of VARIVA
n has been received from a physician concerning a male between 12 and 15 years of age with Y obesity and another male 1/1/2008
(WAES#0804USA
Y nurse concerning a 9 year old male who on 15-Mar-2000 Y was vaccinated
3/20/2008 into 7/2/2008
his leg with the first do
Y concerning a couple of patient 's who on an unspecified
U date was vaccinated with the second
n has been received from a nurse concerning a patient who on 10-July-2008 was vaccinatedNsubcutaneously 7/10/2008
with a7/15/2008
dose of VARIVAX (Me
n has been received from a consumer concerning her daughter who was vaccinated with a dose U of VARIVAX (Merck). Subsequently the pa
n has been received from a physicianY concerning an 8 year old male with no pertinent medicalY history or3/31/2008
drug allergies 4/1/2008
who on 31-MAR-20
Y concerning a 12 year old male who on 22-SEP-1999
Y was 9/22/1999
vaccinated7/3/2008
with VARIVAX (Merck
n has been received from a physicianY concerning a 10 year old female who in approximatelyN2007 was vaccinated SC with a second 0.5 m
n has been received from a physician concerning his 17-month-old male who was vaccinated U at 12 months of age with a dose of VARIVAX
n has been received from physician's office concerning a 7 year old boy with no pertinent medical
N history 4/1/2008
who on 01-APR-2008
4/1/2008 was vaccin
n has been received from a health professional concerning a 15-month-old female with no medical
U history
3/12/2008
who at a 3/21/2008
well check up on 12-MA
n has been received from a physician concerning her 56 year old mother with mild intermittent Y asthma as medical history and no illness at t
n has been received from a physician concerning a 7-year-old female with no pertinent medical Y history or 3/25/2008
drug reactions/allergies,
3/26/2008 who on 2
n has been received from a registered nurse concerning a 32 month old who on 25-AUG-2006 N was vaccinated
8/25/2006with3/30/2008
0.5 ml of VARIVAX (Me
n has been received from a physicianY concerning a child who was vaccinated with VARIVAXY(Merck). "In the past couple 3/1/2008of weeks", in app
n has been received from a physician concerning a female in her 70's who on approximatelyU26-FEB-2008 2/26/2008
was vaccinated
2/26/2008 with a dose of V
n has been received from a consumer concerning her 11 year old son with a drug reaction/allergy
U to soy and peanut,4/2/2008
who on 01-APR-2008
n has been received from a physicianY concerning a 17 year old female with no pertinent medical
N history and
4/1/2008
no drug 4/2/2008
reaction / allergies, wh
n has been received from a consumer Y concerning his 10 year old daughter who on 04-OCT-1998 N was vaccinated
4/3/2008with 4/4/2008
th first dose of VARI
n has been received from a registered nurse concerning her 10 year old son who on an unspecified
Y date3/21/2008
was vaccinated
3/28/2008
with the first dose
Y nurse concerning an 8 year old male who on 03-Nov-2000 N was vaccinated
2/5/2007with 2/5/2007
the first dose of VAR
n has been received from a registered nurse concerning a patient who on approximately 01-APR-2008
U was
4/1/2008
vaccinated with a dose of VAR
Y a 4 to 6 year old male who on approximately 01-APR-2008
Y 4/1/2008
was vaccinated
4/1/2008
with VARIVAX (M
n has been received from a physician concerning an 81 year old female who on 08-APR-2008 U was vaccinated
4/8/2008with "regular
4/8/2008 dose" of VARIV
n has been received from a physicianY concerning a 12 year old male who on the day before Nthe child's first birthday was vaccinated subcut
n has been received from a physicianY concerning a 13 year old (previously reported as 11 yearY old) female with ###
no pre-existing
4/6/2008 allergies, b
n has been received from a physicianY concerning an approximately 36 month old female patient Y with no pertinent medical history who was
n has been received from a physicianY assistant concerning a "7 or 8 years old" male who in U September 2007,9/1/2007
was vaccinated with a secon
n has been received from a physician concerning a 4 year old male with no pertinent medical Y history and no drug reactions/allergies,
3/25/2008 who w
Y concerning a a 13-year-old female with a history
Y of rhinitis
10/2/1995
allergic and4/1/2008
scoliosis who on 02-
n has been received from a licensed Y practical nurse (L.P.N.) concerning a 14-year-old female,
Y weight 179 4/10/2008
pound, height
4/10/2008
67.5 inch, who on
n has been received from a registered nurse concerning a patient who was vaccinated subcutaneous
Y with a 0.5 ml second dose of VARIVA
n has been received from a registered nurse concerning a 11-year-old female who on 05-JUN-1998Y was vaccinated
6/5/1998 4/5/2008
SC with a 0.5 mL dose
n has been received from a registered nurse concerning a 7 year old male who on 22-Jun-2001 Y was vaccinated
6/22/2001 with
3/23/2008
VARIVAX (Merck) (lot
n has been received from a health professional concerning a patient who on 30-NOV-2005 was U vaccinated with ###
a dose
4/1/2008
of VARIVAX (Merck
n has been received from a registered nurse concerning a 14 year old male child who "withinUthe last two 4/1/2008
weeks" on approximately 01-APR
n has been received from a registered nurse concerning a 9 year old patient with a history ofNpremature puberty
4/9/2008 and4/10/2008
asthma and a drug rea
n has been received from a physicianY concerning a 4 year old male patient, who on 24-Feb-2005,
Y was vaccinated
2/24/2005 with 4/1/2008
VARIVAX (Merck) (
n has been received from a physicianY concerning a 41 month old male with autism, speech delayU and encopresis
9/2/2005who 7/31/2007
on 02-SEP-2005 wa
n has been received from a licensed practical nurse concerning a 14 year old female with amoxicillin
U allergy who ###on 21-NOV-1997
4/7/2008 was vac
Y nurse concerning a 15 year old male who was vaccinated U with a dose VARIVAX 4/9/2008
(Merck). On 09-Apr
n has been received from a nursingYstudent concerning herself, a 42 year old female with noNhistory of drug reactions
### 3/1/2008
or allergies and poss
n has been received from a nurse practitioner and consumer concerning a patient who in March U 2008, was 3/1/2008
vaccinated 3/1/2008
with a dose of VARI
Y nurse concerning a 14 year old male with asthma andNseasonal allergies1/15/1996 who4/15/2008
on 15-JAN-1996 was
n has been received from a nurse concerning a patient who on 17-JUN-2008 was vaccinated U with VARIVAX6/17/2008
(Merck).
6/17/2008
The nurse reported t
n has been received from a physician concerning a male between 12 and 15 years of age with Y obesity who in 2008 was vaccinated SC with
n has been received from a certifiedYmedical assistant concerning a 10 year old female with N allergic reaction
4/14/2008
to ZITHROMAX who on 17-JU
n has been received from a veterinarian
Y concerning his 18 month old granddaughter with noYmedical history or allergies, who about a mont
Y nurse concerning a 6 year old male with ringworm of U scalp who was 3/8/2007
vaccinated
4/17/2008
with first and second
Y a 7 year old female who on 14-APR-2008 wasUvaccinated4/14/2008
with the second
4/14/2008
dose of VARIVAX
Y a 12 month old female with a ear infection andYwith no pertinent
10/6/2003
medical history
### or drug react
n has been received from a physicianY concerning a 15 month old male who on 15-APR-2008Y was vaccinated 4/15/2008
with a4/15/2008
dose of VARIVAX (Me
Y nurse concerning a 12 month old boy with dilated cardiomyopathy,
Y 4/9/2008
hypoxic ischemic encephalopath
n has been received from a nurse practitioner concerning a 33 year old female who in approximately
U June 2004, was vaccinated with VARI
n has been received from a physician concerning a female patient who entered an unspecified U study and was vaccinated with VARIVAX (M
n has been received from a medical assistant concerning a 75 year old male patient who at U 2 pm on 18-JUN-2008
6/18/2008 inadvertently
6/18/2008 received a
n has been received from a physician concerning an approximately 6 year old male with epilepsyY and seizure
3/26/2001
disorder,
4/1/2006
and no drug reactio
n has been received from a company Y representative concerning her 11 year old son with noUpertinent medical
6/16/2008
history,
6/16/2008
drug reactions or alle
n has been received from a health professional concerning a patient with reactive airways disease
U and a8/25/2004
history of rhinitis
11/5/2005 allergic and otitis
n has been received from an employee at a physician's office concerning a 4 year old male patient
U with 8/10/2000
no pre-existing
1/25/2004
allergies, birth defec
n has been received from a healthcare worker concerning a 12 year old male with no knownYallergies who 6/16/2008
on an unspecified
6/16/2008date was vacc
n has been received from an office worker in a physician's office concerning a 8 year old maleU with a history
1/5/2000
of adenotansillectomy
5/25/2007 (16-MAR
n has been received from a health professional concerning a 4 year old male with rhinitis allergic
U and asthma
3/22/2005and a history
3/5/2008 of otitis media w
n has been received from a health professional concerning a 5 year old female who on 16-JUL-2001
U was7/16/2001
with VARIVAX (Oka/M
Y from a healthcare worker concerning a 9 year old female
N with no
6/16/2008
known allergies
6/16/2008 who on 17-OCT-
n has been received from a health professional concerning a 45 month old female patient with U a history of9/1/2004
premature6/6/2007
twin birth who on 01-S
Y a 5 year old male who on 18-JUN-2008, today, U was inadvertently
6/18/2008 with two doses
n has been received from an employee at a physician's office concerning an 8 year old girl with
U allergic rhinitis
8/26/1999 who on 4/6/2007
26-AUG-1999 was v
n has been received concerning a 10 year old male with allergic rhinitis, asthma and allergy Nto peanut butter
3/22/2001
who on3/13/2005
22-MAR-2001 was vac
rmation has been received from a registered nurse and follow up information was received from Y the physician 6/9/2008
concerning
6/11/2008a 12 month old fe
n has been received from a medicalYassistant concerning an 18 year old female who on 02-JUN-2008
N was6/2/2008
with a first dose of V
Y concerning a 4 year old male with hypersensitivity andNatopy who on 29-JAN-2004 6/18/2008was vaccinated w
n has been received form a physician
Y concerning a 12 month old patient who was vaccinated U with a dose of VARIVAX (Oka/Merck) (lot num
n has been received from a health professional concerning a 17 month old female with heartUdisease and 9/16/2003
asthma who on ### 16-SEP-2003 wa
n has been received from a women from a pediatric office concerning an 11 year old femaleUwho on 02-JUN-2008 6/2/2008 was 6/2/2008
vaccinated subcuta
n has been received from a male dentist with a history of being given 2 doses of pneumococcal U 23v polysaccharide
4/8/2008 vaccine
4/8/2008close together
n has been received from a physician concerning a female who was vaccinated with a first dose U of VARIVAX (Oka/Merck) prior to pregnanc
Y from registered nurse concerning an 8 year old male Y child with 4/16/2008
no known allergies
4/23/2008 who on 16-APR
Y nurse concerning a female who was vaccinated with U a dose of VARIVAX (Oka/Merck). 4/9/2008 On 09-APR-2
Y nurse concerning a 7 year old female with exercise inducedY asthma 4/8/2008
and no known
4/26/2008 allergies, who on
Y a 5 year old female with no history of allergiesY(including neomycin
4/29/2008or4/29/2008
gelatin) who on 29-APR
n has been received from a physician concerning a 4 year old female who in the afternoon of U 19-APR-2007 4/19/2007
was vaccinated
4/19/2007 in the left arm w
Y nurse concerning a 5 year old male with Amoxicillin allergy
Y who on 6/15/2007
21-MAY-2003 4/2/2008
was vaccinated su
Y worker concerning a 14 month old male with no pertinent U medical4/14/2008
history who 4/28/2008
on 14-APR-2008 was
Y nurse concerning a 5 year old male with no pertinent N medical history
3/30/2004
who on4/11/2008
30-MAR-2004 was vac
Y nurse concerning a 15 to 18 month old child patient out N of 20 who was vaccinated with VARIVAX (O
n has been received from a physician concerning a 57 year old female patient who on 15-APR-2008
U was4/15/2008
prescribed4/15/2008
and vaccinated with a
n has been received from a registered nurse concerning a 77 year old male who on 23-JAN-2008 U was vaccinated
4/29/2008 with ZOSTAVAX (Oka/M
n has been received from a licensed
Y practical nurse concerning an 8 year old female with allergy
Y to pertussis
4/11/2008vaccine4/12/2008
(limplegs) and ZYRT
n has been received from a consumer concerning her 18 month old daughter with no pertinent Y medical history
10/4/2005 or drug
10/4/2005
allergies who on 04-
n has been received from 2 nurses Yconcerning a 6 year old boy, 66 pounds weight and 47 inchesY height,3/26/2003
with seasonal 4/29/2008
allergies who on 26
Y concerning a 30 month old male who on 21/NOV/2006Nwas vaccinated with ### a4/30/2008
single dose of VARIVA
n has been received from a physician concerning a 9 year old boy with no history of drug reactions
U or allergies
12/6/2006 who4/13/2008
on 30-MAR-2000 was v
Y concerning a 12 year old female with no pertinent medical N history 10/1/2007
who on 10-JAN-2001 was vaccinat
n has been received from a motherYand a physician concerning a 13 year old boy with asthma, N allergy to4/15/2008
penicillin and4/15/2008
severe allergies to m
n has been received from a dermatologist concerning a 20 month old male who on approximately U 10-APR-2008
4/10/2008 was vaccinated with a 0.5
Y nurse concerning a 4 year old male with no pertinent Ymedical history 8/28/2001
and no 8/28/2001
known drug reactions/a
n has been received from a health professional concerning a 7 year old female child, with noYknown drug4/15/2008
allergies, 4/17/2008
who on 17-APR-2008, a
Y nurse concerning a 12 month old female with no pertinent N medical4/8/2008
known allergies who on
Y concerning a 14 year old female with no pertinent medical U history 7/10/2007
and no drug reactions/allergies wh
n has been received from a companyY representative concerning his child's piano teacher's daughter
N a 20
3/31/2008
month old4/26/2008
female who in the end
n has been received from a physician who between 1996-1997 was vaccinated with her first,Usecond and third doses of VARIVAX (Oka/Me
Y a 11 year old male with no medical history of drug
Y allergies
6/17/2008
who on 17-JUN-2008
n has been received from a physician concerning a 4 year old male who on 13-MAR-2008 was Y vaccinated 3/13/2008
into the thigh
3/15/2008
with a second dos
Y concerning a 4 year old male who on 22-APR-2008 was Y vaccinated 4/22/2008
into the thigh
4/22/2008
with a second dose
n has been received from a licensed
Y practical nurse concerning a 5 year old female with eczemaY on buttocks
5/2/2008
and no5/2/2008
known drug reactions
Y concerning a male who on 24-APR-2008 was vaccinated Y with his 4/24/2008
second dose of VARIVAX (Oka/M
Y nurse concerning her friend's child who was vaccinated U with VARIVAX (Oka/Merck) about 6 or 7 yea
Y assistant concerning her son who was vaccinated with Y VARIVAX (Oka/Merck). The physician assista
Y concerning a 9 year old patient who on an unspecifiedUdate was vaccinated with VARIVAX (Oka/Mer
Y nurse concerning a 52 year old female with no pertinent Y medical history
4/4/2008 of allergies,
4/18/2008 who on 04-APR
n haws been received from a physician assistant concerning a 19 year old patient who on 15-MAR-2008
N 9/27/1997
was vaccinated 2/7/2008
SQ with a second
n has been received from a medicalYassistant concerning a 24 month old female with no known Y allergies who 6/4/2004
on 04-JUN-2004
n has been received from a registered nurse (R.N.) concerning a 3 year old male who was vaccinated
Y with
2/4/2008
the 2nd dose
2/4/2008
of VARIVAX (Oka
follow-up information has been received from a physician concerning a 9 year old male withYno pertinent6/12/2008medical history
6/12/2008
or history of drug
n has been received from a certified medical assistant (C.M.A.) concerning a 60 year old patientU who was vaccinated subcutaneously with
Y concerning her 18 month old grandson with no N known relevant
5/28/2008
medical6/4/2008
history who on 28-MA
n has been received from a physician concerning a 11 year old female with a history of attentionN deficit disorder and no allergies who on 03
n has been received from a registered Y nurse concerning a 12 month old male (the doctor's son) N with no 6/10/2008
relevant medical
6/13/2008
history who on 10
n has been received from pharmacy student concerning a 60 year old patient who was vaccinated U with VARIVAX. The pharmacy student re
he had vaccine on May 20. On May 21st - pt. c/o dizziness, joints aching, T. 102, SOB, "heart Y racing". Took
5/20/2009
2 acetaminophen,
5/21/2009 stayed in be
n has been received from a physician Y concerning a patient who on an unknown date was vaccinated
N with
4/30/2008
a second4/30/2008
dose of VARIVAX. On
dm. 3/18/09 for 6 mos. well visit 3/19/09 Temp. 101 degrees per mom Temp. in office 99.7 Y (Ax) Dx: Vaccine
3/18/2009
reaction
3/18/2009
d starting 5/18 that Pt has a rash on arms + legs, no fever. Y 5/13/2009 5/18/2009
breaking out into rash on 5/14/09 around
Y 7:00 pm. The rash is red round areas from head to toe. 0 blisters.5/12/2009
Does not seem to be itching.
ters breaking out/popping up on nose Y area - 7 total so far. Patient was consulting doctor U 5/12/2009 5/15/2009
e hypersensitivity reaction to MMR vacc. w/ spreading erythema and urticarial lesion at site ofYinjection. She 5/8/2009
was comfortable
5/8/2009& breathing ea
oke out in a rash after ROTOVIRUSYimmunization given within 24 hours. Also had a temperature N of 101. 5/4/2009
Mother gave 5/5/2009
TYLENOL rash was
stated - that after thigh vaccine (TDAP) he developed a high fever - and generalized rash. StatesY took Benadryl
5/12/2009 + Tylenol
5/13/2009
helped symptoms
of arm, redness, severe pain & inability to use arm for 3 days due to pain & swelling Y 5/7/2009 5/7/2009
lar rash appeared on forehead & spread to back of neck 30 min post vaccines given & lastedY48-72 hrs.
n has been received from a nurse practitioner and a healthcare worker for GARDASIL, a Pregnancy Y Registry product,
### 3/1/2008
concerning a 23 yea
Y 5/15/2009
n has been received from a physician Y concerningY a 21 year old female with partial
Y hearing loss
N due to congenital
6/15/2007sensory
6/22/2007
nerve damage, ir
n has been received from a physician concerning a 13 year old female with cerebral palsy, hydrocephalus
U and shunt which has became oc
n has been received from a female concerning her daughter, for a pregnancy registry for GARDASIL,
Y who on an unspecified date was vacc
vaccine failure. Pt presented 5/18/09 with typical herpes zoster skin lesions. U ### 5/8/2009
n has been received from Y a pharmacist
Y concerning a 19 year old female with no pertinent medical
Y history who was vaccinated with the sec
d irregular breathing with gasping after
Y shallow breathing approx 11 hrs after vaccines givenY. Temp was1/29/2009104. Went1/29/2009
to ER then home and d
to R thigh, area hard, red, hot to touch. Y
n has been received from a consumer Y concerning her son with no known drug reactions/allergies
N and medical
5/1/2002
history who "when about 18
Y a 67 year old female with a diabetes and a history
Y of childhood
2/26/2008
chickenpox,
3/19/2009
who on 27-FEB-
n has been received from a medicalYreceptionist concerning a 76 year old female with no pertinent
Y medical
1/13/2009
history and
1/15/2009
no drug reactions/a
after vaccine redness & swelling at site.
Y Seen at 72 hours after administration. 10 X 8 cm areaY of erythema 5/15/2009
with 2 X5/16/2009
2 cm area induration.
n has been received from a 59 yearYold female registered nurse with latex allergy, unspecified N pain medication
9/30/2008allergy
9/30/2008
and penicillin allergy
fever of 102 degrees F orally -Nausea -Severe, violent vomiting -Tenderness/sensitivity of injection
Y site. 4/22/2009 4/22/2009
a of severe swelling around the site of injection. Pain to touch and radiates heat Y 5/18/2009 5/18/2009
ation was being injected, became faint. Has not done this with other injections. Once patient Y sat for a few5/22/2009
minutse and 5/22/2009
sipped on Coke, felt
umococcal vaccination was given instead of a 1st Hepatitis A. Incident occured 05/21/09 at 1545. 5/21/2009
ction with arm swelling Y 5/20/2009 5/20/2009
ervation: slight diffuse induration in the deltoid area of the right arm. Red and blotchy in the Y
area noted. 4/30/2009
Not hot to touch
5/3/2009
and withoug tend
administered in Right deltoid. ThreeYinch induration around injection site that is tender and warmU to the touch.
5/20/2009 5/21/2009
n in left arm after receiving her first dose of anthrax. The pain started one day after receivingYthe dose and 4/15/2009
lasted for4/16/2009
3 days.
RECEIVED VACCINE ON 5/18/2009 ON THE LEFT ARM ONE INCH BELOW THE TDAP. SHE EXPERIENCED 5/19/2009 FEVER
5/19/2009
OF 102, CHILLS,
ely after administering the vaccine, theY patient experienced near-syncope: pallor, diaphoresis, U hypotension 5/22/2009
and bradycardia.
5/22/2009This lasted ov
arted having reaction to vaccine twoYdays after delivery. Rash swelling and itching at injection Y sight. They 5/5/2009
thought patient
5/7/2009
was possibly getti
led in on very hectic day wanting to get child with bone marrow transplant revaccinated. They Y were on their
5/18/2009
way home from doctor. Recep
mplained of dizziness, nausea and dry heaves. The symptoms lasted approximately 8 hours. Y No treatment5/20/2009 5/21/2009
ental status per MD Y 1/30/2009 1/30/2009
e and worsening myalgias upper extremities
Y and torso. U 5/20/2009 5/21/2009
fter receiving smallpox and anthrax Yvaccine, patient developed fever and chills which resolved Y overnight.5/12/2009
Patient went
5/14/2009
running the next day
ven Pneumovax on 5/11/09, pt called on 5/13/09 and spoke to triage nurse asking if the following Y symptoms5/11/2009
are normal
5/13/2009
after recieving the p
miting, eyes rolling to back of head, twitching
Y for 1 hour, patient went to ER and then was seen Y folling day.5/19/2009 5/20/2009
d to cinic with herpes zoster rash on back and chest that started 5/19. No known chicken pox before vaccine 1/22/2009
or exposure
5/19/2009
to Zoster or chick
jection site and on the back of right arm. Y 5/19/2009 5/20/2009
ting in chair for injection. approximately 30 seconds after injection, observed color (pale) on face,patient
Y 5/22/2009
lost consciousness
5/22/2009 for a moment a
er DTAP vaccine his left upper arm began to swell. It got bright red,swollen, hot to touch andYhad a rash.5/15/2009He was administered
5/15/2009 Qdryl(corn f
iving Varicella vaccine on 4/16/09, pt was seen on 5/16/09 with a Dx of Varicella. Y 4/16/2009 5/16/2009
d Rotavirus vaccine on 4/06/09. Pt Y had ER visitYwith Dx intussusception
7 on 4/08/09. pt c/o vomiting/rectal
Y 4/6/2009
bleeding, low 4/8/2009
grade fever. Moc +
veloped three lesions at 2 days post injection, each approx 3-4" in diameter, within a 10" area U around the5/19/2009
site of injection.
5/21/2009
Pt applied ice. A
ped gradually worsening myalgias and muscle weakness after receiving the Zostavax on 12/22/08 Y and had elevated
### ESR### of 71 consistent
brought in today by her mother. Mom reported to the doctor about SXs 30 days after her 1stYdose of ROTATEQ. 3/27/2009Intussusception
4/7/2009 per Dr. . R
cal swelling and tenderness developing Y over 48 hours since vaccines given. U 5/19/2009 5/20/2009
d soft node to R/L anterior thigh region. Nurse Practitioner recommended to massage the affected U area5/12/2009
& to apply 5/12/2009
warm compresses PRN
d shingles on forehead - red rash with Y discharge 1-2 wks post vaccine, VALTREX ordered U 5/13/2009 5/15/2009
rior arm - 1 area maculopapular 5 cm Y diam. erythema (MENACTRA) (B) Posterior arm - 1 area U maculopapular
5/21/2009 15 cm diam. (VARICELLA)
th fever - 103 - last night + then started
Y with fussiness @ 2p 5/22 + redness at site + painful Y- Rt thigh. 5/21/2009 5/22/2009
zy about 2-3 minutes after BOOSTRIX was given(MENACTRA given about 2 min earlier). Pt Ytried to lie down 5/22/2009
on exam 5/22/2009
bed but felt from bed
per (L) arm: Pain radiates from deltoid to above elbow; to (L) side of neck. Inflammation minimal erythema 5/19/2009
minimal 5/19/2009
veloped firey red rash on both facial cheeks that feels hot to touch. This occurred on may 20. N She received
5/18/2009
an intra-articular
5/20/2009 steroid inject
injection (L) arm was swollen, tender and red, T. 103. Loose stool and vomiting also. U 5/20/2009 5/21/2009
degree 6 days later - Chronic febrile Y seizure (Lasted less than 5 min - sent to ER via ambulance Y and recovered
5/15/2009 - Also
5/21/2009
diagnosed with B-O
t rash on anterior R thigh, same leg/area
Y given DTAP on 5/13/2009 - Rash appeared about 5/18/09 U per 5/13/2009
parent non 5/18/2009
- pruritic. Blanchable e
ministered a TD vaccine when this vaccine should only be given to pts 11 yrs & older & the vaccine the pt. 6/24/2008
needed was 6/24/2008
DTAP.
V combination given into LT thigh on 5/20/09. Today area is warm to touch. Swollen, reddened N approx 3" 5/20/2009
X 5" area5/21/2009
office for well child visit. Given adult dose (1ML) of HEPATITIS A (HAVRIX) vaccine in error.Y LMH staff 5/22/2009notified. CDC 5/22/2009
& poison control con
5/19/2009 N 5/18/2009 5/19/2009
val red, raised area at site of injection left arm covered for possible cellulitis inf - Cephalexin Y500mg TID 5/21/2009
x 1 cd 5/22/2009
04 F and whole upper arm inflamed and swollen - ~ 20-24hrs. Y 5/14/2009 5/14/2009
ERS filed Feb 2003. This 33 year oldYreceived her first three ANTHRAX vaccination 02 Nov 1998, N 12 Nov11/2/1998
1998, & 28 Nov 1998. AVA #4 an
urticarial plaque on left lateral arm Y 4/21/2009 4/22/2009
n on 5-20-09 Pt came back in on 5-22-09 Rt arm red and swollen within the area of the shot.U(foster child5/20/2009 missed this 5/22/2009
dose)
wollen, reddened, tender and hot to touch R upper arm. Afebrile. Received vaccines 5/18/09 - Cellulitis R 5/18/2009
upper arm 5/21/2009
- 2 hours to injection -
Y 5/22/2009
vacc. approx 1500 5/20/09; approx.Y12-14 hours later woke up with severe muscle/joint pain and fever, seen 5/20/2009
in office
5/21/2009
@ 1530 05/21/09 still
and swelling to left arm approximately Y 12-15 hours after injection, warm compress, Allgrax XY48 5/14/2009 5/15/2009
d, warm to touch, red, extremely swollen,
Y hard to touch- treated after Keflex. U 5/18/2009 5/19/2009
d, slight swelling, light redness treated
Y with Keflex. U 5/18/2009 5/19/2009
ed, swollen at sight of injection reports swelling under left arm since 5-20-09. 6 X 8 cm area;Yredness, heat 5/19/2009
to LUE @ 5/20/2009
injection site; pocket
m erythematous indurated circular area. Left upper lateral arm. Patient reports myalgias and Y subjective fevers
5/18/2009the next
5/19/2009
2 days after injection
ed crying for at almost 12 hours interspersed with extreme sleepiness and difficulty rousing from Y sleep, fever
8/24/2007
of 102+,8/24/2007
red, hot site of injectio
ut a cubic inch of muscle, big indentation. No pain just atrophy. I researched and it looks like a side affect of 5/6/2009
the polio5/15/2009
vaccine? Please drop
welling at injection site, site was hard,
Y red and swollen for 6-7 days. Child had fever of 101 for N 3 days, and was covered in hives. Injection s
tachycardia, myalgias, severe arm pain,arm bruising, headaches, lethargy. all symptoms lasted Y about 2.5 5/22/2009
days. worst5/23/2009
being 24-36 hours a
ENTED WITH COMPLAINTS OF CHILLS, BODY ACHES, JOINT PAIN, HEADACHES, VOMITTING Y X 35/21/2009
DAYS. PT5/22/2009
DIAGNOSED WITH UR
med area 8 inches by 3 1/2 inches at Y L deltoid (injection site) Injection given on 5/23/09 U 5/23/2009 5/25/2009
uscle pain in shoulder where vaccine Y administered. Very painful to even move arm for 2 days Y and continued
5/18/2009
moderate-severe
5/18/2009 pain for 4 m
ay 23rd) after vaccination on May 22nd, 2009, my son developed weakness. Day 3 (May 24, U2009) after 5/22/2009 vaccination,5/24/2009
my son had high fever
Y the occurrence of lupus like syndrome in a 42-year-old
N female subject who was vaccinated with
s syndrome. Received IVIG and ASA. Y 5/26/09 Received H&P w/report. FINAL DX: Kawasaki Y syndrome1/23/2009
Records reveal1/31/2009
patient experience
n has been received from a consumer Y concerning her best friend's son, a approximately 13 N months old male who in approximately 2003 wa
n has been received from a consumer concerning a male family member, now 12 years old,Uwho experienced autism after receiving vaccin
n SANOFI PASTEUR'S TDAP product before patient was 11 years old. Y 3/24/2009
a of erythema 5" x 5", left upper arm. No fever Y 5/18/2009 5/20/2009
ents with maculopapular pink rash on trunk, 7 extremities (measles-like) and low grade fever.Y 5/13/2009 5/15/2009
er nurse child was seen today by N.P. and had an "erythema , macular rash" on entire trunk Y(front & back)5/1/2009 and forehead.
5/13/2009
Rash started on 5
after receiving vaccines, patient began vomiting. Vomited several times over the next 9 hours. Y No fever; 5/12/2009
no rash. Patient
5/12/2009
seemed much imp
reaction to PENTACEL vaccination.Y8x11cm erythematous area to right medial thigh slightlyYwarm to touch, 5/19/2009
erythema5/19/2009
fades as infant calms
nt received vaccines on 3/31/09. Mother called on 4-2-09 morning with adolescent having fever, Y rash all over
3/31/2009
the body.4/2/2009
However no difficulty
-serious case received from a consumer Y on 15 October 2008. A 63-year-old female patient with Y history of diabetes, ### asthma ### and allergies to
iven 5/8/09. Fever to 101.5. Syncopal Y episode, pain and swelling of injected arm. SymptomsNbegan day after 5/8/2009
injection.
5/9/2009
Still present but reso
wollen eyelid, decreased appetite Y N 5/19/2009 5/19/2009
arm with redness from shoulder down to wrist, also has red streaks to Rt side under arm, soreness U no fever.
5/20/2009
ely after vaccine administration patient briefly (about 3 sec) lost consciousness. Y 5/8/2009 5/8/2009
n has been received from a 62 yearYold femaleYpatient with an allergy 0 to VICODIN and no otherN medical5/11/2009
on 11-MAY-2009 was
cal reaction 4 X 5 cm Erythema andYind Y 5/18/2009 5/20/2009
sing began to scratch ears & hair. NoticedY rash all around neck, chin, back, belly. Hives roused
U different5/13/2009
sizes, welt5/21/2009
on front, little dots in b
Y Y 5/18/2009 5/23/2009
after receiving GARDASIL # 1, developed redness and itching both legs (thigh to ankle). Skin became more 3/16/2009
red with3/17/2009
NIVEA. No fever.
Y 5/21/2009
d @12:30 am 5/22/2009 stating child have fever of 101 and body aches. Advised to go to ER. U 5/21/2009
5/24/2009 N 5/22/2009
th fever, irritability and crying for 4 days
Y after vaccination. Patient returned solid and slept poorlyY for 5 nights.5/6/2009
Per parents,
5/7/2009patient didn't wish
ut 12 hours after vaccination, rigor then
Y edema. Patchy erythema. No respiratory, no color. Advised
U massage, warm compresses, TYLENO
ticed increased redness + swelling of L arm @ injection site on 5/21 (PM), worsened on 5/22Ywith increase 5/20/2009
swelling 5/21/2009
("fist sized" are of swell
patient reports almost immediately Yafter receiving vaccine nausea and dizziness, then in theYevening fever 5/7/2009
of 102.8, 5/7/2009
mom gave EXCEDRIN
eeks (end of November)Yafter getting Y flu vaccine,
Y client began experiencing
10 Y weakness
Y in legs
N with numbness in### feet and toes.
### He began w
s following administration of vaccine, patient with complaints of pruritis, pain, and redness toYsite. Denied5/7/2009
breathing5/11/2009
difficulties. Six days fo
lips and tongue 30 min after injection lasting 30 min Y ### ###
REFERS THAT THE NEXT DAY OF VACCINE ADMINISTRATION THE CHILD DEVELOPED Y A RASH IN 5/8/2009
THE ENTIRE 5/9/2009
BODY WITH A SL
AINTED AT A RESTURANT 30-1HOUR Y AFTER RECEIVING SHOT AND FEELS CHILLS ALL U OVER BODY 5/26/2009
. NOT5/26/2009
FEELING WELL
n chest, back, and arms post small pox vaccination on 13 May 09. Followed up with NP on 26 U May 09. As 5/13/2009
of 26 May5/26/2009
09 still has lesions will
as healthy at the time she received her Y shots. 10 days later (Friday) she appeared ill with a rashY that would 6/10/2008
go away6/20/2008
and re-appear. She de
Y Y 5/21/2009 5/25/2009
g enterocolitis, symptoms Y started 24Y hrs after Pentacel,
Y Prevnar, Hep
10 YB and RotaTec vaccine Y administration,
5/20/2009
diagnosis
5/21/2009
made 3 days after v
macules on trunk, extremeties and Y face, began on the morning of 5/26/09, worsened as dayYprogressed. 5/6/2009 No other 5/26/2009
cymptoms
veloped mucosal wart inside lower lip 5 days after receiving second HPV vaccine. U 3/30/2009 4/4/2009
ken to facility on 5/21. Report statesYpatient presented
Y with rash on 1face, trunk and extremities.
U 6/9/09 Medical,
5/19/2009 hospital,
5/21/2009
DC summary rece
iving last vaccine MMR noted childs lips pale, no cyanosis observed. Child awake and crying, Y noted child5/22/2009
urinated on 5/22/2009
self per father and wa
d a swollen arm that subsided 4 days after ZOSTAVAX vaccine was administered. Pt saw PCP Y were said 5/18/2009
it may be5/19/2009
an allergy. Vaccine adm
eveloped chickenpox rash - more than 100 lesions Y 7/16/2002
fter MMR, developed itch rash on face and trunk. 1 day of headache 8 days after (gone now).
ately five hours after the vaccination my son was unconsolable for an hour and extremely fussy Y all night. He1/9/2009
developed 1/9/2009
a rash at the injectio
oss, achy muscles and joint pain. fatigue. Symptoms reflecting M.S. and chronic fatigue syndrome. N Symptoms
3/15/2003are getting
1/1/2005
worse over time.
5/5/2009 N 4/29/2009 5/5/2009
ed. 9/9/09 Rheumatology consultant records received DOS 1/5/05 to 6/17/09. Assessment: Y Rheumatoid arthritis, ###uncontrolled anxiety. Patie
03; diarrhea; lethargy; decrease oral Y intake. Hospitalized
Y x 2 days. 26/2/09 ED and inpatient Yrecords received DOS 5/14/09 to 5/16/09. FINA
s and pain in arm. No fever, no redness or swelling at sight of injection but tender to the touch. Y Weakness 5/19/2009
and pain lasting
5/19/20092 days +.
welling with hard middle, itchy, very warm, red and fever 99.5 (my temp. usually runs low). Had Y to go on antibiotics
5/6/2009 for5/8/2009
3 days. Gradually go
ceived PEDIARIX, HIB and PREVNAR #2, RV5, hives occurred approximately 24 hours afterY administration. 8/4/2008
10-20-08,8/5/2008
received PREVNAR
eltoid with 100 cm of erythema, swelling & warmth zero damage + tender noted next day really Y increase5/18/2009
later that night.
5/19/2009
ort received on 13 May 2009 from a physician. Subject Y identification 3number: 1-08-06459. ThisU subject is11/3/2008
participating in a study. A 14-year-
and left deltoid dark red, puffy is swollen like a sausage. Could not lift up arm for four days. N Hot to touch.4/29/2009
Size measured
4/30/2009
5-20-09 10 1/2cm
ort received on 13 May 2009 from a physician. This Y subject is participating
3 in a non sponsoredU Sanofi Pasteur study.### 11/1/2008
This case involved a 1
en area on deltoid of right arm. Progressed over 48 hours, at exam, measured 1 1/2 inches circular raised 5/13/2009
erythema, 5/14/2009
warm to touch. No stre
ort received on 13 May 2009 from a physician. This Y subject is participating
7 in a non sponsoredU Sanofi Pasteur
11/4/2008study. This case involves a 1
ine given, pt complained of tingling along anterior medial aspect L upper arm. Hurt to move Yarm. Also complained
5/14/2009 5/14/2009
of "tingling" going down
a of erythema and swelling on arm at Y injection site - 4 1/2 X 6 cm - at 24 hrs post injection LUA.
N 5/18/2009 5/19/2009
ess in chest & throat 20 mins after receiving vaccines and ERYTHROMYCIN. Has allergy to YCECLOR, was 5/4/2009
given BENADRYL
5/4/2009 returned to d
ng of throat after receiving vaccine and Bicillin, no prior allergy history. Given BENADRYL and Y observation 5/13/2009
- return to
5/13/2009
division.
5/19/2009
ralized tonic - clonic seizure 8 hrs after
Y vaccines. CT, labs EEG normal. Y 5/11/2009 5/11/2009
as administered SMALLPOX vaccine during 1st trimester. Currently in 2nd trimester after learning U of pregnancy.
1/12/2009
ports redness at injection site R arm, denies fever, chills. reports pain 3/0 . Right arm, deltoidU are with redness
5/18/2009measuring
5/18/2009130 cm length n
ema and swelling on Rt deltoid site starting 3-31-09 3/30/2009 3/31/2009
om mom reporting child diagnosed Y with cellulitis (L) thigh @ Urgent Care on 5-14. Has an approx. 5 inch5/12/2009
in diameter 5/14/2009
area of redness & har
10 min. after leaving pharmacy. Y 5/16/2009 5/16/2009
ction - pain, erythema started 5/16 - MOTRIN and BENADRYL given. 5/15/2009 5/16/2009
and exhaustion started 1st week after vaccine and persist. May 1 started body aches, sore throat, temp 101.8 4/6/2009
deg, 4/11/2009
swollen glands in neck,
C received from guardian that child complained of headache leg aches, vomiting x 3 and fever Y (felt hot to5/11/2009
touch) did5/11/2009
not check temp after re
nt was accidently given HPV 5/11/2009
ped 2 cm erythema at local injection site and scattered rash on body consistent with VARICELLA. U 5/7/2009 5/18/2009
on belly 5-17-09 in AM, 101.7 fever on 5-17-09 at 8:00 AM TYLENOL was administered, fever N went down 4/27/2009
did not appear
5/17/2009
again. 7 chicken
with redness, itchiness over 3/4 of entire
Y surface upper left arm. Y 5/19/2009 5/20/2009
e attached encounter Y Y 3/13/2009 3/13/2009
sicles at site of injection of varicella #1 - Occurred ~ 2wks after inj. U 4/9/2009 4/30/2009
5/21/2009
ped diffuse Myalgias approx 12hrs after Pt vaccination given. N 4/27/2009 4/27/2009
mall) of red flat rash in upper arm; tender to touch; started yesterday. U 5/18/2009 5/19/2009
VZV injection site on 5/12/09. No treatment needed. Y 5/12/2009 5/12/2009
ction on left and right anterior, upper thigh, 2 inch by 3 inch red, indurated area. Pain eliated U
due to pt. crying
5/18/2009
upon touch.
5/19/2009
No fever. TYLENO
lled the office at 230 PM on 5/20/09 to report that child broke out in hives all over 10 minutesYafter she left
5/19/2009
office yesterday
5/19/2009AM She did not
vaccine breakthrough. Had VARIVAX-2 doses. Diagnosed with varicella in our office on 5-19-09. U 6/18/2007 5/17/2009
5/19/2009
5/19/2009
as given twice, no adverse reaction noted. Y 5/26/2009
ports a gradual onset of edema and erythema, first to the vaccine site, then spreading to theYentire arm. 5/21/2009
She reports5/22/2009
the site was warm to th
air loss (alopecia) around temples (around
Y ear area, mainly in front) and some hair loss around
N hair line and crown. Has happened the last
d via EMS to Emergency Dept on theY morning of Y 08/11/2006 00:57 actively
1 seizing.
Y Symptoms N began 308/10/2006
minutes prior
8/11/2006
to arrival to ED. No
ceived the Typhoid Vaccine 0.5ml IM Left Deltoid at Approximately 8:15am. Left Health Center Y approx. 8:30am.
5/27/2009Health
5/27/2009
Center alerted at 9
dom twitches and involuntary muscle movement/spasms in my legs, calves, quads, ankles, feet, N and toes 11/1/2008
and sometimes
2/1/2008
in my fingers and
tion red, hot and swollen and tender to touch U 5/27/2009 5/27/2009
ncing flu like symptoms with hot/cold, some sweating, nausea and dizziness. Legs hurting. Y 5/26/2009 5/27/2009
after vaccine administration he presented with widespread urticaria rash. Of note he also finishedU a course
5/21/2009
of Bactrim
5/27/2009
the day before rash s
First Anthrax vaccination was issued in my left arm. Two days later my arm started to swellYand became 5/4/2009 red at the injection
5/5/2009site. This adv
s after experienced fever of 103, chills,
Y body aches, chest pain and shortness of breath. U 5/21/2009 5/24/2009
n chest, shortness of breath, EXTREME fatigue, chronic joint pain, muscle fatigue. N 5/4/2008 5/14/2008
OF GRAVES DISEASE SINCE 2006. UNDER TREATMENT AND MEDICATION. NEEDED IMMUNIZATIONS Y 5/27/2009
TO OBTAIN
5/27/2009JOB TO DO SO
ZOSTAVAX 4/16/09. Developed herpes Y zoster 4/26/09 over T9 on right. Y 4/16/2009 4/26/2009
AX given to 5 year old without complications. Called patients mom on 5/23/09 & 5/26/09 Y 5/22/2009
max 103.8. Multiple tonic / clonic seizures
Y in 1st 24hrs after vaccine admin. (currently 5). ER:UCT+LP. Still5/26/2009
febrile lasts
5/26/2009
seizure 1030 am 5/2
n at ED on 5/11/09 for c/o scratchy Ythroat feeling as if was swollen.Had received vaccinations Y that am for HepA/B and meningococcal. Was
ted to our clinic by patient's PCP: J.YDohemann MD (415)923-3447. 4 hours after receiving vaccines
U pt reports
5/19/2009
fever5/19/2009
of 102 with rigors and
after vaccine administration the patient reported experiencing some fever, chills, and muscleYpain at site 5/18/2009
of injection.5/21/2009
5/25 to report severe muscle pain in left arm with limited ROM. Pain started after 2nd dose of Y Twinrix 5/4/09
5/18/2009
but became
5/19/2009
worse after 3rd do
ed varicella-like rash, greater than 50 lesions on face, neck, trunk, arms, buttocks, and legs U 5/22/2009 5/27/2009
nally gave expired Pneumovax dated 04/02/2009 Lot#0963U on 5/26/09 5/26/2009
d and forearm had slight swelling Y 5/27/2009 5/27/2009
ias of bilateral feet and lower legs, bilat forearms, R hand and inability to fully extend R indexNfinger; started 5/26/2009
the morning
5/27/2009
after the vaccine; s
r 103 F 12 hours later lasting for 4 days with no appetite, listless and not very responsive, would U only take 5/21/2009
some water.5/22/2009
Followed by 2 days
ure 101-103 approximately 24 hrs. post vaccination and loose stools - presented in clinic - noUother symptoms. 5/26/2009 5/27/2009
en- immediately after patient received vaccine he fainted. Y 5/27/2009 5/27/2009
veloped hives about 22 hours after receiving 4yr boosters- DTap, IPV, MMR and VZV. No previous Y reaction,
5/18/2009
no respiratory
5/19/2009 or GI symptoms
ceived DTAP, HIB + HEP A ~ 5-11-09. Patient noticed redness + swelling at injection site ~ 24 Y hours after 5/11/2009
vaccination 5/12/2009
(5-12-09). Left thigh
me to office 5-26-09 + reported sheYhad warmth + redness to injection site 5-20-2009 which Uresolved; then 5/18/2009
on 5-22-2009
5/20/2009
she began to hav
vaccination 2/20/09 - only 2 mo - Between 1st and 2nd dose -should be 6 mo. 4/24/2009
o itching at the site, 5min later startedY coughing. Mom stated he was having an asthma attack, Y but did not 5/26/2009
have inhaler.
5/26/2009
Dr. notified and neb
jection site right deltoid (1) day after injection was given. Seen by Dr. 2 day after c/o rash and Y itching BENADRYL
5/18/2009 was 5/19/2009
prescribed by Dr.
se event. Mis administration of TDAP. Rt is 9 yrs old - should of been TD. ###
Y and described the occurrence of joint pain in an adult
U female 4/29/2009
was vaccinated with B
VARICELLA vaccine given into (R) arm 4x4 cm area of erythema and 9x7 cm area of erythema Y surrounding 5/20/2009
injection
5/21/2009
site to: Septra
EL and VARIVAX vaccines given into (L) leg. 8 x 11 cm area of erythema and warmth on anterior Y (L) thigh.
5/20/2009
Septra. 5/21/2009
arm next day, took BENADRYL heart flutter was noticed on Thursday (2 days later). By Friday Y arm was swelled
5/19/2009 went5/20/2009
down by Sunday.
n has been received from a registered Y nurse (R.N.) concerning a female patient who received U two doses of GARDASIL. The patient had no
n has been received from a certifiedYmedical assistant concerning a 17 year old female whoNon 17-MAR-2009 3/17/2009was intramuscular
4/28/2009 vaccinate
n has been received from a physician concerning a 22 year old female with no medical Y history
U who was 3/19/2008
vaccinated with 5/4/2009
her first (lot# 6582
Y concerning a 19 year old female who experienced Y fever a5/13/2009
few hours after
5/13/2009
receiving the first d
n has been received from an investigator concerning a 35 year old female with no known drug N allergies, 1/12/2009
with HIV and5/4/2009
alcohol use who ente
n has been received from a consumer concerning a male family member, now 8 years old, who U experienced autism after receiving vaccine
n has been received from a consumer concerning a male family member, now 10 years old,Uwho experienced autism after receiving vaccin
Y for the Pregnancy Registry for VARIVAX (Oka/Merck)
Y concerning
9/26/2008 a 26 year### old female with a
n has been received from a pharmacist Y concerning a 62 year old hospitalized
Y female with pneumonia,
Y urinary
5/19/2009tract infection,
5/20/2009diabetes, hype
n has been received from a licensed Y practical nurse for GARDASIL and MMR II, Pregnancy YRegistry products, 2/11/2009 concerning
2/11/2009 a female patient
Y 5/28/2009 5/28/2009
Hives neck back, abdomen arms and leg started 5/21/09 in the evening. Treated with ZyrtecYX 7 days. 5/20/2009 5/21/2009
PD" testing using ANTHRAX Vaccine - 5m experienced area of erythema 3' X 2 1/2: with 1 cm Y central induration.
5/12/2009Tender,
5/13/2009
not hot - Resolve
V vaccine ordered by physician and nurse administered it. The child was 5 yrs old and the vaccine Y should 5/26/2009
not have been given, as it is indic
aised) rash in crops over the antero-medical aspect of left thigh no erythema. Y 3/26/2009 5/1/2009
at Inj site. Red itchy rash. U 5/20/2009 5/22/2009
ous patch over the vaccine site left upper arm - lateral posterior aspect no warmth; no tenderness; Y full range
5/12/2009
of motion
5/13/2009
nsider this a vaccine failure for him to Y be fully immunized and get pertussis at age 7 Y 5/23/2007 5/1/2009
was administered to left deltoid on Tuesday May 26, 2009. Came to office today to show me Yhis left arm 5/26/2009 which was reddened
5/26/2009around the en
zed area of enduration 2-4 inches above right elbow. Nickel-sized area of enduration 2-4 inches Y above 5/13/2009
left elbow. 5/15/2009
Slight erythema to both
ad small pox vaccine on the 17th of May. He returned for follow up on the 26th. His skin reaction Y showed 5/17/2009
local redness
5/27/2009
and white blister. H
ld probably be considered a vaccineYfailure since the child was fully immunized and was diagnosed Y with 7/18/2007
pertussis at age 6.
e fever (not even 100) 5/26 in the evening followed by redness and swelling at the site on 5/27. Y Fever gone 5/26/2009
5/28 although
5/26/2009redness & swellin
ced swelling and redness at injection site 5/27/2009. Prescribed keflex and benadryl. U 5/19/2009 5/27/2009
ONE CALL FROM MOTHER STATING CHILD HAD RASH ON BODY WHICH APPEAR 45 MINS POST 5/28/2009 IMMUNIZATION. 5/28/2009CLIENT RETURN
fter receiving TdaP imm., pt. was sitting
Y sewing at approx. 10:30am and had magnified circles Y in front of 5/12/2009
both eyes. 5/14/2009
Vision was not affected
reased sensation and decreased strength in the Y left arm. 7/7/09 Hospital
4 records received DOS 5/11/092/12/2009to 5/15/09. Assessment: Disturbed
d rash c/ second injection, but thought it was due to starting a new OTC product. 3rd immunization Y given,1/22/2009
and rash reappeared.
2/5/2009
numbness, pain, limited ROM and inabilityY to perform many normal activities of daily living. Diagnosed
N with
4/15/2009
axillary nerve
4/15/2009
dysfunction... put o
cines given to pt, Lt leg Varicella was administered, Rt leg MMR and Kinrix administered. Lt leg area 35cm/25cm 5/27/2009red 5/28/2009
and swelling. Rt leg
eloped 48 hours after immunization. Low grade temp. U
this second HB shot during a 9:30 am appointment on 5-20-09. The first HB shot I receivedYwas from the 5/20/2009
same physician
5/22/2009 a month earlier o
d stated Pt had started getting a rash Y to both legs, mom informed to bring back to clinic, then Y mom called 4/24/2009
and stated 4/24/2009
he was getting swolle
th reddened raised area at site of VARIVAX injection. Approximately 1/2 hour after injection-Yseen by MD5/28/2009 recommended 5/28/2009
ice and BENADRY
ble crying with head twitching - lasted for about 30 minutes - low grade fever 1st 24 after shots. 5/27/2009 5/27/2009
arm, legs + face. Y 5/26/2009 5/26/2009
ody aches, arm pain. Approx 1 in rednessY @ injection site. - Recommended IBUPROFEN 600 Y mg q 6 hrs5/26/2009
prn. - Went 5/26/2009
to ER - 5-27-09
mplained of "high" fever several hours after injection (although did not have a thermometer).YSweating, could 1/14/2009
not sleep,
1/14/2009
numbness and ting
1; eyes and lips became swollen and Y puffy after leaving office. Returned 30 minutes later; pulse
Y 98%, BP 5/27/2009
112/68. BENADRYL
5/27/2009 1tsp po give
painful - swelling (L) thigh - 3cm X Y4 cm 1day post vaccination Y 5/26/2009 5/27/2009
4/9/2009 5/26/2009
st 1st dose pt noted flashes in visualY field and fatigue. Inc in flashes after 2nd dose. Reported Y dec in visual
2/23/2005
field 2-3 days post 3rd dose, In
Y 4/16/2008 5/27/2009
ed rash developed within past 3 days Y 5/25/09. Blisters - vesicles with fluid - fatigue. Y 5/4/2009 5/25/2009
uscle pain and swelling. Supra clavicular adenopathy Y 5/26/2009 5/26/2009
veloped myalgias in the neck and back within 24 hours of administration of Td booster. AlsoYhad some nausea 5/26/2009 and5/27/2009
some wheezing startin
Y concerning a 22 year old female with unspecifiedN drug reactions/allergies
4/6/2009 4/30/2009and medical history
n has been received from a pharmacist Y concerningY an 81 year old male
0 with hypertension, cancer,
U diabetes
10/8/2008
and a history
5/5/2009of heart attack w
n has been received from a physician concerning a 9 week old male with no pertinent medical N history reported
5/13/2009who 5/22/2009
on 13-MAY-2009 was v
ed from a consumer the following information on 14 May 2009: A female patient was vaccinated N with Influenza
11/1/2007virus11/1/2007
vaccine (batch no. or m
red ZOSTAVAX vaccine 5/20/09 at 9:30am. Reported she awoke next am with generalized hives N over body
5/20/2009
including5/21/2009
buttocks and scalp. N
nt to ED with swelling to right leg. Red
Y and warm to touch. Y 5/7/2009 5/9/2009
firm area on Rt deltoid approx 2minYwide running 1/2 to elbow. Parent reports started 1 afterNadministration 3/31/2009
vaccine.3/31/2009
Mother plans PMD visi
back, abdomen, arms, face after vaccine Y (24 hours) no high fever. Mother plans PMD visit due N to current 3/31/2009
ear infection4/1/2009
also.
mplaint (1/1): This 12 month old female Y presents today for evaluation of a rash. Rash-Associated Y Signs and 5/22/2009
Symptoms: 5/23/2009
The following chara
ed after vaccination and bumped head on floor. Monitored for 50 minutes. Sent home with mom Y to monitor 5/26/2009
s/s concussion.
5/26/2009 BP 94/60, P 72
ax- rash and pain. Treated with BACRIM DS initially and changed to Acyclovir treated x 1 week. Y Treatment 3/30/2009
started 4/09-
4/1/2009
4/24/09. Folliculitu
ight thorax returned after 2nd Hep. B vaccine - came to clinic on 5/7/09 - 'Shingles'. Treated U with ACYCLOVIR 5/4/2009
X 3 weeks-
5/7/2009 5/22/09 still symp
VARIVAX 5-21-09, seen in office 5/23/09 arm, red, warm to touch for 2 days. 15 x 14 cm erythemas Y with5/21/2009
4 x 6 cm central
5/21/2009induration and 5-
9 given VARIVAX, developed erythema with 3 mm central papule vesicle seen on 5/21/09. Y 5/18/2009 5/18/2009
Y U 5/27/2009 5/29/2009
ate 4 minutes after receiving vaccines; I started getting dizzy, nauseated, cold sweat, and a headache.
Y There
5/4/2009
was a 5/4/2009
burning in my arm goin
ular redness with warmth. no s/s infection. supportive care : compresses and motrin prn. Y 5/27/2009 5/28/2009
ates that he had vaccinations administered on Tuesday and wednesday afternoon around 1:30 Y p.m. he began
5/26/2009
having5/27/2009
fever and chills. He a
ate 2 minutes after receiving vaccines: Y I passed out. Right after I woke up I started throwingYup and the Rn 5/5/2009
clinic was5/5/2009
unable to stop it and
utes after i got the 1st shot, body felt warm and tingly. then i had a small seizure according toYthe tech, but did not lose consciousness. the
ter given approx 10 am on 5/27/09 r del im. spoke with pt on 5/29 and she reports on 5/28/09 Y she awoke5/27/2009
with headache
5/28/2009
and chills took tem
LN,VOMITING,URI.sYMPTOMS STARTED Y IN THE PM AFTER SHOTS. Y 5/28/2009 5/28/2009
y AM 5/19/09 with frequent vomiting and fever. Frequent vomiting lasted until 0700, then final, Y isolated emesis
5/18/2009at 1700.
5/19/2009
Temp max 103. F
her called and reported that Kahlyndra Y c/o not feeling well approximately 2 hours after vaccine Y administration.
5/27/2009
Following
5/27/2009
am c/o nausea, an
a pharmacy clinic to receive Zostavax. Pt is s/p renal transplant and on chronic immunosuppression.
N Screening
5/1/2009questionnaire used was d
ap administered R deltoid. 1-9-09 Soreness reported to Employee Health Nurse. 2-27-09 - AppointmentU scheduled
1/2/2009 due 1/9/2009
to report of persiste
hrs after vaccination, arm became red, swollen,Yand painful. admitted 2 to hospital 48 hrs afterYvaccine receive,
5/11/2009
and treated
5/12/2009
for cellulitis of arm
adm. 2:30pm,Fri.22 May 2009. 3 days later 2am woke up with difficulty breathing, productive N cough with5/22/2009
green phlegm,
5/25/2009
no fever. All day (
eaction distal to injection site(whihcYwas on right deltoid) extending about 6 cm with induration Y to inner bicep.
5/28/2009
Has minimal
5/28/2009 warmth, not too
, generalized body aches and chills. Reports that they do not have a thermometer so have not U been able5/28/2009
to take a temperature.
5/29/2009 Some loca
, 1991. "Hold up four fingers. That's right, you're four years old!" On patient's birthday
Y he was N coming down8/19/1991
with a cold.
9/20/1991
August 19, 1991. O
ted 13 days s/p vaccination of MMR, TDaP & Varicella w/ rubella type rash; pink macular papular U rash involving
5/16/2009 face,
5/28/2009
UE's & torso; Pt also
rash on trunk 26 days after Immunization administration, rash non tender, pre eval. Y 5/1/2009 5/27/2009
ceived vaccines at 12:00 at 14:45 became
Y hoarse and felt like he was having difficulty breathing,
Y also mild
5/28/2009
cough. Developed
5/28/2009 flat, red rash
en lethargic, decreased appetite. Bright red rash on cheeks and face. Rash on legs, had slight U rash prior5/26/2009
to administration
5/26/2009on legs now mor
MMR and VARIVAX vaccine 4/3/09. Missed period 4/17/09, did not know was pregnant at time. 4/3/2009
d area on arm; Warm to touch. Swollen Y (1.5X10 cms). Placed on MEDROL DOS-PAK. Dx:YLocalized allergic 5/12/2009
reaction.
5/13/2009
er, redness 2-3 " down arm, warm to Y touch. Ached. 0 Fever. 3rd day stinging, less redness. Y 5/26/2009 5/28/2009
on. mild edema, tenderness, slight erythema. Y 5/28/2009 5/29/2009
ch area around injection site is warm, swollen and red with nodule. Painful. Difficulty raising arm U and lifting 5/27/2009
arm. Recommended
5/27/2009 medical eva
as given initial dose of Gardasil vaccine in (R) deltoid. Almost immediately after vaccine wasYgiven she c/o 5/19/2009
dizziness5/19/2009
& then lost consciousn
swelling, warmth, bruising with a few hours of administration. Patient + presented with aboveUsymptoms 5/26/2009 in office 725/26/2009
hours later. Temp 96.9
was reported via a statement of injuries received via a lawyer and described the occurrenceUof joint pain in 8/1/2000
an adult male subject who was
me in clinic stating that she could no longer move her left arm. Patient had had some Y swelling
N in left arm12/4/2007
after a Td 12/4/2007
vaccine on 12/04/07. It
on 5/26/09 c/o feeling nervousness. States that it started ~ 3 days after receiving Adacel inj. N which he is still
5/13/2009
having the5/16/2009
SX. as of appt on 5/
ed-macular rash to left thigh. Warm to touch, swollen. U 5/27/2009 5/28/2009
cine given, Patient with h/o fainting with shots, became weak, laid down, had episode of emesis, Y VSS, patient5/28/2009treated5/28/2009
and recovered, mothe
ceived Subcutaneous dose of ZOSTAVAX 5/26/09. Patient returned to pharmacy 5/29/09 with N questions5/26/2009
about localized
5/29/2009
reaction to injectio
0 mm after immunizations were given (Hep A - Varicella - Meningococcal). Pt developed throat Y tingling sensation
5/20/2009and 5/20/2009
dizziness, then collap
5 min after 1 mms given, child dev. hives near injection site, L leg. variable hives on trunk back Y & face. Pt5/21/2009
given diphenhydramine
5/21/2009 10 mg in
.7 degrees F, vomiting, irritability, pallor,
Y poor feeding, sleepy presented to ED approximately Y 7:30pm on5/22/2009
5/25/2009.5/25/2009
05/18/2009 pt told mom left upper arm Y hurts. Mom noticed left arm red, swollen warm to touch. Mom called 5/18/2009
Dr, she5/18/2009
told mom to put heat o
was reported by a healthcare professional and described the occurrence of arm swelling in aY child subject of unspecified gender who was v
was reported by a healthcare professional and described the occurrence of arm swelling (injection Y site) in a child subject of unspecified gen
was reported by a healthcare professional and described the occurrence of arm swelling in aY child subject of unspecified gender who was v
was reported by a healthcare professional and described the occurrence of arm swelling (injection N site) in a child subject of unspecified gen
was reported by a physician and described the occurrence of bruise injection site in a 4-year-old Y female subject
4/9/2009 who4/9/2009
was vaccinated with c
was reported by a physician via a GSK Y representative and described the occurrence of armUswollen in a child subject of unspecified gende
Y the occurrence of injection site blisters in a 4-year-old
U male subject
5/6/2009 who was
5/7/2009
vaccinated with KI
was reported by a physician and described the occurrence of rash in a subject of unspecified U age and gender who was vaccinated with KIN
ash at vaccine site and on upper extremity
Y Y 5/27/2009 5/30/2009
hot;It was not until 3rd day of the Shot . The area of the vaccination became very hot, achedYand red.(Felt 5/25/2009
inflamed)5/25/2009
Two days later the pro
02.7; Headache; Fatigue; Was given tylenol 480 mg every 4-6 hours for 16 hours; slept mostYof the day; drank 5/27/2009 liquids
5/28/2009
but did not eat; no oth
a of induration at injection site with swelling
Y and pain. Y 5/28/2009 5/29/2009
d gunk in her eyes real badY the morning
Y of theY10th. She had a fever
14 of 104.9 when we tookUher to the emergency
5/8/2009 5/10/2009
room where they gave
as vaccinated with Smallpox on his left arm on 20 May 2009. Pt's Smallpox blister 'popped' in U his sleep the
5/20/2009
night of 30 6/1/2009
May. He noted that
rm swelled up to the wrist and is hot to the touch. 5/27/2009 5/28/2009
body aches - Patients relates having fever with pertussis as a child. Y 5/5/2009
for immunizations on 5/28/2009. Child received DTAP, HPAC, IPV & MMR. Mother telephoned Y this morning5/28/2009
& stated 5/28/2009
that child began to br
lled, client had high temperature 103.9.
Y Went into convulsions. Sent to ER, diagnosed with UTI. Y Took her 4/22/2009
to pediatrician,
4/24/2009stated no diagnos
rate, fever, vomiting, diarrhea. U 5/22/2009 5/28/2009
d 4/29/09. Mother noticed small "pimple Y like" lesion at site of VARIVAX injection (Left thigh) Yon 5/1/09. Small
4/29/2009
cold sore
5/10/2009
like blister on mouth
Typhoid cap appropriately --> 6 hrs. later had dizziness, light-headed followed by nausea andY vomiting assoc. 5/20/2009with movement.
5/20/2009 Hx of 2 episo
swelling pruritus in place of injection. Y 5/15/2009 5/17/2009
14 hours after vaccines administered Y (102 degrees F). Y 5/26/2009 5/27/2009
bout 12:00 patient became weak, pale, Y collapsed to floor, febrile, tachycardia. Patient seen inY ER, monitored, 5/26/2009
labs (CBC,
5/27/2009
BASIC chemistry a
area of redness over the skin at the site of injection 7 1/2 x 4 cm. No further reported problems U as of 5/26/09.5/5/2009 5/5/2009
severe hives. Y Y ### ###
mplain of muscle pain in left deltoid muscle. Pain persists one month after injection. N 4/28/2009 4/29/2009
is not to be started after 12 wks of age this pt. is 6 mons old. Y 3/9/2009 3/9/2009
n has been received from a physician concerning a female patient who on an unspecified date U was vaccinated with the second dose of GA
n has been received via a literature article regarding a case in litigation concerning a male who U in November 11/1/2004
2004, 11/1/2004
was vaccinated with a d
turned to clinic on 5-13-09. Lft arm injection site with 4-5 cm area of swelling. Area red and non U tender to5/11/2009
touch. Patient5/12/2009
reports itching to ar
n has been received from a case in litigation from a lawyer concerning a patient who on 19-SEP-2003 U was
9/19/2003
vaccinated with a dose of Hep B
d spinning, stomach sore, throat hurt for short time. Patient presents to clinic 4/24/09 at 8:50am, Y report "stomach
4/23/2009still 4/23/2009
hurts" to lower abdom
ed redness and swelling began around Y 1500 on 5/20. She applied cool compress around 1700 U applied ice 5/18/2009
pack, at 2000
5/20/2009
applied lotion "aloe
x 2 1/2 cm indurated, increased warmth. Fever 39 degrees C. Prescribed Keflex. 5/28/2009 5/29/2009
lling, redness, heat, and rash at injection site. Y 5/20/2009 5/25/2009
nto office and never was immunized. She was going to camp and needed imms. Dr. Asked nurses Y to work
5/29/2009
on seeing5/29/2009
what imms could be g
as administered the DTaP vaccine instead of the Tdap vaccine. There has been no known orYreported adverse 5/15/2009 reaction
5/15/2009
to the patient. In the
er dose of Rota vaccine given patient developed Y intussuception requiring
3 surgery for repair. Y6/2/09 ER records
3/30/2009 received
4/3/2009
DOS 4/3/09. FINA
atient was given the MCV vaccine early. The recommended age to administer is between ages Y 11-12, it 5/29/2009
is approved5/29/2009
for ages 2-55. He was
d a 12 year old female who was alert Y and oriented but appeared nervous, comfort measuresYwere taken.5/20/2009 I proceded5/20/2009
to administer the vacc
ceived MMR and Varicella vaccine'sYon May 21, 2009 from Merck and Co. Came into office today with rash 5/21/2009
on face 5/31/2009
and chest patient has n
elling in lympyh node on side of chest. Site swollen, warm to the touch. Lasted approx. 5 days. Y Doctors perplexed ### at the ### location of the sw
photographs the patient developed right sided ptosis and an enlarged pupil between Y September N 1st and 7th.9/4/2008
The parents
9/7/2008 noticed abnorma
e up the night of vaccination (5/26)withY pain. The Y next morning the mother
1Y noticed a red, round,
N hard area 5/26/2009
approximately
5/27/2009
4-5 inches. The c
der soft tissue infection with tender Yindurated area central eschar surrounding cellulitis. Treateed with Zithromax and 5/23/2009
Bactrim.Cultured are
Tenderness at surrounding injection site (Left Deltoid) U 5/31/2009 5/31/2009
l Saturday 05/30/2009 with headache, stomachache. Also injection site of menactra (r arm) Yred and swollen 5/29/2009
approx.5/30/2009
1cm.
wing administration of vaccine the patient developed stomache ache, fever, and headache. Highest U fever5/29/2009
was 101. 5/30/2009
iven on 5/26/09. Day after arm hurt, administration site, red, swollen,firm to touch and warm.YWorsened on 5/26/2009
Thursday. 5/27/2009
Saw Employee Healt
post vaccine 2 days ago, no fever, no previous vaccine reaction. Recieved DTaP IM and VZV SQ but reaction 5/27/2009started
5/27/2009
around DTaP area, p
nic Seizure acttivity lasting 2 minutes. Y 6/29/09 Y Hospital records received
2 DOS 5/19/09 to 5/21/09.
Y Assessment:
5/18/2009 Acute
5/19/2009
onset seizure second
ace torso arms and legs onset 05-29-09. Pt. c/o itching. Parent is giving Benadryl. Possible Fifth Y Disease5/29/2009 5/29/2009
vaccine was administered, the patient Y complained of pain in the right arm, started crying, becameU diaphoretic,
6/1/2009
ashen,6/1/2009
and lost consciousnes
aculopapular rash on face, exerting,Ytrunk, back starting on 29 May 2009. U 5/21/2009 5/29/2009
over injection site - X 2 days - cool compresses. Y 5/13/2009
at injection site x 2 days. Treatment cool compresses. Y 5/13/2009 5/14/2009
ely following injection patient had syncopal episode for 15 seconds. She had Flailing of arms/YLegs when5/29/2009 she was unconscious,
5/29/2009 as nurse wa
on 5/29/09, raised, itchy, painful x 2dY seen in the office 5/29/09: T: 98.2. Exam: dry papules upper Y forearms,
6/26/2007
back, trunk, scattered = 6 = blis
at site of injection up to 15 cm. Peak with underlying induration almost entire extent of quad.Y(right). 5/29/2009 5/30/2009
s receipt of third AVA vaccine on 5/2/2009
Y (AVA #1 8/2/05, #2 8/17/05). He reported no problems Y for 2 days.
5/2/2009
5/4-7/2009
5/2/2009
he c/o: 1) a roun
ceived Tdap IM R arm on 4-8-09. Right Y arm red and swollen; warm to touch. Good ROM. Pt.Ustate she took 4/8/2009
pain medication
4/12/2009 for discomfort.
sented in clinic on 4/3/09 @ 10:45 AM c/o swelling and redness of left arm. Client denies difficulty U breathing 4/1/2009
and negative
4/1/2009
for rashes. Client
e and vomiting within a few hours following vaccine administration. Client had a fever and had Y a racing pulse
1/28/2009
the evening
1/28/2009
following vaccine
tion were given at 5:25pm. Bil Redness of upper arms noticed at 5:35pm 6:50 redness receding. Chest - 4/8/2009 CTA ; No SOB,4/8/2009
A&O x 3, NAD, 18
eralized itching right shoulder increased back + legs, welts noted above RD site + upper back Y - Benadryl4/13/2009
12.5 mg 15ml 4/13/2009
PO Given @ 1640.
eived Immunization on 3/26/09 (DTAP Y and MMR). Mom states, "Started on TYLENOL and MOTRIN, Y but3/26/2009
spiked temperature
3/28/2009104 on 3/28/09
witnessed seizure on 5/21/09. H/O probable
Y seizure
Y activity in the past
4 6 wks. After seizure, Y pt has had complaint
5/20/2009of5/21/2009
headache, dizziness, w
l cord, right vocal cord, polyps
Y cancer.
Y Lost of voice.
Y Rash in skin complete
5Y body.YPain to joints
N complete11/4/2003
body. Gallbladder
11/5/2004 removal with, m
4/14/09, diarrhea, diaper Y rash - rash
Y - face, scrotum
Y bruised w/infection.
8 7/13/09 Hospital DC summary3/24/2009received DOS 4/14/2009
4/15/09 to 4/22/09.
s in face, body, hands, feetY BELL's Palsy
Y in face.
Y Losing ability to walk.
14 Y Low blood pressure readings.
Y Kidney (not
###normal
11/1/2008
readings). MRI's (
brile seizure; Negative workup at Hospital.
Y 6/22/09
Y Medical records2DC summary received DOS Y 5/20/095/19/2009
- 5/22/09. 5/20/2009
Assessment: Seizure w
eloped poor appetite with associatedY vomiting, Y sudden in onset, worsening
1 over a few hours.YChild evaluated5/13/2009
at office
5/22/2009
exam consistent with
U
ollen, itchy & hot to touch. Y Y 5/26/2009 5/27/2009
vaccine breakthrough. Diagnosed in office with varicella on 5-26-09. Had over 100 lesions noUfever. 2/11/2009 5/24/2009
+ redness at injection site. N 5/20/2009 5/20/2009
n left arm, jaw, left leg for two weeks after vaccination. U 5/15/2009 5/15/2009
veloped an erythematous patch in right Y thigh hours after shot was given. It got indented andYbigger, with some 5/7/2009
induration,
5/18/2009 measures: 3x 1 c
veloped furuncle abscess site of vaccine
Y about 1 wk after shot given. It is probably unlikely this
Y was secondary 5/6/2009to shot.
5/13/2009
Furuncle was in upp
erythema and induration around vaccination site. Reaction probable cause from VARIVAX. Y 5/27/2009 5/27/2009
days after inj pt was seen in ER forYrash that was felt to be eczema. Y 4/28/2009
n has been received from a physician concerning Y a 24 year old female 1 patient who on 26-AUG-2008
U was5/21/2009
was received from a consumer via Y Sanofi Aventis on 20 May 2009. A female patient, with a history of Type II diabetes, Hashimoto's thyroid
ately two minutes after injection of vaccines Mom noticed and questioned to nurse about bilateral Y lower extremity
5/21/2009redness.
5/21/2009 Nurse called Dr.
009 24 hours after immunizations were given L upper arm started to swell & redden. They were advised5/26/2009 to use Tylenol
5/27/2009
+ cold packs by clin
t a Tdap 5/14/09 and developed cellulitis
Y on the (L) upper arm site of the injection. Then was seen at the5/14/2009
doctors office on 5/21/09.
d ADACEL 4/27/09- And developedYcellulitis on site of injection. She was seen at ER. Y 4/27/2009 4/29/2009
9 Patient received DTaP #5 and Varicella #2 to the (R) Deltoid by RN and IPV #4 and MMRYII #2 to (L) Deltoid. 4/16/2009 Family
4/17/2009
brought pt to clinic a
Y 5/28/2009 5/28/2009
d PENTACEL 3/3/09 @ 2mo. well-child on 3/16/09 called nurse line - (mom) stating child non Y stop screaming.
3/3/2009 This 3/3/2009
office called back 3/9 -
as given Tdap in error as this has only been studied to age 64 and recommended for ages 11-64. U Patient5/22/2009
having no adverse symptoms per
vaccine breakthrough. Diagnosed with Varicella on 5-26-09. Had over 200 lesions. No fever.U 6/7/2007 5/23/2009
and bruising at site with pain. SterileYabscess Lt. leg. Y 5/22/2009 5/23/2009
ingles of L chest and arm 7 monthsYafter vaccine. Zoster/Shingles. Y ### 5/25/2009
5/27/2009
d area developed erythema and edematous swelling 5 1/2 6 1/2 cm. There is also warmth to the area though 5/27/2009
no induration
5/28/2009 or fluctuance of
en, hard to touch, painful with bruising
Y large lesion 5" X 5" sterile abscess. Y 5/22/2009 5/23/2009
d diarrhea for 3 weeks, fever, speech and motor regression, has been evaluated for autism by N specialist,11/5/2008
results inconclusive.
11/8/2008 MRI and EE
Y 11/5/2008 ###
e right deltoid since injection. also with small lump. parathesia intermittently radiating down to U right elbow,5/29/2009
with loss 5/29/2009
of strength to right arm.
e and dizziness s/p Tdap and HPV #3. Y Immunization given at 1515, gradual onset of headache U over course 6/1/2009
of the day. 6/1/2009
Patient to ED at 220
ng ataxia with onset approximately 11/08.
Y Severe gross motor and fine motor impairment noted. N 6/15/09 Received ### PCP
11/1/2008
medical records fo
oss of felling in left arm, hand afterward
Y and left arm had chills.There ia a golf ball size swelling Y to the upper5/28/2009
left arm.5/28/2009
ceived dose #4 of DTAP IM on 5/26/09. Parents report they noted large reddened area with Y mild swelling5/26/2009
at site on 5/27/2009
5/27/09. Client without
administered instead of MMR as requested by parents. No adverse event noted. Y 5/29/2009
nt recevied 3rd dose of Rotateq
Y on May
Y 15, 2009. Y She developed intussusception
1 on May 25,Y 2009. 7/14/09
5/15/2009
Hospital 5/25/2009
records received DOS
was administered on 5/26/09. Client had reaction to vaccines on 6/01/09. Came in clinic today Y 6/02/09, 5/26/2009
left deltoit sligtly
6/1/2009
redness and swell
oke up the next day with raised, itchy rash all over body except on face, chest and upper trunk. U Took OTC 12/9/2008
medicines and ### rash lasted 3 wee
turned to clinic 3 days post vaccination with right thigh erythemic, slightly swollen and warm to Y touch. Mother
5/26/2009
states5/27/2009
that symptoms started
d fever 103 with diffuse sweats x 24 hrs, irritability x 48 hrs, 7 days after vaccinations. Rash Y broke out about5/7/2009
24 hrs 5/14/2009
after fever broke - macu
MA, EDEMA AND INDURATION 1.25"X Y 1" TO RIGHT DELTOID. ICE PACKS, IBUPROFEN YAND TYLENOL 5/28/2009
FOR AGE 5/29/2009
PRN.
ter fainted and was taken to the ERYto be monitored, after going home she began with a fever... U this is the6/1/2009
day after receiving
6/2/2009 her rd HPV sh
Y (also
Y the subject's mother)0 and described the occurrence
N of cyanosis
9/27/2006 in a9/27/2006
2-month-old male sub
izures - 5-20 minutes of seizures - VALIUM
Y 2 milligrams
Y given - tachypneic
1 spell 5-10 seconds
Y recovered 5/18/2009
without ventilation.
5/19/2009 6/12/09 Hosp
ccines given Pt c/o dizziness, fan on pt - cool cloth on forehead - B/P checked, decreased 88/46 Y -head of5/18/2009
bed down5/18/2009
- foot of bed elevated.
20/09 Spoke to Dad - baby doing well, no ill effects. Child here for visit, received overdue imms Y / MICR was 5/18/2009
"down" - Child had these imms
munizations Thurs. PM 5/21/09, but didn't notice swelling & erythema until Saturday 5/23. Pt Y reports "extreme
5/21/2009
pain" Sat/Sunday
5/23/2009 but feels be
idmorning patient developed a fever and sweats (soaked clothes), dizziness and felt like sheYwould blackout 5/20/2009
if stood5/21/2009
up. Also started mens
ution-Progressive swelling, tenderness, erythema at a site 5/20/2009 5/21/2009
ped petechiae of lower extremities below knees. (R) greater than (L). These areas appearedYwithin 48 hours 5/19/2009
of vaccinations.
5/21/2009No squeezing
ted Saturday 5/23/09 102.2- gave MOTRIN and TYLENOL to help bring fever down. Rash started N on Sunday-was
5/13/2009 flat 5/23/2009
and then red pimple
chicken pox lesions- head, trunk, and scalp extremities. Friend broke out 5 days ago. U 5/17/2000 5/24/2009
ed urticarial rash at site L arm Y U 5/21/2009 5/24/2009
Tdap to right deltoid 5/22; developed Y chills and fever and headache that evening. Seen in UC Y 5/24; right5/22/2009
UE was not 5/22/2009
red, warm or tender. O
e, too warm, flushing and nausea. Y U 6/2/2009 6/2/2009
HPV she was weak, T.100, decreased eating, hives runny nose & sneezing. Y 6/1/2009 6/2/2009
d muscle and tender pain sustained since TWINRIX injection 05/04/09. U 5/4/2009 5/4/2009
en, shortness of breath. Mom statedYallergic to VARIVAX event though she got MMRV. 5/19/2009 5/21/2009
redness, and soreness left upper arm. 13cm by 14cm. Y 5/19/2009 5/20/2009
ately 3 weeks post ZOSTAVAX, developed 8 lesions, dime sized, left upper arm. A couple ofYweeks later,3/23/2009 developed 4/1/2009
sever, debilitating kne
len, cellulitis (TYLENOL). Y 5/18/2009 5/21/2009
and edema, warm to touch, measuring 6x7 cm oval on right deltoid. 5/28/2009
ted 1 day after receiving vaccine. Pt vomited x 1, was lethargic for about 48'. Slight sore throat Y 2 days later.
5/19/2009 5/20/2009
eck, Day 7, c/o some nausea, 2 episodes Y of vomiting. Told to go to hospital ER if couldn't keepY fluids down 5/22/2009
over weekend.
5/31/2009Nausea & vomiti
tomach", shaky, jittery, chills/hot + "feeling
Y just different, not myself" No diff. breathing, swelling
U or rash. Patient
5/7/2009 vomited
5/7/2009
while talking with h
d bump at the injection site; small red dots from injection site spread to arms, also on torso and Y back 5/11/2009 5/20/2009
adiating to her jaw, shoulder and neck.Y Stiffness lower back painful and stiff making it difficultYto walk. Went 5/7/2009
to PMD on 5/8/2009
Fri 5-8-09. c/o " ever
mother at approx. 9 pm on 5/13/09. Pt c/o- H.A.; No relief with ADVIL; 5/14/09 at 11am - Pt. still Y experiencing5/13/2009
H.A. and 5/13/2009
given 1 TYLENOL by
rts child vomited on Thursday pm. Friday
Y developed red, raised rash on buttocks which spread U to entire 5/28/2009
body by Sunday,
5/29/2009MD appointment
5/19, 20 c/o pain lt side of chest & shoulder back c/o bad H/A 5/19 LT deltoid upper arm swollen (9 cm 5/18/2009 10 cm) warm 5/19/2009
to touch. c/o could n
s after 3 17-09 injections (not sure which day) noticed decreased mobility of R shoulder and N"lightening bolts" 3/17/2009
down3/20/2009
arm to fingertips. Patien
th c/o rash on chest and bilateral arms.
Y generalized itching. Y 5/22/2009 5/23/2009
MMR shot on 1/16/09. Diagnosed with Y measles on 1/15/09. Broke out entire body with red bump. Y Fever up 1/6/2009
to 105. Irritable.
1/15/2009 Rash and symp
turned to the pharmacy complaining of itching within 10 mins the area was slightly raised, red, Y and hot to5/23/2009
the touch -5/23/2009
it extended about 3" di
cal swelling and erythema. Local and distant urtitaria. @ 3rd p shot. N 5/26/2009 5/27/2009
n 5/28/09 patient noticed next day some
Y redness then next day redness increased and swelling Y up to 6 inches
5/28/2009 pain 5/29/2009
in area. Itched all over w
theaded & thinks she may have fainted (briefly) while sitting in chair 3-4 min. after HPV #3 inject. Y 6/1/2009 6/1/2009
Tdap to R Deltoid 5/22; developed Ychills + fever and headache that evening. Seen in UC 5/24, Y (R) UE was 5/22/2009
not red,5/22/2009
warm or tender. On 5
5 AM on 5/27/09 T 102 Crying unconsolable
Y - vomited X T - ate only 5 grapes - Temp 102.6 U ax in office at
5/26/2009
11:30 AM5/27/2009
on 5/27/09. Physical e
Y Y 5/19/2009 5/30/2009
ven a TB vaccine while he had a fever Y of 104 and a case of Strep throat. He began to have neurological
Y problems ### about 24 ###hours later. (Tro
9 - pt had swelling & redness of the (L) thigh. Pt instructed to Ice area & admin APAP. Pt was U seen in ofc.5/13/2009
5/15/09. Was5/14/2009
given XY2al 2.5 m
arm became very red, warm to touch, Y tender. Limited ROM with inflammation. TX= P.O. Antibiotics, Y pain
5/13/2009
meds, subsequent
5/15/2009IV antibiotics.
n has been received from a physician, for GARDASIL, a Pregnancy Registry product, concerning Y a female patient who was vaccinated with
n has been received from a registered nurse who heard from another contact concerning a 22 U year old female patient who was vaccinated
hile at home developed 104 temp and seziure. Presented
Y to hospital4for treatment. Y 5/19/2009 5/19/2009
ENTED WITH COMPLAINTS OF N/V AND ABD PAIN X 2hrs POST VACCINATION. PT TREATED N WITH5/22/2009
PHENERGAN, 5/22/20091 LITER NS, SIQ
to clinic 5/29/09 with 1 day of body, joint aches, radiating up from legs, associated with low grade U fever. 5/27/2009 5/28/2009
rs of receiving vaccines pt developedY localized cellulitis with red dermatitis of fluid filled blisters.
Y This occured5/19/2009in the5/19/2009
area where the DTaP v
d chest pain and was admitted for myocarditis
Y on
Y 25 May 2009. Admitted
1 to medical center. N Received call 5/14/2009
through call5/25/2009
center reporting post
mitted to hospital with paralysis below the neck. History of GARDASIL vaccination; Y Last dose U 04/17/2008. 4/17/2008
No definite3/10/2009
diagnosis. Described
above is simply the most recent event, one of many Y throughout the past 9 months. This dateUreflects the 8/20/2008
diagnosis given
5/20/2009
by a neurologist o
with erythema, mildly inflamed with induration, per pt. it already subsided. Y 5/27/2009 5/28/2009
mmunizations administered at an exam. Y 5/31/09 Fever 100-101 degrees. No or rash. 6/1/09 Fever Y and malaise - no other localizing signs. 6
rash Tylenol given as needed Fever 102 degrees F Diarrhea 11-12 days after vaccinations Y 5/18/2009 5/29/2009
ain in left arm w/tingling sensation inYleft fingers 5/6/2009 5/9/2009
omiting, fatigue. Y 6/1/2009 6/1/2009
daughter to a physician she had never Y been to before. While we were there the nurse suggested my daughter 5/18/2009 get the
5/18/2009
GARDASIL injection.
ccinated on 5/28/09, went to schoolYon 5/29/09 and upon return home from school mother noticed Y swelling
5/28/2009
and redness
5/29/2009
on right arm. Patie
ng our office, the patient passed outYwith increase tone. Taken to the ER for evaluation of possible Y seizure6/3/2009
activity. CTScan
6/3/2009 & blood work a
er receiving the MMR vaccine, Evan came down with 103 degree fever. The following day (8U days after 5/26/2009 vaccine), his6/2/2009
fever is 104 degrees.
d approx 1530 on 6/3/09 stating "my son got shots there yesterday now he is having an allergic reaction."6/2/2009 Mom questioned
6/3/2009 as to what kind
fort in abdomen, like cramping or feeling of gas. began approx 8 hours after injection ( 4:30 PM Y ) and lasted 6/1/2009
through the6/1/2009
night. 2. aching in a
RED BUMP FIRST SHOWED ON WEDNESDAY, Y 27 MAY, THEN AS THE DAYS PROGRESSED U THE 5/26/2009
BUMP STAYED 5/27/2009
BUT THE REDNE
f right arm where vaccine was given. Y Antibiotics and antihistamines given. U 6/1/2009 6/2/2009
se headaches and fainted and had a seizure. Y 5/29/2009 5/29/2009
ours after receiving the third of three injections of GARDASIL, I began to experience intense muscular pain and headache 5/23/2009 which continued
months after being given the GARDASIL
Y vaccine. I had a ct scan done, which showed that my lymph nodes 5/7/2007
were enlarged. ###A little over a
ay arm (R) became painful - swollen and red. Pt took TYLENOL all day. On Wed 6/309 Pt begins N with "spinal
6/1/2009
pain" body
6/2/2009
aches, headaches
edema erythema hyperemia measuring 15X12 cm oval. 6/1/2009 6/2/2009
pprox. 10:45 AM - Pt fainted outsideYclinic in the front passenger side of her car. Revived when Y her arm was 5/29/2009
shook by5/29/2009
nurse. Ambulance w
5/21/09 LDT - RTC 5/27/09 and large red warm localized reaction to Td. Y 5/21/2009 5/27/2009
hematous, macular rash on her back, trunk. No fever. U 6/2/2009
eral 5 inches x 2 inches tender, erythematous swelling. Y 6/1/2009 6/2/2009
e red rash raised bumps (hive-like) 1 patient sat for 1/2 hr gave Benadryl 12.5 melt tablets (1)Y+ 1 to take home 6/3/2009(2prn)6/3/2009
= 4 tablets (iced rash
ed Health center on 6/3/09 2:20 PM to report flushing, palpitations. Had 2-3 episodes of palpitations U and flushing.
6/2/2009Vaccination
6/3/2009 for Typhoid g
wollen arm. was seen a ER & followed Y up with us 5 days after initial shot 3 days after ER vistis. Y 5/28/2009 5/30/2009
ven Pneumovax on 5-26-09. He states Y that he became nauseated within a few minutes, then vomitted. 5/26/2009
The following 5/26/2009
day, he developed b
ARICELLA vaccine given all following info received from clinic 5-6 DEPO PROVERA shot - 5-11 U " Lump 4/30/2009
on arm" - Pain5/11/2009
shoulder to elbow"
iving immunizations and walking to office to be checked out he became "light headed" fainted hitting desk.6/1/2009
Small abrasion
6/1/2009 R eye brow + bo
103 for 3 days, loss of apetite, body aches, fast breething, fussiness Y 5/28/2009 5/29/2009
utes of receiving the 1st does of gardisil she was dizzy, pale, light headed, saying that she couldn't
Y breathe.
6/3/2009
it sounded6/3/2009
like she was gaspin
F 101.8, ACHY ALL OVER WITH SHOOTING PAINS DOWN ARMS AND LEGS OCCASIONALLY. Y PATIENT
6/2/2009
ALSO6/3/2009
FELT PAIN IN MIDDL
minutes cheeks were red and swollen with urticaria Y 5/20/2009 5/20/2009
n has been received from Y a pharmacist regarding a case in litigation concerning a young female
Y relative (exact age unknown) of a healthca
Y a child male
0 patient who on approximately
Y 27-MAY-2009
5/27/2009 was 5/30/2009
vaccinated with the
rmation has been received from a nurse and follow up information from a medicalYassistant who U reported4/21/2009
that a 49 year4/21/2009
old female was on 2
n has been received from a pharmacist reported Y that a patient was believed
0 to received a dose
U of PNEUMOVAX4/1/2009235/29/2009
in April 2009 but no do
ness, swelling and itchy @ site 3cm x 2cm raised rash R upper arm with Sl blistering . Benadryl Y + Ibuprofen
5/26/2009
PRN, cold 5/28/2009
compresses to area
ed nodular papular rash 6/3/1996 5/29/2009
swelling, heat @injection site Y 5/3/2009 5/3/2009
on the area of injection 5x8 cm with 2x3 cm of - induration. U 5/27/2009 5/27/2009
vaccine break through. Diagnosed with varicella on 5-29-09 U 2/2/2007 5/22/2009
g motor paralysis 6/9/09 Hospital ER Y records received DOS 5/28/09. Post immunization patient Y c/o shoulder
5/27/2009
pain, knee
5/28/2009
pain, generalized a
5/29/2009
me to the clinic 6-1-09. Stating sheYhad a red area on left thigh. States the red area startedYon Sat and5/29/2009
has gotten 5/30/2009
larger. Band aids are s
of chest tightness within 5 min after immunization with HEPA, HPV, TDAP. PPD test done also Y at same5/28/2009
time. Symptoms5/28/2009persisted for 3 da
being preg. 12/31/08. Had US on Feb'2009 and was informed baby had problems and abortion Y done 3/18/09 ### at OB.3/18/2009
9 MILD Other - Fatigue, Some dizziness U 6/3/2009 6/4/2009
vaccine 5/27/2009 and seen 5/29/2009 with red very swollen arm treated with BENADRYL, Y ice, Hydrocortisone
5/27/2009 1% 5/28/2009
cream for itching.
mildly itching rash, 10 cm, over injection site U 5/27/2009 5/28/2009
Neuropathy. 3-6mo after vaccine. Tests,Y pain medication. Y N ### 1/1/2003
owing vaccination, child developed erythema
Y and edema of lower, lateral aspect of upper right
U arm, in region
6/1/2009
of subcutaneous
6/2/2009 varicella vacc
D TDAP, GARDISIL, MENINGOCOCCAL Y INJECTION,
Y TOLERATED 1 WELL, WALKED OUTUOF EXAM ROOM 6/3/2009AND 6/3/2009
PASSED OUT (5 -7 M
HAD PNEUMOVAX ON RIGHT DELTOID Y AREA ON 3/30/09 .ON 3/31/09 HE HAD MUSCLE Y ACHES AND 3/30/2009
ON 4/1/09 3/31/2009
DEVELOPED FEVE
STATED THAT SHE EXPERIENCED Y DEEP THROBBING PAIN AT THE SITE OF INOCULATION Y ON 5/20/2009.
5/15/2009 SHE 5/20/2009
SOUGHT MEDICA
munization clinic 6/04/09 at 12:30 PM, C/O headache on 6/03/09 (the evening of taking the vaccines.) Headache 6/3/2009worse 6/3/2009
6/04/09 with Naus
with rash and fever of 102 on 05/30/2009 and continued with pruritic rash that developed into U red oval shaped
2/2/2006areas5/30/2009
with vesicular lesion o
d vaccines on 6/2/09. On 6/3/09 after Y pt got home from school, mom called office stating arms N were now6/2/2009
both red at6/3/2009
injection sites and sor
ess, swelling at site, started 2 days after injection. Y 6/1/2009 6/3/2009
lling morning after vaccine, no fever, no treatment needed Y 6/3/2009 6/4/2009
symptoms appears one week after receiving
Y vaccine. U 5/26/2009 6/1/2009
min after receiving immz, pt appeared Y to have a seizure; loss of consciousness <45 seconds, Y jerky movements,
6/1/2009 urinated
6/1/2009
on self. Ammonia
baby check-up and vaccination
Y on 4-20-09,
Y visited
Y physician on 4-23-09
41 Y with N/VYand lethargy.
N By that 4/20/2009
evening, she 4/23/2009
was taken to the ED w
ding in line 5-10 minutes after the injection
Y making an appointment when she lost conciousness Y and suffered
5/29/2009
tonic clonic
5/29/2009
movements for 30
GARDASIL on 5/27/2009 - swelling/ redness started within 24 hours - seen 5/29/09 - treatedY with MOTRIN, 5/27/2009
BENADRYL.5/28/2009No previous Rxn
fter receiving MMR, patient developed Y measles like rash. Y 5/20/2009 5/30/2009
Y 5/28/2009 5/29/2009
ast PM (about 5-6 hours after injection) very fatigued then this AM 6/4/09 dizzy, nauseated. Now Y slightly better.
6/3/2009No rash
6/3/2009
- No difficulty breath
rash on chest, abdomen, and eyes 6/4/2009 6/4/2009
nced (L) arm pn @ injection site with approximately 1 cm surrounding ecchymosis, arm has U erythema/induration
6/1/2009heat6/2/2009
approximately 115x1
eloped one month after the vaccine Ywas given. Rash is red, bumps, painful on arms and legs. Y Was seen by 2/4/2009
PCP and3/1/2009
given PREDNISONE.
d, papular to trunk & limbs 3 days after vaccine - lasted one week - No treatment Y 3/4/2009 3/7/2009
vomiting approximately 8-9 hours afterY vaccines given - administered @ ~1500 on 06/03/09 U Started vomiting
6/3/2009
~ 0100 6/4/2009
- 0200 06-/04 /09
d immunization 9:05 AM, pt went out to smoke a cigarette, 15 mins later started feeling dizzyYand sweating. 6/4/2009
Pt went inside
6/4/2009 to sit, started to
had c/o nausea with emesis after injection by another nurse earlier that day. He was told toYcheck with this 2/5/2009
nurse before
2/5/2009leaving his shift.
EDIARIX given simultaneously Y 5/28/2009 5/28/2009
Y and described the occurrence of rash in a 58-year-old
U female4/27/2009
subject who5/7/2009
was vaccinated with B
was reported by a physician via a GSK representative, and described the occurrence of a rash Y in an adult 3/30/2009
subject of3/31/2009
unspecified gender wh
nduration (R) arm 4/29/2009 4/30/2009
n VYANESE doses after vaccines. YA couple of hours later hyperactive behavior had escalated U more than6/3/2009
normal. Called
6/3/2009pediatrician but d
d shot Fri - Pt brought in Monday to be seen. Noted markedly erythematous area that measures Y probably 5/29/2009
3 x 2 cm.5/31/2009
around that faint redne
was reported by the mother of a consumer and described the occurrence of swelling at the injectionU site3/25/2008
in a 5-year-old male subject who w
was reported by an other manufacturer
Y via a nurse and described the occurrence of nauseaYin a female subject who was vaccinated with (
was reported by a physician via a sales representative and described the occurrence of swelling N in a subject
4/2/2008
of unspecified
4/3/2008 age and gende
was reported by a physician via a sales representative and described the occurrence of swelling N in a subject
3/19/2008
of unspecified
3/19/2008 age and gende
was reported by a physician via a sales representative and described the occurrence of swelling U in a subject of unspecified age and gende
was reported by a physician via a sales representative and described the occurrence of swelling U in a subject of unspecified age and gende
was reported by a physician via a sales representative and described the occurrence of extensive Y swelling
3/18/2008
of vaccinated
3/20/2008
limb in a subject o
was reported by a healthcare professional and described the occurrence of swelling of legs U in a subject of unspecified age and gender who
was reported by a healthcare professional and described the occurrence of swelling of legs U in a subject of unspecified age and gender who
was reported by a physician and described the occurrence of swollen buttocks in a 4-year-old U male subject3/25/2008
who was 3/26/2008
vaccinated with INFAN
Y and described the occurrence of swollen axillary N nodes in a 5-year-old
5/7/2008male 5/8/2008
subject who was va
was reported by a physician via a representative and described the occurrence of erythemaUin a child subject of unspecified gender who w
was reported by a physician via a representative and described the occurrence of swelling inY legs in a subject of unspecified age and gend
was reported by a healthcare professional via a sales representative and described the occurrence U of nonspecific reaction in a subject of u
was reported by the mother of a consumer and described the occurrence of nausea in a 4-year-old N male 8/5/2008
subject who8/6/2008
was vaccinated with
was reported by a healthcare professional and described the occurrence of injection site reaction U in a subject of unspecified age and gend
was reported by a physician, via a GSK sales representative, that described the occurrenceUof swelling at the injection site in an unspecifie
was reported by a healthcare professional and described the occurrence of swelling injection Y site in an 18-month-old
8/19/2008 8/19/2008
was reported by a healthcare professional and described the occurrence of swelling of injection Y site in a8/19/2008
5-year-old 8/19/2008
female subject who was
was reported by a healthcare professional and described the occurrence of swelling injection Y site in a 5-year-old
8/20/2008male8/22/2008
subject who was vac
was reported by a pharmacist and described the occurrence of an unspecified adverse event U in a child subject of unspecified gender who w
was reported by a healthcare professional and described the occurrence of crying in a 4-month-old U male subject who was vaccinated with
was reported by a healthcare professional and described the occurrence of limb swelling in U a child (15 months to 5 years) subject of unspe
vaccine administered, mother reportsY fever of 99.5,
Y then began having 2 myoclonic jerks of arms,Y legs and5/14/2009
head. No 5/14/2009
decrease in level of aro
o BPH, intra-cranial hemorrhage 10yrs ago admitted
Y on 5/25 with a 41 Ywk h/o HA, fevers, rigors and progressively
5/7/2009worsened
5/13/2009 weakness, with
Y N 6/28/2008
0.5 degrees F, achy joints/neck, HAYeyes sensitive to light, numbness in feet/hands. 5/21/09.Y5/27/2009 Follow 5/15/2009up with
5/20/2009
parent. Parent state
KINREX + MMR on R deltoid on 5/29/2009 - came into office 06/02/09 necessary with cellulitis Y + reddened 5/29/2009
@ site. 5/30/2009
minutes after injection Pt became rigid all over, very stiff, and fell down to table. After severalYminutes then6/2/2009
began to arise
6/2/2009
but was very grog
degree F fever, body aches, joint pain: Rash at injection site. Symptoms began to subsideYafter 36-48 5/24/2009 hours. 5/25/2009
ected with 2nd GARDASIL inj. About Y 30 seconds later pt fainted fell head first off of bed. Pt hit
Y right forehead
5/29/2009
on floor
5/29/2009
and ice was applied. P
30 papules on trunk and groin - No vesicles - very itchy 4/11/2007 5/29/2009
m red whelp to (R) deltoid, not tender to touch, cellulitis. Treatment - BACTRIM DS U 5/27/2009 5/29/2009
ed pt came home form Daycare on Thursday 5-28-09 and c/o pain in (L) arm, Mom also stated Y it was itchy.
5/27/2009
Area was5/28/2009
reddened, itchy and s
rs after receiving vaccines became irritable, crying & inconsolable for 1 1/2 hrs. Left leg hadYnickle sized3/31/2009
bruise at injection
3/31/2009 site. Left thigh l
redness, heat, bruising after 3 days. Pt was Pt used cold packs and warm packs Y 5/27/2009 5/28/2009
Q site redness, heat. Pt saw physician
Y who prescribed "Steroid Inj and BENADRYL OD Y 5/19/2009 5/20/2009
n arms / legs about 1 hour after receiving,MENACTRA, HPV #1, HEP A #1, on 5/27/09 no other complaint. 5/27/2009 5/27/2009
n has been received from a physicianY concerningY a female with unspecified
0Y reported drug reactions/allergies
U 4/30/2009
with Behcet's Syndrome and a
orted in a news magazine article that a male who on an unspecified date was vaccinated with U a dose of MMR II. Subsequently the patient d
n has been received from a physicianY concerningY either 15 or 16 years 0 old male patient whoUon an unspecified date was vaccinated with a
n has been received from a physician concerning a female patient who on an unspecified date U was vaccinated with a dose of GARDASIL (
xperienced swelling in the lymph node of the left armpit. 5/25/09 chills, generalized malaise,YTemp 99.8 5/15/20095/26/09 Malaise
5/24/2009
continued, fever a
ema and induration at arm injection site. Y 5/26/2009 5/27/2009
thigh red/warm swollen with itching within 24 hours of vaccines given. Y 5/29/2009 5/30/2009
ven dose #2 of GARDASIL, seems to Y tolerate well. No c/o offered - fainted upon preparing to leave facility,
5/13/2009
hitting back
5/13/2009
of head hard on doo
and erythema at Lt site of immunization
Y 10 days after immunization. No signs of injection - NoY treatment given
5/14/2009
- Local
5/24/2009
reaction presumed to
with erythema and purpura skin in large circular area 8cm - no adjacent to but not symptom surrounding
U needle
5/29/2009 insertion
5/30/2009
site from vaccinatio
substantial swelling of injection armYfrom shoulder to elbow, skin sensitivity, stiffness - joint pain
Y (ankles,4/30/2009
knees, elbows, 5/1/2009
wrists, neck) - feve
Multiforme rash started on 5-22-09 started in groin area spread allover started on BENADRYL Y change to5/15/2009
ZYRTEC 5/22/2009
on 5-26-09 PRELONE
swelling of R deltoid area. ErythemaYand induration surrounding injection site. Y 5/26/2009
min of receiving JE vaccination, client had a seizure lasting 1-2 min. Alert & oriented after, though
Y very pale6/4/2009
and unsteady.
6/4/2009 BP 122/80 No s
ss on neck, arms, legs, about 10 minutes after shots were given, no difficulty breathing, nor Y swallowing, no 6/4/2009
rash noted. 6/4/2009
BENADRYL 25 mg
e swollen warm to touch. Swelling from Y knee to hip Y 6/3/2009 6/3/2009
was reported by a physician, via a GSK sales representative, that described the occurrenceYof injection site hot to touch 9/4/2008
in four child subjec
U of erythema
9/15/2008 in a9/16/2008
5-year-old male subje
was reported by a healthcare professional and described the occurrence of swollen thigh (injectionY site) 8/22/2008
in a 5-year-old female subject who
was reported by a physician, via another health care provider, and described the occurrenceYof injection site hot to 8/29/2008 touch in a 3 year old fem
Y and described the occurrence of floppy in a 6-month-old
Y female subject
### who was ###vaccinated wit
was reported by a consumer, the subject's grandmother, and described the occurrence of seizure Y in an infant female 11/1/2008
was reported by the grandmother of a consumer and described the occurrence of hyporesponsive U reaction (unspecified) in a 4-month-old f
was reported by a healthcare professional and described the occurrence of an unspecified adverse U event in a subject of unspecified age a
was reported by a healthcare professional and described the occurrence of an unspecified adverse U event in a subject of unspecified age a
Y and described the occurrence of swelling injection Y site in a 4-year-old
3/16/2009female3/16/2009
subject who was v
nd swelling in a 6x6 are to Right thigh where MMR vaccine was administered, swollen area was Y hot to touch 6/2/2009
and painful6/3/2009
d shot Tues afternoon; minor discomfort at injection site. - Started to feel extreme fatigue Weds. Y afternoon6/2/2009(approx 1300hrs)
6/3/2009quickly followe
n 2 days following the injections. It began as a ring about an inch from every injection and onU the next day6/1/2009had covered 6/3/2009
her whole body exc
of malaize approximately 12 hours after Y injection. 36 hours later, muscle pain in the upper insideN of calf of5/21/2009
lower left5/22/2009
leg. Pain in upper bod
rts child developed night terrors and feels it is due to DtaP. Had first night terror night vaccine
U given, has5/29/2009
had one again 5/29/2009
2 other times when
@9:16am MOC t.c. c/o mild dizziness 1 hours post vaccinations then severed ha, lbp and dizziness U with falling
6/4/2009this morning
6/4/2009on ambulation
d urticaria all over body 3 days after receiving vaccinations. Also on a new med - flonase, and U has tried a 6/1/2009
new food - 6/4/2009
cherries, so etiology u
ent had 3 vaccines administered on Y 5/26/09 @ approximately 12:00 pm. Client called @ approx Y 1:25 and5/26/2009
stated "I'm5/26/2009
having trouble breathin
, Swelling, Tenderness, fevers, Elevated
Y white Yblood cell count. 6/26/2009
3Y MR received for DOSU 6/4-7/2009 6/3/2008
with D/C6/4/2008
DX: Cellulitis. Pt pres
MOTHER REQUESTING LIST OFYIMMUNIZATIONS GIVEN AT LAST VISIT ON 05.27.2009 U (MOTHER 5/27/2009
WAS GIVEN 6/4/2009
RECORD THE DAY
ived rotateq on 4/3/09 and was admitted to theYhospital for intussusception
4 on 4/9/09. 7/24/09
Y Hospital records
4/3/2009 received
4/9/2009
DOS 4/9/09 to 4/2
n left arm wth mild erythema on the site not likely cellulitis. U 6/4/2009 6/5/2009
mother calls to report that about 3 hours after immunizations received client began feeling "lethargic"
U and then
6/3/2009
later in6/3/2009
the evening develope
ed Hib and DTP/DTap vaccinations on 04/Jun/2009 and developed pain and sore at the injection N site. He6/4/2009
cried when6/4/2009
I was holding him up,
LA FROM VACCINE Y 5/28/2009 6/3/2009
rts child had 1st seizure 6-3-09 at 2030
Y lasting approx. 1 min. taken directly to hospital ER. CT Y of head and 6/3/2009
CXR done. 6/3/2009
Ativan and Tylenol
OF DIARRHEA (5 TIMES DAILY), VERY ODOROUS Y 1/5/2008 5/25/2009
days after Hepatitis B vaccine my thumbY and pointer finger on right hand were numb and i went N to my family 5/16/2007
doctor 5/20/2007
and within the next wee
vomiting, headaches, pain in joints,Y backache, aches in the arm that was injected. Bad mood U and sleepnessness.
5/26/2009 5/27/2009
rienced generalized macular papular rash over body with "strawberry toungue" beginning 06/03/09 U afebrile
5/20/2009 6/2/2009
d vaccine on 6-2-09. on 6-5-09 patient still complains of injection site redness, warmth and itch. U i advised 6/2/2009
pt to take some 6/3/2009
ibuprofen for the
ak out in hive after MMR and Varirex, the right thigh swell up and swollen where MMR was administered.
U Gave
6/5/2009
Benadryl 6/5/2009
2.5 ml po x1 , no re
ain in deltoid area, swelling and slight fever. Pain for 3 days. 6/2/2009 6/2/2009
ion site became itchy within 1 hour & Y became very red that evening. 6/4: Site became painful, U swollen, tneder,
6/3/2009
redness 6/3/2009
spread, and she be
U 6/5/2009 6/5/2009
e evening on the day of injection the patient developed a egg sized lump on the back of the right Y arm. When 5/28/2009
the arm5/28/2009
was reassessed in the
bed itching during the night and small red dots over her body. She took Benadryl during the am Y and now (6-5-09,1:00pm)
6/4/2009 6/5/2009 reports no S/S.
NOTICED ON 06/04/2009 2 SMALL WHITE SPOTS ON ROOF OF MOUTH. NO FEVER, DID U HAVE DAY 6/1/2009
OF IMMUNIZATIONS.
6/4/2009 ANOTH
ion site was found to be swollen, firm, red, and hot to touch. Patient temp of 99.00 in the afteroonY after the
5/25/2009
injection 5/25/2009
resolved by 2300 that s
for evaluation of red swollen right thigh.
Y Warm to touch. Sore. Treatment advised: supportiveYmeasures. Cool 6/3/2009
compresses
6/5/2009 and Tylenol.
ater of administration of the vaccine Pt called the pharmacy complaining of numbness and tingling sensation. 6/3/2009
From the6/3/2009
talk to Doctor at offi
ing, erythema (10 x 10 cm area) itching,
Y mild induration directly under injection site (2 x 2 cmUarea). 6/2/2009 6/3/2009
.5 cm erythema around injection site. Warm non tender. U 6/3/2009 6/4/2009
welling, tenderness, redness and warmth Y over right deltoid appeared 2 days after injection. Mild
U erythema 6/2/2009
without warmth6/4/2009
left upper arm.
of left arm with edema and erythema. U 6/2/2009 6/3/2009
reaction. Sore and swelling. Y 5/26/2009 5/29/2009
d severe localized reaction to this immunization. N 6/2/2009 6/4/2009
Y (also the subject) and described the occurrence
Y of
U injection site
5/12/2009
pain in a5/12/2009
ented to clinic 6-4-09 w. cc "crying a lot", 7 cm reddened swollen LAT at site of 4th INFANRIX. Y Mom advised 6/2/2009
to warm6/3/2009
packs, return to clinic
was reported by a consumer (also the subject)Yand described the occurrence
6 of pneumonia Yin a 81-year-old male subject
2/24/2009who was vaccina
of breath and dizziness Y 6/4/2009 6/5/2009
mitted to clinic with warm red areasYon bilateral upper extremities. Pt rec'd vaccines on 6/3/09. MENACTRA 6/3/2009
in (R) arm
6/4/2009
and Tdap in (L) arm
meter induration with 2 in wheal on LA surrounding VARIVAX adm site. Normal pulses. bilat.Y 6/3/2009 6/5/2009
2 days after vaccine T. 102 + moreYjerky movements after 3 days of vaccination as per mom less of balance 6/1/2009and frequent falling lethargy,
pain, swelling left arm onset day after
Y rec'd VARICELLA vaccine in left arm. Low grade fe. Y T 99.2. 10 X 6/3/2009
6 cm red tender
6/4/2009lesion below inj s
chest & back rash red, bumps mild itching
Y x 1 1/2 hrs without fever, general malaise saw MD 5/23/09. 6/1/09 5/21/2009
Blood work
5/23/2009
showed low white
ted skin under bandage around vaccination site. Individual, isolated rash clusters under arm & across chest 5/22/2009
and abdomen.
6/1/2009
ped intussusception requiring
Y surgical reduction.Y Also had symptoms4 of resolving virus + viralYexanthem 5/28/2009
c/w parvovirus5/30/2009
(fifth's disease) on t
e fever, overall "joint aching" + head "feels too big for her body" 6/3/2009 6/4/2009
scle spasms to arm x 24hrs. Nickel sized area "bullseyes" at injection site. Unable to do promY because pain. 6/4/2009 6/4/2009
oid with erythema and swelling. Y N 6/4/2009 6/5/2009
excessive of arm, shoulder & neck involving
Y throat. U 5/31/2009 6/1/2009
and swelling after 6 hours on date ofYvaccine. Then rash that became larger the next day. The Y next she mad5/29/2009
an observation,
5/29/2009was on 6/3/09
et of wheezing approx 10 minutes post Y vaccine administered nebulized albuterol given. Y 5/22/2009 5/22/2009
d received the Typhoid vaccine first.Y Then she was administered the Hep. A. As soon as theYHep, A was5/21/2009 removed the 5/21/2009
nurse, patient slump
Tetanus booster and Hep B shot at 4:30pm on Thursday June 4th. Woke up at 5:30 June 5th Y very dizzy.6/4/2009
Called Dr.6/5/2009
He said to wait it out
IN TO RECIEVE ANTHRAX AND SMALLPOX Y VACCINES AT 141 MDG WA ANG. PT RECIEVED Y INITIAL
6/6/2009
ANTHRAX 6/6/2009
VACCINE. HE WA
echiae & edema - transient & self resolving. Y 6/2/2009 6/3/2009
in all muscle groups, Fatigue, rectal bleeding. (On initial series 6 doses bleeding remained for Y several months)
6/6/2009 Concurrent
6/7/2009 doses 1-2 week
t from a typically developing boy, to full regression in to Autism within one week of Y his MMR Nshots. He also7/18/2000
recieved7/18/2000
the Varicella vaccine o
in hives (10/19/07). Developed a allergy
Y to peanuts which had not been presentYprior to theNimmunization. Long ### term adverse
### affect PDD
thigh was red, warm, swollen
Y & itchy shortly after the injections. He was in pain & wanted to U be carried because
6/1/2009his6/1/2009
legs were weak. Arou
s after the vaccination, I'm getting weaker and Y weaker. Have cold symptom
6 like. Went to dinner.
U After 103/24/2004
minutes, experience
4/6/2004 hiccup. My c
ke a huge hive 2 x 3 1/2 inches. It was red and hot and lasted 5 days. (It was on the injection Y site). 5/15/2009 5/15/2009
, swelling and warmth to site whereYvarivax was administered. 5/28/2009 5/29/2009
h rabies vaccine, had progressively worse
Y headaches, sweats/chills, facial redness, muscle fatigue, general fatigue, ### uncoordinated,
### confusio
mom, states she tried to feed her in the AM and she vomited. Vomiting x 3 from 7:30 Am - 12UN. Refuses to 5/6/2009
eat or drink.
5/7/2009
No fever or diarrhe
red swollen area at one injection site (believes to be varicella) running fever. (Right arm siteYof injection). 5/26/2009 5/27/2009
immunizations @ 9AM - broke out in Y rash starting @ 12 N 1 place under eye (looked like blister-
Y went away-
5/26/2009
2 under5/26/2009
neck @ 1:30 they wen
ely following administration of GARDASIL she was sitting on exam table, felt lightheaded andYfainted. falling 6/3/2009
to floor. 6/3/2009
Mother in room reporte
2/20/09 ----> mom reports LA (left arm)Y injection sit on 03/03/09 became red, raised, warm toYtouch physician 2/20/2009
diagnosed
3/3/2009
as cellulitis. Paren
all area of urticaria @ flexor surface of (R) arm on day of vaccination, but four days later, she Y developed urticaria
5/4/2009over 5/4/2009
entire upper body &
n has been received from a medicalYassistant concerning a 17 year old female with a historyYof convulsions 5/28/2009
and under5/28/2009
the care of an unspe
ped severe urticaria over entire bodyY several hrs after administration of several vaccines. This Y resolved with5/8/2009
BENADRYL 5/8/2009
& PREDNISONE
n has been received from a 17 yearYold femaleYwith no medical history or drug allergy who was N vaccinated 12/1/2007
with 1st,12/1/2007
2nd and 3rd doses of G
and induration at injection sites. Pain to touch at injection site. 5/27/2009 5/29/2009
n has been received from a pharmacist concerning a female who "one or two years ago" on Uunspecified dates was vaccinated with the first
n has been received from the author of a literature article, title stated above concerning a healthyY 16 old male who more than 8 years after
n has been received from an office Y manager concerning
Y a 12 year old
0 female who on 19-MAY-2009Y was5/19/2009
vaccinated5/19/2009
m rash 24-36 degrees after immunizations 5X care - tylenol and/or motrin. U 6/2/2009 6/3/2009
RIVAX + PCV given. 5/15/09 Dx Ataxia DM T 100.5. 5/29/09 Ataxia persists. 6/5/09 Child back Y to normal 5/7/2009
no signs of 5/15/2009
ataxia.
d, raised, tender, warm to touch area approx 2" x 3" at Varicella injection site. T. 99.3. C/o slightY nausea, seen 6/3/2009
in our Public
6/4/2009 Health Office at
om brought child in, Dr saw a red, hot to touch area to (L) deltoid, measured 5in by 5in in diameter.
Y 6/4/2009 6/5/2009
ated 18 hrs after vaccine child was sitting in cart at Kmart and fell over and was very pale andYappeared to3/4/2009 have fainted.3/5/2009
This lasted 15 min
diarrhea, vomiting, fatique, temperature of 100, left work, did not see a doctor Y 5/29/2009 5/29/2009
and itching palms on evening of June Y 1. Some itching
Y during the week,
1 with bad hives on eveningY of Friday,6/1/2009
June 5. Visited
6/5/2009 urgent care clin
ollowing vaccination with Anthrax, Smallpox,
Y Typhoid (18 May). Pt. with pruritic papular lesionsU which started5/18/2009
on distal6/5/2009
extremities (wrists/an
occal vaccine given at 0907 IM prior to discharging. Pt. had no knownYallergies and not allergic Y to eggs. At 5/17/2009
1015 pt c/o5/17/2009
back and rt flank pai
e and diplopia accompanying Y a cerebellar
Y hemorrhage occurring within about 24 hrs of an influenza
Y vaccination. ###7/31/09 Hospital
### records r
zure lasted 1 min about 2 mon after Ygiving the 0.5 ml IM shot of DT.Tdiphteria-tetanus) Y 6/8/2009 6/8/2009
SED A 12 YEAR OLD FEMALE WHO WAS ALERT AND ORIENTED. THE MOTHER STATED Y THAT THE6/5/2009CHILD WAS 6/5/2009
DUE HER LAST HP
al congestion, lost voice, body aches, rash at injection site Y 5/20/2009 5/20/2009
hours: Significant swelling at injection
Y site and redness, 101 - 102 Fever, Chills, Muscle pain.U After 30 hours: 5/29/2009
Wet Cough
5/30/2009
(diagmosed as br
administered on Tuesday,6/2/09. On Thursday a 2.5 inch x 2 inch erythematous, raised, tender, Y area noted 6/2/2009
around injection
6/4/2009 site. This area
/ 6 days post vaccine noticed warmYto touch /redness / swelling / itchy at around injection site Y on left arm. 5/26/2009 6/2/2009
oke up with a very sore arm. The site of the injection was swollen and tender. He complainedYof feeling overall 5/27/2009weak5/28/2009
and achy. He was runn
ely after having vaccines, patient had a seizure that lasted a few seconds. Dr. did a neurologic Y exam 5 minutes 6/8/2009and 306/8/2009
minutes after episod
ceived injection on 5/26/09 and was fine until the evening of 5/27 when she had a red spot the Y size of a quarter
5/26/2009 at the
5/27/2009
injection site. The are
head ache, nausea, bloating and diarrhea 2 days after taking last of four live virus oral typhoid U vaccine capsules.
5/27/2009 Treatment
6/4/2009 not sought. Imp
RECORD OF FEVER x48 HOURS AFTER VACCINATION; "RASH" FIRST APPEARING AROUND Y NECK, 6/2/2009
THEN TRUNK 6/4/2009 TO UPPER AND
side of injection swelled significantly, with hard raised lumps, lasting 5 days Y 6/2/2009 6/3/2009
s her arm was very swollen. She had a temp. of 104 degrees and she was in bed for 4 days.Y She did not 2/10/2009
call our office
2/10/2009
or report this to any
d a large local reaction at site of DTaP 3 days after the injection. Resolved with ATARAX. Y 6/3/2009 6/6/2009
4 hours, body ache and sore arms x 48 hours. Welts to left arm- (1) anthrax, (1) Tdap >x 5 days. Y 6/1/2009 6/2/2009
hot was given on Friday, June 5th appointment was at 9:15 for a physical. Left arm hurt immediately N after6/5/2009
and began6/6/2009
to swell and was very
n has been received from a consumer Y concerningY his 24 years old fiancee
1 who on 25-MAY-2009 N received5/25/2009
the first dose
5/25/2009
(0.5ml) of GARDA
n has been received from a physician Y concerningY a 15 year old female3 patient who Y on 14-NOV-2006,
N 16-JAN-2007
6/12/2007 and 3/1/2009
on 12-JUN-2007 w
n has been received from a consumer concerning Y his son with general0 sensitivity to all vaccines
U (no specific vaccine or manufacturer given
n has been received from a medical assistant concerning a 55 year old female with Y a historyNof chronic obstructive
5/5/2009 pulmonary
5/5/2009 disease and
.7, Myoclonic movements, joint pain,- Y given ibuprofen,
Y TYLENOL, IV 4 ROCEPHIN: adverse reaction
U began5/28/2009
within 1 hour
5/28/2009
of vaccine adminis
L vaccine - neuritis (LUE) - thoracic outlet syndrome - no strength (L) arm/(R) arm (decrease U strength)- 4/16/2008
decrease vasc 4/16/2008
(L) arm (with elevat
in arms & shoulders. Evaluated by Geneticist & Rheumatologist. 6/9/2008 7/14/2008
n in LDMIM. 30 minutes after shot client upper arm had some swelling, heat to touch and reddened Y raised6/4/2009
area L- 3inch6/4/2009
W 3inch. Light rash
and induration at site injection (L) Deltoid 6x7 cm. Area pruritic. Y 5/27/2009 5/28/2009
ports pain at site, fever, sore throat for 2 days post injection following sores at site, left shoulder
U pain and4/15/2009
decreased4/15/2009
strength and range of
y urticaria, agitation about 1 hr following
Y MMR/VARIVAX increase RR increase HR also, chills. Y BENADRYL, 6/4/2009
EPI, ORAPRED
6/4/2009administered -
and warmth to left thigh area. About Y 10x10 cm area. Y 6/2/2009 6/4/2009
action to KINRIX DTAP-POLIO- Friday 4-17-09 child had small knot. Saturday 4-18-09 childYhad knot 6 4/16/2009 inches in diameter,
4/18/2009 hot to touch.
ceived PENTACEL vaccine on 6/1/09. Leg became red and large amount of swelling on thigh. Y Very fussy,6/1/2009
cried for over an hour.
6/3/09 she noticed onset of itching, redness,
Y and that area was (hard). Pt states 12-15 hoursUafter injection6/2/2009
Sx began6/3/2009
to appear. She denies
and low grade temperature. Y 4/4/2009 4/4/2009
e temperature and lethargic. Y 6/2/2009 6/3/2009
ven PENTACIL at 9:00 am on 6/1/09. He went to daycare and when mom picked him up in Y afternoon noticed6/1/2009
area around
6/1/2009 shot on anterior
arm swollen below injection site 10 Y by 15 cm. Also complained of chest pain: NL EKG; NL enzymes. Y 5/1/2009 5/3/2009
t states: Left upper extremity is difusely
Y reddened, starting around glenohumeral area extending Y towards5/27/2009
elbow. Covers5/28/2009
area of superior &
rash at injection site. Rash is 2-3" long and 2" wide. Patient sought medical attention but only U a hot compress 6/1/2009was recommended.
6/2/2009
inconsolable crying. DTaP/IPV/HIB/PREVNAR
Y and ROTATEQ given at 9:45 am 6/1/09. Crying Y began 9:00 6/1/2009
pm, stopped
6/1/2009
9:00am 6/2/09.
e swelling approximately 15 minutes after vaccines. BENADRYL PO given upon return to clinic. Y 6/3/2009 6/3/2009
diarrhea 12-15 x 1 day. Lasting > 2 weeks. All stool studies normal. Y 4/16/2009 4/26/2009
diarrhea 12-15 x 1 day lasting > 2 weeks All stool studies normal. Y 4/16/2009 4/26/2009
nt legs broke out in hives evening of injection 6/1/09. Woke up next AM & hives on arms & legs. Y Patient took 6/1/2009
25 mg BENADRYL
6/1/2009 8 AM on 0
s, fatigue, rapid HR, abd pain, numb legs- sx's intermittent since then and continue. 7/2/09 Medical
N records received
### 1/15/2008
DOS 11/11/08 to 6/12
other states that pt was a little feverish the morning following her vaccines and that she had some
U redness6/1/2009
at the DTAP 6/2/2009
vaccine site. Yester
cry for 4 hrs - hard to console 6/2/2009 6/2/2009
thigh, redness, some pain and getting bigger. Can walk normally. Started later the night of shots.
U Treatment,
5/26/2009
warm5/26/2009
compress for swelling a
ced hives on torso, no fever and injection site look ok per patient mom. U 6/1/2009 6/1/2009
accines and approximately 4 minutes later skin turned lace like pink and blotchy resembling Y hives. Dr. notified
6/1/2009
eval pt6/1/2009
and given 10 mg Ben
ool IZ's 5/26/09, when child came back fur PPD reading father states child's leg had some rednessY we examined
5/26/2009it and
5/27/2009
measured it.
Y 5/26/2009 5/26/2009
5 min after 3rd GARDASIL injection - Had received injection then walked on to waiting area Y to get father. 6/2/2009
Fainted after 6/2/2009
return to exam soon
-102 rash on 6-3-09 seen in office. Y Y 6/1/2009 6/3/2009
ed rash. Started on 5/30/09 after a fever. Y 5/21/2009
helps, cellulitis treated with BACTRIM. U 5/27/2009 5/29/2009
d to toe entire body on 5/27/09. Started with fever 104 @ 2-3 days prior then rash. ReceivedNMMR immunization 5/14/2009 of 5/27/2009
5/14/09.
er arm red, swollen, and warm to touch.Y Measures about 7 inches in length. Mom took child N see APN. APN 5/18/2009
is treating
5/20/2009
area with butt paste,
er, T: 99 - 101 degree F from the evening to next day, then started having cough - o/e: Chest: Y some wheezes 5/21/2009
and crackles
5/21/2009 (rales) on base
reaction to INFANRIX vaccine in (L) thigh" (MD) Parent "(L) Leg swollen. Onset was Tues. after Y vaccines." 5/26/2009
Rectal temp
5/27/2009
101.5, Tylenol give
vaccine break through. Diagnosed in office on 6/2/09 with varicella. Had about 20 pox. U 4/29/2008 6/1/2009
ven HIB that was expired. Y
edness pain at injection site x 4-5 days - better slowly over 3 wks but left with residual brachial
Y neuritis. 3/26/2009 3/26/2009
6/4/2009
d ENGERIX B vaccine IM in both RYand L deltoids on 5/4/09. At approx 2:30 PM 5/6. Pt wake Y from ncp and 5/4/2009
noted her 5/6/2009
right arm was numb-
redness, and swelling extending over Y entire upper left arm and shoulder. Began 1 day after N injection. Prescribed
5/27/2009KEFLEX
5/28/2009 x 7 days, Predni
dvertently received ZOSTAVAX instead of Chickenpox varicella, CDC called no further f/u. Parent Y informed 6/8/2009
of local reaction to look for. Sup
ut after received shot with brief tonic/clonic activity of upper extremities lasted 3-5 seconds. No
Y loss of bladder
5/21/2009
control.
5/21/2009
ceived #2 GARDASIL on 5-12-09 and called 5-15-2009 reporting c/o itching / have several hours Y after she
5/12/2009
had GARDASIL
5/12/2009 5-12-09. Pt took
thematous indurated lesion on thigh, developed 24-48 after immunization (L thigh). U 6/6/2009
stomach felt queasy; sat down; says her vision was fuzzy; became pale; fainted; assisted toYa lying position 6/8/2009
et fanned;6/8/2009
regained conscious
Y Y 6/1/2009
given 5th HEP B today within 10 min of injection being given in (R)D. Employee noted backNteeth became 6/8/2009
numb on both6/8/2009
sides upper & low
e named patient was seen in my office on February 7th, 2009 with a complaint, which I witnessed one bump on### her shoulder area. Two day
cess @ site of injection. Negative Gram Y stain Negative Culture. Y 1/3/2009 2/5/2009
es high temp starting 1 hour after administration
Y around 101.3 degrees F. Mom gave motrin Yand temp came 6/5/2009
down to6/5/2009
normal soon after dos
NKA, PMH: Dementia, Hypertension, CVA,OA/DJD, hyperlipidemia Patient also has h/o stroke. Y Patient was 2/19/2009
admitted 2/19/2009
for fracture following m
d not know she was pregnant at the time of vaccination and was vaccinated with Anthrax andUHPV 6/2/2009 6/2/2009
d meningitic like illness while
Y out of Y
state. Ultimate
Y diagnosis is Acute 7 Disseminated Encephalomyelitis
U (ADEM).
5/18/2009 Had5/29/2009
ataxic gait, stiff neck w
es after receiving Pediarix on Left thigh.Entire leg became red/purple per mom- bled small amt Y at site. stopped
6/9/2009with bandaid
6/9/2009-then blotchy/v
with 2nd gardasil vaccination, beenYhaving myriad of symptoms. Initial symptoms included N headaches that12/1/2008
started12/1/2008
after the first vaccinatio
s sister also received an immunization and was discussing other shots she'd received in theYarmed forces. 6/9/2009
Client stated
6/9/2009
she felt dizzy. I ha
<5 min. after admin of vaccines. From a sitting position while assuming standing position, she Y fell to floor. 6/4/2009
Syncope duration
6/4/2009 <5 sec. First aid
Y DEVELOPED HIGH FEVERS 101.5-103 FOR 2 DAYS THAT STARTED 10 DAYS AFTERYSHOTS WERE 5/29/2009
ADMINISTERED.
6/7/2009 OTHER TH
s of L facial drooping since 730 am Y this morning. Episodes last about 30 seconds, pt gets glazed over look 6/8/2009
in eyes and6/9/2009
becomes lethargic.
Y 6/8/2009
#1 (1423X) given in right arm on 4/23/09.
Y Adverse reactions symptoms began 4/24/09 exhibitedN by: dizziness,
4/23/2009
headache,
4/24/2009
stomach pain, nau
ness, swelling of about 3 inches. Slight itchiness. Slightly sore. Y 6/8/2009 6/9/2009
re, drooling, swelling of injection site.
Y SOB, passed out completely. No response X 10 min. This Y occurred 6/8/2009
several hours 6/8/2009
after the injection w
sh on arms and hives + joint pain, leftY arm. Y
hours of vaccine c/o sore throat - light headiness U 6/8/2009 6/8/2009
n with TYLENOL, fussiness, decreased eating U 6/8/2009 6/8/2009
degrees about 12 hours after immunizations Y 6/8/2009 6/9/2009
en 2X NL size, Red, hot vesicules aroundY injection site had given Benadryl in ER. Y 6/5/2009 6/6/2009
- large hives at site of injection - myalgias and arthralgias Y 6/2/2009 6/2/2009
r the immunization, child developedY~ 2" red raised tender area surrounding VARIVAX site - Yno vesicules5/30/2009 - now it brown
5/31/2009
skin surrounding s
tous swelling, right deltoid area. DayYafter shot was given. Y 6/5/2009 6/6/2009
old male patient received a first time dose of MENACTRA (lot number U2816AA) intramuscularly N in the right
5/5/2009
deltoid on5/6/2009
05 May 2009. On 0
serious case was received on 08 May 2009 from a health care professional. A 12 year old female Y patient 5/7/2009
received a second
5/8/2009dose of ADAC
ted on (L) ear - Spread down face and Y trunk with a fine, flat, red rash that continued down hisY body - No 5/27/2009
fevers noted.6/8/2009
d syncope episode immediately after MENACTRA vaccine + HGB blood draw. Pt was sitting Y on exam table 6/5/2009
and stated.
6/5/2009
I didn't feel good, I
Y 11/6/2008 11/6/2008
ours, fever (up to 101 deg. F) headache, bodyaches, redness and soreness at site. Bodyaches, Y fever and 5/29/2009
headache 5/29/2009
intermittent for 2 1/2 m
and small purpuric areas on R lower Y leg. Y 5/29/2009 5/29/2009
4-36 hours after vaccine (R) deltoid. Swelling at injection site according to mother- 3 1/2 in high Y 2 1/2 in wide.
5/28/2009Described
5/29/2009
red firm- like 2 go
n has been received from a staff member in a physician's office concerning a 46 Y year old female
U who on4/13/2009
13-APR-2009, 4/13/2009
at 9:40, was vaccin
n has been received from a consumer concerning two of her friend's children who on an unknown U date were vaccinated with MMR II and d
ort received on 29 May 2009 from a Y health care professional. A 58 year old male patient received
U DECAVAC 4/28/2009
intramuscularly in the left delto
ort received on 05 June 2009 from a health careYprofessional. A 47 year old female patient who N delivered twins
6/3/2009vaginally on 02 June 2009 r
MMR II and HAVRIX vaccine on (R) thigh, and Dtap, VARIVAX and IPV on (L) thigh. Noted N large area of 6/8/2009
swelling and redness on (R) thigh
ceived DT on 6/1/09. Started feeling ill 6/2/09; l.g. -HA, fatigue, red sore arm. On 6/3/09 had Ysignificant episode
6/1/2009 of dyspnea
6/2/2009 with headache
given 5/26/2009. Left leg appeared red, warm to touch and painful when touched. Mom noticed Y this on 5/26/2009
6/9/09. Subsequent
6/5/2009appt. 6/6/09.
all" sized area around injection site. YDr Wright believes it is a shingles lesion. Being treated with
Y Acyclovir.6/5/2009 6/6/2009
w fever, broke out in tiny hives (scalp, tummy, back, not legs). Hives light not raised, itchy. Fatigue,
Y diarrhea,
6/8/2009
very thirsty.
6/8/2009
Now only has a c
e within 2 hours. Had fasting blood test on 6/1/09. Arm was swollen at injection site, lump, fever Y 102, nausea,5/29/2009
stomach5/29/2009
ache, vomiting, swol
d severe vaso response and faintedYat check out window approximately 8 minutes after receiving Y vaccine.6/8/2009
She fell hard
6/8/2009
and hit the floor w
er extremity cellulitis. Swollen, red, warm to touch. Painful to patient at administration site. U 6/1/2009 6/3/2009
ceived Tdap vaccine during school Tdap clinic on 5/13/09. On 5/18/09 PHN received phoneYcall from school 5/13/2009
nurse.5/18/2009
She reports patient's a
o right thigh 5 cm around and warm to the touch and redness. Mom stated child had fever as Y high as 1026/8/2009
F - temp today6/9/2009
98.5.
d Hep B #2 dose on 06/08/09. She Y had a little redness at the site and went to bed. She woke N in the middle 6/8/2009
of the night6/8/2009
with neck pain. The
and diarrhea, dehydration. Vaccine given at another Y facility. do not have
2 lot information. 6/18/09
Y ER records 6/1/2009
received6/6/2009
DOS 6/10/09 to 6/11/
led clinic approximately 2 hours after Y receiving Menactra Vaccine stating client complaining Y of headache 6/8/2009
and shaking. 6/8/2009
Advised to follow up
5/28/2009 N 5/26/2009 5/28/2009
s given an adolescent dose of Hep B in lieu of the adult dose. U 6/10/2009
mother reported patient had fevers and Y headache pain since immunizations on 12/15/2008. Patient Y had high fever### and also ###
seemed to be h
was given shots 05/06/09. On 5/11/09 Y the mother noticed a rash on her face which she bestY describes as 5/6/2009
looking like
5/11/2009
heat rash. On 5/13/
ed papules. Red base withe yelllowish vesicles. Rash noticed 48 hours ago. Mom was usingYcortisone cream. 5/26/2009Per Drs 6/8/2009
order patient was to
GIVEN ON THURSDAY, JUNE 4, 2009. SUNDAY A.M. WHEN I AWAKENED MY BODY WAS Y HURTING 6/4/2009
ALL OVER, 6/7/2009
AND MY SKIN HUR
ERYTHEMA 1"X 2" TO RIGHT DELTOID. Y TX-ICE PACK PRN PAIN AND BENADRYL FOR AGE U PRN ITCH.
5/21/2009 5/22/2009
xis (w/in 30 min, irritability,
Y vomiting,Yhives, wheezing). EPI SQ x1, albuterol/atrovent neb, decadron
Y IM, prednisolone
6/10/2009 6/10/2009x5 days. 6/12/09 Me
received DTaP and Prevnar vaccine in January at age 16 months, parents state child was often Y quiet, less
1/8/2009
active than 1/8/2009
usual, and often sta
given 5/20/09. Vomited starting 5/28. Y Temp to 104.6
Y starting 5/29. Mild
2 rash, cough also. Developed
Y severe
5/20/2009
red rash 5/28/2009
5/29 - eventually spre
nning on bilateral arms. On and off Yx 1 wk. Rash Y down bilateral legs1and cont. on arms x 3-4Ndays. Began 4/21/2009
with rash4/23/2009
to face and neck 6-8-0
ools 24 hours after administration ofYROTOVIRUS - continuous for 6 d N 6/3/2009 6/3/2009
vaccine on 1-23-09. Since that date until present date pt c/o pain in rt deltoid area- no swelling,
U edema or 1/23/2009
temperature 1/23/2009
noted.
Juvenile Rheumatoid Arthritis-> seen at medical center. Tx Prednisone, Methotrexate, LEUCOVORIN. N 1/09 started
### 1/14/2009
having back pain, unila
owing inj - inj site slowly turned red and swollen "looked like a spider bite" x 1wk- Cont. to getY red and turned
4/30/2009
into a calloused
5/7/2009 blister appea
0 minutes after receiving vaccine, childY broke out in rash. It started above his eye lids, and inYthe anticubital 6/9/2009
fossa of both
6/9/2009
arms, then progre
ion, redness and tenderness to left Y shoulder area measuring 5cm by 5cm. Pt treated oral Antibiotics.
U 6/8/2009 6/10/2009
mins after rec'vg all imm. appeared fine; started to stand then fainted x 20-30 secs. Revived w/coolY water 6/10/2009
compress &6/10/2009
light stimulation. Rema
started (L) thigh increased on 24 hr and worsened in 48 hr, gotten better, no trouble. Y 6/8/2009 6/9/2009
5/13/2009
DIARIX but didn't need a dose of DTaP or IPV. Y 5/19/2009 5/19/2009
-"Kiwi size"- approx. 3-4 in diameter. Swelling - 1/4 in -raised, painful Afebrile. U 6/8/2009 6/8/2009
inic 1 week after vaccine 6-9-09. According to dad 1 day after receiving the vaccine her attitude N changed 6/1/2009
she became 6/9/2009
compulsive, says she
next day with increased redness and knot under site. Tx with ice. 6/10/09 Pt was seen in office Y today with6/5/2009
pain left arm,
6/6/2009
firm nodule at injec
n: 11/10/98. Received anthrax vaccine Y #1- denies problems. 11/24/98. Received anthrax vaccine N #2- denies
1/8/1999
problems. 12/11/98. Received
medical conditions diagnosed since starting
Y ANTHRAX
Y vaccine series, including fatigue,
Y reproducible
N arthralgias
1/22/1999 / myalgias, and obstructive
Dermatitis, focal Start: 01/2004 Comment:
Y Tinea capis. Symptom: Lymphadenopathy, axillary N Start: 09/2004 ###Comment: bilat axillary a
ceived FLUMIST and ADACEL vaccines Y on 10/31. She developed severe arm pain and swelling Y in the left shoulder ### and arm a few hours af
ceived Tdap into the left shoulder onY 10/31, the arm developed pain, swelling, heat, and itching at the site since### then.
Fever start: 10/31/2006 - Comment: Undocumented, no temperature taken. Symptom: Chills Start: 10/31/2003### - Comment: Have occurred
n: 37 y/o female developed severe Y right shoulder and arm pain and swelling a few hours after Y receiving ADACEL ###vaccination. Symptom: P
old female received DTaP on 12/12/2006 Y at the clinic. Mother noticed child developed a largeU erythematous and ###indurated area on the left
11/4/2001 N 6/6/2000 11/1/2001
U 4/19/2009
n has been received from a consumer Y concerning her approximately 36 month old son with N no pertinent medical
4/9/2007history or drug reactions o
Y a 23 year old female who on 29-MAY-2009 was U vaccinated 5/29/2009
with the first
5/29/2009
dose of GARDASIL,
n has been received from a consumer, for the Pregnancy Registry for GARDASIL concerning Y herself, a 2/12/2008
26 year old 2/12/2008
female, who on 12-FEB
n has been received from a physician Y concerningY a 16-year-old female2 patient withY no medicalN history who 5/18/2009
was vaccinated
5/28/2009 with the second
Y 5/4/2009 5/7/2009
DACEL and MENACTRA 05-12-09 pm., Y Wed pm 5-13-09 adolescent woke up with "baseballYsize knot" -5/12/2009 "hard to touch 5/13/2009
and large red whelp
degree and rigor 12 hours after injection - Resolved 12 hours later without treatment. Y 10/3/2008 10/3/2008
ed Urticaria Patient treated with Prednisone
Y Y 5/29/2009 5/29/2009
was given to me months ago in my left arm. It was understood that it was result in some soreness N for a while.
2/23/2009But there is a numbness and
m to touch 2x2 circumference. 6/3/2009 6/5/2009
vaccine breakthrough. Diagnosed with varicella in office today. U ### 6/2/2009
r vaccine. Severe local reaction: swelling, erythema, warmth, itching. Given Loratidine. 6/4/09- patient states 3/10/2009
after seeing
3/13/2009Dr and taking the
on 6/5/09 c/o pain in (L) arm with swelling and pain radiating to upper scapulae area. This occurred U when he awoke. T-102 in am. Seen at c
er arm area of induration and erythema 156 mm X 75mm. Right upper arm circumference 7Y1/8 "and left is 6/1/2009
6 1/2". T-99.9
6/2/2009 area hot to touch
hed side effects which have been checked. Abdomen cramps; ache: joints; aches: whole body; bowels:9/27/2007 irritable, cellulitis; chills, chills feve
ceived PNEUMOVAX 23 vaccine in her left deltoid muscle at her place of employment on 04/09/2007. Y She 4/9/2007
experienced 4/9/2007
swelling and pain in
n the clinic on 5/20. Mom states that on 5/19/09 pt had fever 105 and rash. Today rash is worst but no fever. 5/18/2009
Red bump 5/19/2009
raised pink on abdo
ction with marked erythema, warmth,Y and pain at injection site within 12hrs of administration.USize of affected 5/27/2009
area 12cm
5/28/2009
X 10 cm Treated w
on neck after 1st shot (4-5 days later) thought it was from something else, itching also. After Y2nd shot rash 4/24/2009
widespread 4/28/2009
on trunk, neck, arms
n after injection (s/s) Pt got hot, very moist feeling, felt nauseated, dizzy. After she sat for about
Y 5-10 min 6/9/2009
and had drank 6/9/2009
of H20 she felt bet
swelling from shoulder to elbow - MOTRIN - rest- elevation Y 6/9/2009 6/10/2009
red, swollen, bruised, warm to touch. U 6/4/2009 6/6/2009
ven ADACEL instead of DAPTACEL at age 4 yrs 10 mths. No adverse reaction. All other vaccines given in6/2/2009 another state.
omiting 24 degrees after vaccines. Advised pedia lyte (5m. am'ts) Then gradually elevated toYformula. Same 6/9/2009
symptoms6/10/2009
after 1st series of v
tchy, warm, sore, rash 6" long x 4" wide went to my doctor, prescribed KEFLEX generic cephalexin Y 500 mg 6/5/2009
twice daily6/6/2009
for 7 days.
was reported via medical records that were forwarded by lawyers and described Ythe occurrence U of polyarthralgia
7/27/1999in an adult male subject w
d Tdap vaccine in the ED. The vaccine is to be given to patients between 11-64 years of age.Pt Y reported5/27/2009
to our office6/2/2009
on 6/8/09 that 6 days
sician note: "her right arm shows an inflammation, some redness and mild induration at the Y site of her recent
6/6/2009
injection
6/7/2009
when she got her pn
r to 101F responded to NSAID's, nausea, sattelite lesions, marked inflammation of shoulder Y with bilateral5/24/2009
swelling of 6/3/2009
axillary and cervical ly
eived vaccines MMR, and Hep. B. on Monday 06/08/2009. Called today.Stated on Tues nightYtongue became 6/8/2009
sore and6/9/2009
swollen. Still sore an
erythema, swelling 3-4" in diameter 24 hours after receiving shot. Warm compresses and Benedryl Y advised.
6/9/2009 6/10/2009
ug reaction of head chest back armsY and legs. U 6/9/2009 6/11/2009
ely after vaccine was given, the patient developed pallor and was dizzy. Y 4/6/2009 4/6/2009
HE, DIZZINESS, PROBLEMS WITH SPEECH, NAUSEA, STOMACH ACHE, SLEEPINESS,NNO APPETITE. 5/29/20096/12/095/29/2009
Medical records rece
pular, red in color, blanching, generalized in arrangement U 5/29/2009 6/10/2009
unk and forearms presented after second pill administered. Y
unk and back with some itching. Y 6/9/2009 6/10/2009
e long seizure associated with feverY2 hours after administration of Dtap and Prevnar Y 6/8/2009 6/8/2009
et 6/7/09, duration of 3 days; Eye sensitivity
Y to light: onset 6/8/09, duration 1 day; Runny Nose: Y onset 6/7, 5/28/2009
duration still6/7/2009
ongoing as of 6/11/0
perienced yesterday (6/10/09) on the body from face to upper thigh, fever. Mom gave Tylenol- U steaspoonsful
6/4/2009
and applied
6/10/2009 Calamine lotion.
mm area of induration, warm to touch, erythematous Y 6/9/2009 6/10/2009
nduration, pain, itching, warmth, 14cm x 11.5 cm area surrounding injection site. Local cellulitis Y 6/2/2009 6/9/2009
: Pt. had conjunctivitis in both eyes Yand was tx'd with antibiotic gtts x5 days. 8 May 09: Annual Y physical exam
5/29/2009
was normal.
5/29/2009 Conjunctivitis ha
ose of Hepatitis A given by error too early from first dose.CDC called and verified that this dose Y would not 6/11/2009
be valid and6/11/2009
should be repeated
0 seconds after the first injection myYdaughter became faint and passed out, she then began U having a seizure,
6/11/2009
the entire
6/11/2009
episode lasted app
tly, but want to report now. 3 Influenza vac, with identical reactions each time of visual change Y (marked) 11/1/2004
& headache. 11/1/2004
Recovered all 3 times
Molluscum after previous dose of PROQUAD. Y 7/31/2006 6/9/2009
rom a nap around 5pm on 6/9/09 and Y noticed (L) arm was red, swollen, and warm to touch. Y Gave TYLENOL 6/9/2009
d/t LG fever
6/9/2009
of 99 per mother,
ts with red, raised area on outer Lt thigh + tender to touch, about size of a baseball -SX began this a.m. 6/11/09- 6/10/2009 Area
6/11/2009
is site of KINRIX inj.
ter Tdap, Menactra , Varicella vaccines administered - Vital taken rest, fluids, EKG. Y 6/11/2009 6/11/2009
ash within 6 H of administration of PREVENAR Lt - MMR, VARIVAX, HAV 6/11/2009 6/11/2009
eaction. Injection site, swelling, red Yand hot Fever treated with Motrin and Benadryl. Y 6/8/2009 6/10/2009
2 cm red, cellulitic area were INFANRIX given - x2 days - warm compresses-PO AUGMENTIN, Y 400 POBID 6/8/2009 6/10/2009
Y 8/14/2008 5/5/2009
syndrome, headache + fever treatedYwith Keflex 500mg - PO TID X 10 days. Y 6/9/2009 6/9/2009
with blisters on mouth. Y Y 6/7/2009
of the eyelids, dizziness, feel sick. top center of head tender to touch, hurts. "This feeling" will N not go away!1/9/2009
I called1/10/2009
the Doctors Office the
01) 24 hours after immunizations - red rash on trunk 10 days after immunization U 5/25/2008 6/5/2009
nger rash, erythematous nodules well demarcated. N 5/20/2009 6/3/2009
meter redness no induration or tenderness
Y - no cellulitis - no treatment necessary Y 6/5/2009 6/7/2009
ther of the client reported the following
Y events occurred after vaccination of client for Yellow U Fever and Typhoid
5/27/2009 VI at5/28/2009
clinic on 5/27/09. 5/28
y swollen upper left arm shoulder toYelbow. No fever good movement in shoulder, elbow, and wrist prescribed 6/4/2009
Keflex6/7/2009
for cellulitis.
e out in hives within 24 hrs. Y 6/4/2009 6/4/2009
veloped rash about 1 1/2" in diameter at injection site. White in center. U 6/2/2009 6/4/2009
er vaccine administration, approximately
Y 15-25 minutes child had syncopal episode that wasYprolonged with 6/5/2009
noticeable 6/5/2009
pallor, and fluctuan
ped redness, swelling & induration of R thigh approximately 48 hrs after receiving vaccines. YMinimally tender, 6/3/2009
no fever 6/5/2009
or other systemic sy
MMR, varicella, PREVNAR with Hep A 6/8/09. Began with erythematous rash that night thatYbecame a generalized 6/8/2009 urticarial
6/8/2009RXN the next
d spots located on her scalp, forehead and face Lt is bilaterally. Spots itchy. no blistering -TreatmentY - acyclovir
5/15/2009 X 7 5/28/2009
days
icellaform rash on chest, back, abdomen,
Y buttocks, upper thighs. Treated with diflorasone diacetate
N ointment
5/14/2009
for itching.
5/22/2009
Y 6/1/2009 6/1/2009
inistration of GARDASIL patient got dizzy + started perspiring. Y 6/8/2009 6/8/2009
n has been received from a physician, Y for GARDASIL, a Pregnancy Registry product, concerning Y a 15 year old### female with ###
no medical hist
n has been received from a registered nurse, for GARDASIL, a Pregnancy Registry product,Yconcerning6/26/2008 a 17 year old 8/6/2008
female patient with n
n has been received from a physician concerning Y a 16 year old female 7 patient who is a tampon U user and who on an unknown date was vac
n has been received from a pharmacist Y concerning Y a 69 year old female
0 patient who
Y on 11-MAR-2009
N was
3/11/2009
vaccinated3/15/2009
SQ with 0.65 mL of
d vaccines 6/10/09. Had High fever (TMAX 104.1) (6/11/09), given TYLENOL/MORIN; No vomiting, Y no seizures.
6/10/2009Also 6/11/2009
with runny nose, mild
and warmth at the site of injection the Y size of a golf ball. Entire thigh was swollen. U 6/10/2009 6/11/2009
ection site. Low grade fever; back pain started 6/4 in pm; lethargic; aches; cough; weaknessYin limbs, decreased 6/3/2009PO6/4/2009
all lasted 2 days. No l
on- Red, itchy, warm 2 1/2 U 6/8/2009 6/10/2009
er patient received shots child began Y to run a high fever of 104 - 105 degrees, and developed Y a cough. Stated
6/9/2009 also had
6/9/2009
decrease in appeti
VAQTA and MENACTRA. After MENACTRA (approx 1 min) Pt slumped to side and fainted. Recovered Y immediately
6/12/2009 6/12/2009
c/o dizziness and head
d vaccines approx. at 2:30 pm on 6-11-09 mom states at 8:00 pm that night pt began with redness Y and itching
6/11/2009to palms
6/11/2009
of hands. Hands ha
tvaccinial lymphadenitis beginning post-vaccine
Y day 5, involving left axillary, supraclavicular U
and cervical nodes,
6/1/2009 non-suppurative,
6/5/2009 no system
9 developed headaches that progressed to lethargy, Y slurred speech22and imbalanced gait. HeUwas hospitalized 5/6/20096/2/09
5/23/2009
(and remains hospital
Patients Mother called office and reported
Y that Left arm at site where daughter received vaccine U is red, hot
6/9/2009
and swollen.
6/10/2009 Provider Dr. mad
cine administered pt became flushed,tachycardia,thick
Y tongue.tingleing in lips and throughYout body. Pt 6/10/2009
evaluated6/10/2009
in Occ Health. Remai
ted for a few seconds. I held her in chair until she came to and then we got her on the examYtable and let 6/12/2009
her rest for6/12/2009
about 15 minutes. S
4 hours from the vaccination time patient stated that she had a raised reddened area aroundUthe injection 6/9/2009 site(left deltoid)and
6/10/2009she started ex
d sensation in left arm, left arm weakness, and cold left hand U 6/5/2009 6/6/2009
ately 24 hrs after vaccination. Noted left arm swelling and c/o numbness from shoulder to wrist. U After 48 6/10/2009
hrs remains6/11/2009
swollen but no erythem
periencing itchy palms and Y also had pressure in his ears. Pt was red and flushed. Pt also had Y itching on the
6/8/2009
back of his
6/8/2009
head. Epi was adm
ounding vaccine site was red 2-3 inches Y in diameter in right arm, no induration,no heat present U 6/3/2009 6/3/2009
28 year old male with complaints of hives that started showing up within the first week of getting N home from 5/16/2008
deployment.
5/25/2008
He reports it was
immunizations began having neck pain with radiation down back; right arm discomfort and then N later in week6/4/2009
right knee
6/5/2009
lateral discomfort a
developed a maculopapular rash at the varivax injection site, on 5/25/2009. Y 5/15/2009 5/25/2009
ash and swelling noted in left deltoid. Received 2 vaccines on 06/11/09, noticed soreness inULeft arm 146/11/2009 hours later.6/12/2009
Awakened next morni
d muscle red/swollen and warm to touch 1 and 2 days after administration. Size of tennis ball. Y Improving 6/10/2009
today on day6/11/2009
2.
ECEIVED VACCINE ON 06/09/09 AT MARYMOUNT PRIMARY CARE AROUND 4PM WENT HOME AND6/9/2009 HOUR LATER 6/9/2009
ARM BECAME S
was reported via a statement of injuries received via a lawyer and described the occurrenceUof flu-like symptoms in an adult male subject w
ain at injection site (~ 3" inch diameter), oval shape rash /redness. U 6/10/2009 6/11/2009
n with what looked like bug bites - Mom Y stated they appeared with VARCELLA shot + gettingYworse - Mom 5/27/2009
took child5/29/2009
to hospital - trans. Pt t
with swelling to right arm. Y 6/10/2009 6/10/2009
hematous rxn to both legs, 6 x 6". Y 6/8/2009
rm and tender indurated area at site of VARIVAX- 7x9cm. Y 6/10/2009 6/11/2009
NACTRA injection. Child had brief syncopal episode. Lasted about 30 seconds, then alert, normal Y neurologically.
6/12/2009 6/12/2009
confluent smooth area L deltoid. Local Rx. Y 6/10/2009 6/11/2009
09 after receiving immunizations the child had Y rhythmic movements1of arms and legs followed Y by lethargic5/26/2009
periods where
5/26/2009
baby was unresp
mplains of headache after 1 hour ofYHep A shot, muscle cramps on the left arm, tingling of the U left fingers.
6/12/2009 6/12/2009
tes she has muscle cramps over both Y shoulders, back neck, these symptoms appeared 15 minutes U after6/12/2009
shot, nausea,6/12/2009
sweating. 3 hours a
reaction at site of VARIVAX. Slightly tender. 6x6 cm. Y 6/10/2009 6/11/2009
esented to office with redness, hot to touch, knot at injection site, and treated with VERIPRED Y 20mg. 6/9/2009 6/11/2009
d ZOSTAVAX vaccine on 6/10/09 - RTC on 6/12/09 C/o pain, red, warm to touch at injectionUsite. Advised 6/10/2009
warm compresses.
6/11/2009 Given RX for
elling and redness at injection site. Ice pack applied. BENADRYL given one per day. Y 6/11/2009 6/11/2009
and redness at injection site 1 week Y after administration. Y 6/4/2009 6/11/2009
oid pain with radiating to neck and forearm.
Y Paraesthesia in right arm following Tdap immunization.
N 6/8/2009 6/8/2009
ad to toe rash. Blisters mostly on chest. 6/12/09 Rash almost gone. 0 blisters. Y 6/3/2009 6/7/2009
, in chest, pale, warm, nauseated. Cold packs were applied, she denied any difficulties breathing Y and recovered
6/12/2009 completely
6/12/2009within a few m
f 5/27. arm pain On 5/28. abdominal pain, leg pain; tingling backs of legs & feet. Light headed, Y passed out 5/27/2009
in shower.5/27/2009
Temp 100.8.
at daycare. He took a longer than average
Y afternoon nap and woke up a little warm. He wasYstanding at the 6/3/2009
window6/11/2009
with his caregiver whe
nization on 5/26/09, had episodic spells
Y of rhythmic movements of arms and legs followed by Y lethargic episodes.
5/26/2009Baby 5/26/2009
felt cold to mother d
eloped Abnormal Seborrheic dermatitis after vaccination,
Y also Failure
6 to Thrive. N 6/7/2007 6/8/2007
MR 10 days post vaccine Y 6/2/2009 6/12/2009
days after my 2nd vaccine, my was swollen and extremely red above the injection site. Soon N after, I developed
6/1/2009 a rash6/3/2009
(starting on my back
d vaccine in the hospital. Approximately 1.5 days after administration RN noticed moderate swellingU and6/13/2009
redness of6/14/2009
right upper extremity w
Y 0 N
ort was received 04 June 2009 fromYa consumer, who is also the patient. A 67-year-old female U patient with1/1/2008
a history of1/2/2008
penicillin, seafood an
ort received on 08 June 2009 from another
Y manufacturer whose initial reporter was a health careU professional. A 24 year old female patient
n has been received from a physician Y for the Pregnancy Registry for GARDASIL regarding an Y 18 year old female ###with6/1/2008
depression and a his
n has been received from a physician concerning an approximately 80 years old Y female whoNwas vaccinated 8/2/2007
with a 0.65ml
8/2/2007dose of ZOSTA
n has been received from a physician, for the Pregnancy Registry for GARDASIL, concerning Y an 18 year6/13/2008
old female who on 13-JUN-2008
n has been received from a physician concerning a 29 year old female who on 14-MAY-2009 Y was vaccinated
5/14/2009
with VARIVAX
5/14/2009(Oka/Merck) (
n has been received from a nurse, for the pregnancy registry for GARDASIL, concerning a female Y with no7/1/2007
known allergies
5/24/2008and no pertinent
Y concerning Y a 10 month old female
0 with a history
Y of wheezing
Y who was vaccinated 12/1/2006
with 3 doses of RE
n has been received from a consumer Y concerning Y his 15 year old daughter
0 who was vaccinatedU with GARDASIL. After the patient received
arted sneezing approx. 20 minutes after gettingYimmunization. Left eye 1 swelling and pt. c/o itching
Y - rash 6/10/2009
on thigh. BENADRYL
6/10/2009 40 mg given
s (not just in shoulders with shots - though it is worst there), sore lymph nodes (at back of neck),N sore throat, 6/5/2009
aching ears,
6/5/2009
loss of appetite (n
AY, JUNE 4TH, RIGHT SIDE OF FACE Y STARTED Y SWELLING. PARENT 5 TOOK HER INTO Y EMERGENCY 6/4/2009
ROOM. BY 6/4/2009
THE TIME THE M.D
and briefly passed out a few minutes after vaccines administered. Client laid on exam table and Y given juice.6/15/2009 6/15/2009
RECEIVED ALL THE VACCINES LISTED Y IN ITEM NUMBER 13 ON 06/10/2009 SHE STATED N HAD AN 6/10/2009
OUTBREAK 6/11/2009
OF HIVES THE FOLL
ection patient complained of left arm pain rest of day. Next day had headache, chills, body aches, Y and hives
6/12/2009
to arms6/12/2009
and torso. 2 days late
ching under armpits 10/30 red and Y itchy under arms, down side of breasts, on stomach and Y down to the pelvic### area. 10/31### went to stat care
anthrax vaccination, member states she had 5 menstration flows in a 6 week period. This reaction Y has never
8/15/2007 happened
8/22/2007
to her prior to vacc
ped zoster rash within 24hrs of receivingY vaccine. Pt was seen in office 6/15/09 and started on U Famciclovir6/9/2009
and Prednisone.
6/9/2009
on given at 9:20 a.m. Patient showed signs of excessive tiredness at 7:45 p.m. Vomiting occured Y beginning6/12/2009
at 4:00 a.m.
6/12/2009
er receiving DTaP #4 and Hepatitis Y A #1, patient presented to ER with c/o redness and swelling Y at injection 6/9/2009
site. Today
6/13/2009
(6/15/09)mom repo
e given on 5/20/09. Shot site got swollen,
Y hot and erythematous. Was adv to try ice and BenadrylY initially.
5/20/2009
Came into 5/21/2009
offc on 5/22/09 & wa
w fever INJECTION ON 6/10/09 DEVELOPED A 4 INCH RED BLOTCH ( NO FILLED) ON LEFT Y BACK 6/10/2009
OF ARM AND 6/11/2009
FELT MALAISE x 1
d zoster pain 48 hours after administration
Y and classic rash 6 days after vaccine. U 6/8/2009 6/10/2009
extreme swelling to injection site per mom. Witnessed by Dr. at home visit. Y 6/10/2009 6/11/2009
d vaccinations on 6/9/09. He was up most of the night after vaccine with pain in his left thight. U On 6/10/09,6/9/2009
thigh was 6/9/2009
red & still painful. Also
pells started in January 2009. They Yoccurred multiple times per day and continued for over 2Nmonths. She 11/4/2008
also experienced
1/9/2009 nausea, dizzin
ng, redness, irritation at injection site with little blister bubbles at site. Y 6/11/2009 6/12/2009
ike rash developed 3 days after given Zostavax Y 6/10/2009 6/13/2009
en dots around injection site. Hives on upper deltoid to elbow. Pt to take BENADRYL q 6 hours Y prn call if5/18/2009
worse. 15cm 5/19/2009
hive around injection
n site approximately equal to 2 X 2" red swollen, hot to the touch, raised area. The next day injection has 6/12/2009
gotten approximately
6/13/2009 1 " bigger t
ddenly fell to the floor about 1 minute after. Y 6/8/2009 6/8/2009
ateral lower extremity edema. Assoc Y with pain that makes walking difficult. Also assoc with malaise
Y and 4/17/2009
fatigue. Occurred
4/23/2009both times she w
d erythema multiforme w/in 96' of DTaP, Y Hep A, PREVNAR and MOTRIN. Y 6/3/2009 6/7/2009
Y and described the occurrence of labial swelling inYa 16-Year-old 1/22/2009
female subject
1/23/2009who was vaccin
rts she noticed hives on baby's back; Buttocks at 8 PM on 5/27/09 - approximately 4 hours after Y injection5/27/2009
- and a fever5/27/2009
of 99.9 gone by noo
een on 6/9/09 for pap smear - during course of visit she advised provider that she refused any Y further GARDASIL. Stated that apx 3 hours a
in waiting area. Y 6/11/2009 6/11/2009
11/11/08 - 1st sore on outer vaginalYarea/left side. 11/12/08 - fever 101. 11/14-18/08 - more Y sores-outer 11/7/2008
left vaginal area. 11/20/08
### DR. take
s red rash, left side of forehead and surrounding Lt eye, consistent with shingles. N 6/2/2009 6/4/2009
.T. Congestion; 6/2/09 Fever, leg pain; Y 6/6/09 headache,
Y vomiting;126/10/09 - broad-based gait, facial weakness/?
5/13/2009asymmetry.
5/31/2009 7/21/09 Hosp
pain, erythema in (whole upper right) arm of injections. Symptoms started within 24hrs. At 4 U days starting6/11/2009
to improve.
e on 6/5/09 mother noticed left arm was red and swollen from shoulder to elbow. Afebrile. Cold Y compress 6/4/2009
applied. 6/5/2009
erve palsy "Bell's palsy" Y U 6/11/2009 6/12/2009
cines 6/3/09, started with fevers to 104-105 on 6/4/09, seen in clinic 6/5/09 with fever to 104.4, Y no S/S URI, 6/3/2009
UA dip (-).
6/4/2009
F/U call 6/6/09 fever
9-4AM started vomiting/diarrhea, 11:00AM
Y Fever 100.7. By 7:00 PM fever 102.8. ContinuedYto vomit, went 5/28/2009
to emergency
5/29/2009
room. Received I
s in wrist, elbow and shoulder of arm ADACEL was administered, began within a few minutes Y of injection.5/21/2009
Numbness 5/21/2009
was in (R) arm. Full ra
ped body aches, myalgias on 5/29/09. Y The next day, she was much better. Y 5/28/2009 5/29/2009
ling R Deltoid Y 6/4/2009 6/8/2009
d rash on hands, chin 6/12 taken to Medical Center Rx for Prednisone 20 mg Qd II tabs 6/15Yspoke with 6/11/2009 mother, patient6/12/2009
is doing well today.
n waiting room. Fell and hit her head on chair in waiting room ~ 5 min after receiving vaccines. Y Possibly 6/15/2009
hit head on6/15/2009
seat cushion or possibl
th large area of erythema, warm to touch Y 6/10/2009 6/11/2009
deltoid ~ 3 cm oval shaped area erythema, edema + warmth + induration 0 fluctuation + tender U to palpation.6/10/2009
given Bactrim
6/11/2009DS #14, T by mo
vaccine adm. on 6/10/09. Mother noted "small red bump" at site yesterday. Larger red round Nspot today. 6/10/2009 (Left triceps6/11/2009
area) (6cm diameter) S
ceived her vaccine on 4/20/09 am and began screaming at 4/23/09. She was seen in the ERYafter 2018 on 4/25/09, when abdominal x ray,
e headache and swelling RT arm - Aspirin Y TYLENOL. Ice pack initially. (2) Repetition of above U q 2 weeks2/27/2009
with shooting2/28/2009
pains RT side body
he had swelling and pain at injection site. Y 6/4/2009
9 Pt saw Doctor reports received TdYBooster at Hospital on 5/19/09. Left arm erythema induration Y 2 degrees.
5/19/2009DX: Local
5/21/2009
allergic reaction to
within 4 hours, cellulitis picture 48 Y
hours later. U 6/9/2009 6/10/2009
d MENACTRA) Tdap 8/407. Head ache /st over time developed fatigue (sleep up to whole day) N and headache 9/19/2007 (1st 10/8/2007
concerning Reaction). (
A on 10/29/08 HA started that he did not have at time of apt & vaccine. Seen 10/31/08 for abd N pain & HA. ### ###
red 5/22/09; on Sunday, 5/24/09 Pt developed papular rash on upper back and chest, with itching. Y Both 5/22/2009
itch and rash 5/24/2009
diminished over next
n has been received from a physician concerning a patient who on unspecified date was vaccinated U with a dose of GARDASIL (LOT# not r
n has been received from a physician Y concerning Y a 19 year old female0 with sulfonamide allergy,
Y allergy to2/2/2007
PEDIAZOLE 2/2/2007
and AUGMENTIN,
Y aYfemale with no allergies
0 who on 20-JUL-2007 Y and on 24-SEP-2007
1/25/2008 1/25/2008
was vaccinated IM 0.5
n has been received from a nurse practitioner concerning 3 children who was vaccinated with U GARDASIL. The nurse practitioner reported
Y concerning a teenage female who within the last two years
Y (approximately 2007) was vaccinated IM
n has been received for the Merck pregnancy
Y registry, from a nurse concerning a female patient,
Y who was 9/28/2006
vaccinated with### two doses of GA
n has been received from a registered nurse, for the pregnancy registry for GARDASIL concerning
Y a 21 1/16/2008
year old female
1/16/2008
with a history of la
n has been received from a physician for the Pregnancy Registry for GARDASIL, concerningY a 17 year old female ### with
2/12/2008
no known allergies
n has been received from a Nurse Practitioner, for the Pregnancy Registry for GARDASIL, concerning
Y a 19
5/9/2008
year old 5/9/2008
female with thrombocy
n has been received through the Merck
Y pregnancy registry from a registered nurse concerning Y a 21 year 4/3/2008
old female with
6/5/2008
no pertinent medic
n has been received from a physician concerning four female patient's who were vaccinatedYwith dose of GARDASIL. Subsequently the pa
n has been received from a physician, for the Pregnancy Registry for GARDASIL, concerning U a 21 year 2/20/2009
old white female with no significant
Y nurse concerning an 11 year old female who on 11-MAR-2009
U was
3/11/2009
with GARDASIL (lot
n has been received from a registered nurse concerning a 11 year old female who on 24-MAR-2009
U was3/23/2009
vaccinated3/23/2009
n has been received from a registered nurse for the pregnancy registry for GARDASIL concerning
Y a 16 year
5/19/2008
old female,
5/19/2008
who on 26-FEB-20
Y nurse, for the GARDASIL a Pregnancy Registry product U concerning 3/20/2009
a 14 year 3/20/2009
Client received MMR and Varicella vaccines.
Y Mom was instructed to observe carefully for fever
Y 5-12 days5/28/2009
after vaccine 6/3/2009
administration and to
Y
n has been received from a medicalYassistant concerning a female who was vaccinate with on U unspecified3/3/2008
dates (doses and LOT# were no
n has been received from a caller concerning her daughter a 17 year old who became very ill U after receiving5/1/2008
injection5/1/2008
n has been received from a 20 year old female patient with parakeratotic cells evidenced in N
previous PAP 4/28/2009
test, who4/29/2009
on 20-APR-2009 was v
n has been received from a consumer concerning herself with no previous pregnancies and Nno reported past 5/1/2009
drug history
5/1/2009
who on 01-MAY-
Y history 4/15/2009
reported and 4/16/2009
no known drug allerg
Y concerning a 15 year old female who on 27-Feb-2009
Y was2/27/2009
vaccinated2/27/2009
intramuscularly. 0.5ml
n has been received from a nurse practitioner concerning a 16 year old female patient with aNhistory of epstein-barr
5/1/2009 virus5/2/2009
infection and lymp
n has been received from a physician concerning a teenager female who was vaccinated with N the first dose of GARDASIL in April 2007 and
Y concerning a 15 year old female with PENICILLIN allergyN and no pertinent
11/5/2008medical1/1/2009
history who was v
Y nurse (RN) concerning a 17 year old female who on 24-JUL-2008
U 7/24/2008
was vaccinated
12/9/2008
with the first dose
n has been received from a mother concerning a her daughter who on 3-JUN-2008 was vaccinatedU with her
6/3/2008
first dose of GARDASIL (dose
n has been received from a physician concerning a female patient who on 04-MAY-2009 was Y vaccinated 5/4/2009
with the first5/4/2009
dose of GARDASIL (
Y concerning a female patient who was vaccinated with YGARDASIL and experienced syncope, the pati
n has been received from a consumer concerning her 12 year old daughter who on an unspecified
U date was vaccinated with her first dose
n has been received from a doctor of
Y osteopathic medicine (D.O.) concerning a female who Yon an unspecified date was vaccinated with the
n has been received from a registered nurse concerning a 21 year old female with no pertinent
U medical history5/1/2009or drug
5/1/2009
n has been received from a medicalYassistant and the patient's mother, for GARDASIL, a Pregnancy
N Registry
4/21/2009product,
4/21/2009
concerning an 17 ye
n has been received from a licensedY practical nurse, for the Pregnancy Registry for GARDASIL
Y (Lot # 659184/0843X),
8/21/2008 8/21/2008 concerning a 25 yea
n has been received from a 25 year old female certified medical assistant concerning herselfYthat she was vaccinated IM with the third 0.5 m
n has been received from a Certified
Y Medical Assistant concerning a 14 year old female withNno pertinent 4/7/2009
medical history
4/24/2009
who on 07-APR-2
n has been received from a healthcare worker concerning her 18 year old daughter who wasUvaccinated11/9/2007with the third11/9/2007
dose of GARDASIL a
n has been received from a 23 year old female who on 04-MAR-2009 was vaccinated with with N second dose 3/4/2009
of GARDASIL.
5/4/2009The patient ha
n has been received from a consumerY concerning her daughter a 23 year old female with a history
N of eczema and Dairy allergies (cause of
Y concerning a 15 year old female who on 06-MAY-2009 Y was intramuscular
5/6/2009 vaccinated
5/6/2009 with her 05ml d
n has been received from a pharmacist who heard from a nurse (mother of the patient) concerning
U the female patient who on unspecified d
n has been received from a 23 yearYold female with no medical history or drug allergy who onN 01-May-2009 5/1/2009
was vaccinated
follow up information has been received from a registered nurse concerning a 27 year old female
Y with penicillin
3/9/2009 allergy
3/9/2009
and no pertinent me
Y concerning a female patient about 20 years old who on N an unspecified date was vaccinated with a do
Y concerning a female who in October 2007, was N vaccinated 10/1/2008
with the first
10/1/2008
dose of GARDASIL.
n has been received from a nurse manager
Y concerning a 25 year old female who on 08-MAR-2009
Y was vaccinated
3/8/2009 with 3/8/2009
GARDASIL. There
Y concerning a 14 year old female who on an unspecified U date was intramuscular vaccinated with GAR
n has been received from a licensed practical nurse concerning her 16 year old daughter withY DURICET allergy8/3/2007 and no pertinent medical h
n has been received from a female who in 2006 was vaccinated orally with GARDASIL and U just recently had been diagnosed with human p
n has been received from a consumerY concerning her 16 year old daughter with lactose intolerance
N and4/22/2009
not other drug 5/9/2009
reactions or allergie
Y a consumer and a secretary concerning a 15 year oldNfemale patient 5/8/2009
with no history
5/8/2009 of allergies who
n has been received from a medical assistant concerning a 21 year old female with no allergies
Y or medical 4/23/2009
was vaccinated intra
n has been received form a physicianY concerning his 33 year old daughter who had been vaccinated
Y with GARDASIL series. During one of
n has been received from a physicianY concerning a 17 year old female patient who on 27-Feb-2009
Y was2/27/2009
vaccinated with 3/1/2009
the first dose of G
n has been received from a physician concerning a patient who was vaccinated with GARDASIL. U Subsequently the patient experienced co
n has been received from a physician concerning a 21 years old female with no pertinent medical
Y history 5/6/2009
who was vaccinated
5/6/2009 with GARDA
Y nurse in a physician's office and a registered nurse inUa county health2/5/2009
department,
2/5/2009for the Pregnancy
n has been received from a medicalYassistant concerning a 26 year old female who on 08-MAY-2009
Y was5/8/2009
vaccinated5/8/2009
n has been received from a physician's assistant who reports an office had several patients Ufaint after receiving GARDASIL. It was unknow
n has been received from a medicalYassistant, for GARDASIL, a Pregnancy Registry Product, Y concerning5/4/2009
a 17 year old 5/9/2009
female who was va
n has been received from a nurse concerning a 24 year old female who on 11-MAY-2009 was U vaccinated 5/11/2009
with a 0.5 mL first dose of GARD
n has been received from a certified medical assistant concerning a 14 year old female with Yno pertinent5/14/2009
medical history
5/14/2009who on 14-May-20
Y concerning a female patient who in 2008 startedN the series of GARDASIL. Concomitant thera
n has been received from a receptionist
Y concerning her daughter who on an unknown date was U vaccinated with a dose of GARDASIL (lot n
n has been received from a certifiedYmedical assistant concerning a 25 year old female patient
N who on 17-APR-2009
4/17/2009 4/17/2009
received the first dose
Y a female who on an unknown date, was vaccinatedY IM with the first dose of GARDASIL 0.5m
n has been received from a physicianY concerning a 15 year old female with a history of headaches
Y who on unspecified dates were vaccina
n has been received from a physician and a registered nurse concerning an 18 year old female Y who on 18-Mar-2009
3/18/2009 3/18/2009
n has been received from a nurse practitioner concerning a 25 year old female who on 20-OCT-2008
U was
4/16/2009
vaccinated4/16/2009
n has been received from a licensed practical nurse concerning her 25 year old female friend N who on 18-MAY-2009
5/18/2009 5/19/2009
was vaccinated with he
U with10/2/2007
the first dose
11/1/2007
of GARDASIL on 02
n has been received from a physicianY Assistant and a Licensed Practical Nurse concerning N a 16 and half 1/9/2009
years old 1/14/2009
female with familial risk
n has been received from a physicianY concerning a female who was born on 09-Jun-1988 was U vaccinated8/7/2007
the first dose of GARDASIL (Me
n has been received from a Nurse Practitioner concerning a 17-year-old female patient who Yon 07-AUG-2007 7/24/2008
was vaccinated
n has been received from a physicianY concerning an 11 year old female with no illness at time
Y of vaccination4/8/2009
or pre-existing,
4/8/2009birth defects o
n has been received from a licensed practical nurse concerning a female who was vaccinated U with a dose of GARDASIL. Subsequently, th
n has been received from a physicianY concerning a 20 years old female who was vaccinatedUwith GARDASIL 4/8/2008
three times:
5/8/2009 1st dose given o
n has been received from representative reported experience as reported by a nurse concerningY a female5/18/2009
patient who
5/18/2009
on 18-MAY-2009 wa
Y a female who was vaccinated with a first doseUof GARDASIL. Subsequently the patient expe
n has been received from an office manager concerning a 15 year old female who on 11-NOV-2008U was vaccinated 5/1/2009
n has been received from a Registered Nurse (R.N) concerning a female patient who on an U unspecified date was vaccinated with a dose o
n has been received from a medical assistant concerning a 23 year old female with not reported
Y drug reactions/allergies
3/10/2009 3/11/2009 and medical histor
n has been received from a physicianY concerning a teenage female who within the last two years
Y (approximately 2007) was vaccinated IM
n has been received from a certifiedYmedical assistant concerning a 12 year old female patient
U with cystic 5/13/2009
fibrosis, no
5/20/2009
drug reactions/allergi
n has been received from a 34 year old patient registered nurse with allergies to IMITREX, COMPAZINE,
U 5/21/2009
MACROBID, 5/21/2009
for the Pregnancy R
n has been received from a physician concerning a teenage female who within the last year Uwas vaccinated 1/1/2008
with a dose of GARDASIL vac
n has been received from a consumer Y for the pregnancy registry for GARDASIL concerning U his 17 year 4/21/2009
old girlfriend4/21/2009
with anemia, irregular
n has been received from a physicianY concerning a 16 year old female patient who "a coupleUof months ago" was vaccinated with the first a
n has been received from a physician concerning a 25 year old female with a history of miscarriage
N before
5/12/2009
the vaccination
5/19/2009 who on 12-MAY
n has been received from a physicianY concerning an 11 year old female who on 19-MAY-2009 Y was vaccinated
5/19/2009 with5/19/2009
the second dose of GA
n has been received from a mother concerning her daughter who on 31-MAR-2008 was vaccinated N with3/31/2008
GARDASIL (Lot # 659
n has been received from a nurse practitioner for GARDASIL, a Pregnancy Registry product,Y concerning a 23 year old 3/3/2008
female with allergies
n has been received from a physician concerning a 15 year old female student with no medical U history and 2/25/2009
no known 2/25/2009
drug allergy who on 2
n has been received from a Certified Medical Assistant (C.M.A.) concerning a 24 year old female
N patient who
5/1/2009
on 13-MAR-2009
n has been received from a consumer concerning his 16 year old daughter with "brachial plexus"
N of her 10/1/2008
right arm which
10/1/2008
was diagnosed a fe
Y Nurse concerning a 25 year old female patient with no Y pertinent 5/15/2009
medical history
5/16/2009
and no drug reactio
n has been received from a physician concerning a "14 year" old female patient who was hospitalized
Y couple days for "Helicobacter pylori"
n has been received from an emergency
Y medical technician concerning a 15 year old femaleNpatient with5/21/2009
no drug reactions
5/21/2009 or allergies who
n has been received from a physician concerning a female who was vaccinated with a dose Uof GARDASIL. One or two months after the GA
n has been received from a physician concerning a female patient who on an unspecified date N was vaccinated with5/22/2009the first dose of GARDA
Y a 23 year old female patient who on 20-MAY-2009N was vaccinated
5/20/2009with 5/26/2009
a second dose of GA
n has been received from a consumer,Y for the Pregnancy Registry for GARDASIL, concerning Y her 15 year old ### daughter with ###seasonal aller
Y nurse (R.N.) concerning a female who on 27-MAY-2009 U was vaccinated with a dose of GARDASIL (
n has been received from another physician
Y (not the patient's physician) concerning a female
U who was vaccinated with a dose of GARDAS
n has been received from a physician concerning four female patients who were vaccinated Ywith doses of GARDASIL vaccine. Subsequen
n has been received from a physician concerning four female patients who were vaccinated Ywith doses of GARDASIL. Subsequently the pa
n has been received from a physician concerning four female patients who were vaccinated Ywith doses of GARDASIL. Subsequently the pa
n has been received from a nurse through a representative concerning a female patient whoYwas vaccinated with the first dose of GARDAS
n has been received from a medical assistant concerning a female patient who was vaccinated Y with the first dose of GARDASIL and had fa
n has been received from a nurse practitioner concerning a 11 year old female who on 19-MAY-2009 U was
5/19/2009
n has been received from a physician concerning a patient who on an unspecified date was U vaccinated with a dose of GARDASIL (LOT# n
Y concerning a female about 14 years old who Y was vaccinated5/29/2008
with the5/29/2008
first 0.5 mL dose of GA
n has been received from a physician Y concerning an approximately 25 year old female who U on "20-MAY-2009"
5/20/2009was vaccinated, 0.5 ml, with
n has been received from a medical assistant concerning a female patient who was vaccinated Y with the first dose of GARDASIL and had fa
n has been received from a medical assistant concerning a female patient who was vaccinated Y with the first dose of GARDASIL and fainted
A ROUTINE PHYSICAL, I WAS GIVEN Y A TETANUS Y AND GARDASIL 2 VACCINE SHOT. APPROXIMATELY
Y 6/10/2009
FIFTEEN 6/11/2009
AND A HALF HOUR
n has been received from Y a medicalYassistant concerning
Y a 9 weeks2old female patient with Y
no pertinent5/28/2009
medical history
6/3/2009
and not known alle
n has been received from a physician Y concerning Y a 7 months old female
0 with unknown drugYallergies and 4/16/2009
unknown 5/26/2009
medical history who on
n has been received from a hospice nurse concerning a 16 years old female withYunknown drug N allergies and unknown medical history who
n has been received from a health professional for the pregnancy registry for GARDASIL concerning Y a female
10/7/2007with a history of atrial septal
d Alopecia Areata Universalis beginning three days after receiving third GARDASIL booster, Tetanus with 10/1/2008
Pertussis injection, and Flu vacci
the vaccine and a month later was diagnosed with Grovers disease which is a rash Y on the back and chest. 12/1/2007
Seems to me it### very coincidenta
en 6/8/09 for 5 year WCC and received MMR, VZV, PV, DTaP, Hib and Hep A. He woke up this a.m. c/o itchy 6/8/2009
red rash
6/9/2009
on (L) upper thigh w
ce visit: Red, warm area on left thigh, painful (to touch), Y 6/1/2009 6/3/2009
dedness, dizziness since vaccine series completed one year ago. Fainted 6/4/09. U 4/1/2008 4/1/2008
Y 5/8/2009 5/8/2009
numbness of the Rt fingers & right Y arm & nose 2 weeks seen by 5.26.09. No symptoms after Y 6-12-09 4/24/2009 5/12/2009
ely after receiving vaccine, right armYbecame very sore. Redness developed at 11:00 PM. Warm Y to touch.
6/10/2009
Area is 6/10/2009
very swollen.
ain at the injection, Limited movement. Fever, chills, body aches for 2 days. Y
nderness and swelling at site. Lasted for 2 weeks. Required medication for several days - ADVIL Y 5/20/2009
me in for office visit - Urticaria on Rt thigh, warm to touch, non-tender. Y 6/1/2009 6/3/2009
fice visit- firm, red, tender, warm area on (L) thigh. Y 6/8/2009 6/9/2009
action rash, swollen area around injection site. Itchy hand etc. Rash is 40mm in length. 6/10/2009 6/10/2009
TIVE ERYTHRODERMA - required Y hospitalization
Y due to dehydration. 1 Treated with steroids U
for over 2 wks.
5/11/2009
6/17/095/13/2009
Medical record receive
cribed area on (R) leg is approximately 1 inch from injection site. 3 inches wide and 2 inches U tall and red and6/4/2009
hot to touch. Per mom spoke w
iven on 6/5/09. On 6/7/09 area on left leg - raised, warm, measuring at 6 x 8 cm. Y 6/5/2009 6/7/2009
s a quarter-sized red area at the injection site that is warm to touch. There is also significantYbruising in a 6/5/2009
3-4 inch area6/6/2009
surrounding the red
PCV-7 in (R) thigh and PENTACEL (DTaP-IPV-Hib) in (L) thigh on June 5 in PM. Increased Y sleepiness rest 6/5/2009
of June 5,6/6/2009
2009. On 6-6-09 not
a 6cm x 3cm erythematous rash on her (R) upper anterior thigh Laterally & anteriorly is the injection
U site. 6/2/2009 6/4/2009
woke during night with chills, painful skin irritation. Full body aches, light-headedness, exhaustion,
N lack of focus,
6/6/2009
periods
6/7/2009
of mild confusion, re
7cm x 5 1/2 cm warm to touch. 6/3/2009 6/8/2009
g, redness, pain 4/23/2009 5/1/2009
hr. - hives and swelling throat, took BENADRYL - 50 mg, then another 25 mg 6 hrs. later. Ok Y next day. 4/21/2009 4/21/2009
d and swollen 35 mm X 35 mm Y 6/4/2009 6/5/2009
ived PENTACEL, PREVENAR, GENHEVAC B, and ROTATEQ on 5/4/09. On 5/5/09 child dev'd Y factile fever 5/4/2009
and red5/5/2009
maculopapular rash o
oid, red, warm to touch. Swollen, raised,
Y 6cm x 3cm. Y 6/9/2009 6/10/2009
adache "head pounding" chest tightness and some shortness of breath (although speaking Y normally) and6/8/2009
"feeling cold"
6/8/2009
- visibly shivering. v
d Immunisation and then in about 2Yhrs developed so many hives on face, neck, arm, abdomen- Y had swollen
6/2/2009
upper lip.
6/2/2009
Was seen at emerg
ven MENACTRA - Vaccine given 5/28/09 Y redness 5/29 then seen 5/31 in ER Hosp. for right armY swelling5/28/2009
shoulder to5/29/2009
hand - Numb/tingling h
ed shingles like rash in left T8-9 dermatoma,
Y 2 days after receiving the vaccine. 6/11/2009 6/13/2009
days post vaccination seen in office Y for rash. ATARAX Rx. U 6/3/2009 6/13/2009
vd MMR SubQ @ Health Dept. 6-11-09 Y Pt. returned to HD. Exhibits approx 10 mm by 15 mm Y reddened6/2/2009
& inflamed6/5/2009
area upper outer aspe
lls, headache, sore throat achy arms and legs. Y 6/1/2009 6/1/2009
Y 7/1/2008 7/2/2008
irritability with green/mucus colored stool with presence of blood, which was Hemacult + andY in office, pt 6/4/2009
improving. 6/6/2009
at 2 AM on 6/9/09 with temp of 101.4 & feeling dizzy. As of 8 am was feeling better, temp gone. Y 6/8/2009 6/9/2009
urred 5 to 7 days after shingles vaccine on sides of neck and other places shingles would appear.
N Was 3/13/2009
taking NITROFURANTOIN
3/18/2009 MACRO
vaccines 4/21/09. That night he had chills and temp of 100 degrees. Stayed home from school Y on 4/22 AM.4/21/2009
Had been4/22/2009
treated with MOTRIN
6/8/2009
m red area with 3x4 cm raised x 6cm area. No drainage - warm to touch. Doctor advised Benadryl cream to 6/2/2009
area with6/3/2009
ice packs. If no better
itching, erythema, and swelling aboutY 2 days after injection. Improved with BENADRYL administration,
Y no
6/9/2009
pain/tenderness.
6/11/2009
ss, swelling, erythema. No treatment necessary. Y 6/11/2009 6/11/2009
m neck back, chills fever sweating. Dizzy,
Y nausea, fatigue, muscle weakness. U 5/27/2009 5/29/2009
6/10/2009
/9/09, on 6/11/09 MOC called, stated pt. had red area back of rt. arm, size 1"x2", hurts a little,
U not itchy 6/9/2009 6/11/2009
6/9/2009
se reactions previously
d fever and a seizure afterwards. WasY taken to the ER at medical center. Y 6/4/2009 6/5/2009
n and stated that 2 months after ZOSTAVAX, she was dx with shingles. Pt had never had shingles Y disease
3/24/2009
before. 6/1/2009
dema, tenderness, fatigue onset 15 hours after injection. Felt arm pain with movement 15 hours after injection.
6/8/2009
Unable6/9/2009
to move arm withou
ite is reddened and raised. Circumference is approx. 2 inches in diameter. U 6/9/2009

tenderness, nausea Y Y 6/5/2009 6/6/1999
ough. Chicken pox 6-8-09 Lesions- neck- face. hands + arms. Y 5/28/2009
ng at menactra injection site within Yhours of administration. later same evening pt c/o heat swelling
Y redness
6/12/2009
at site pt
6/12/2009
taken to care now dx
was given Typhoid at 0915 on 06/06/2009.Y He had onset of localized pain and discomfort at site.
Y Approximately 6/6/20091 hour6/6/2009
later his pain spread
pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 5 10/28/2008 with Pneumonia.
Y Vaccination
9/22/2008took place ###on 9/22/2008. Ac
pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 4 12/21/2008 with atrial fibrillation.
Y Vaccination
9/22/2008 took place ### on 9/22/2008
pneumococcal vaccine trial, with severe COPD, Y was hospitalized on 2 3/26/2009 with vertigo Yand small bowel
6/13/2007
obstruction.
3/26/2009
Vaccination took
th and 13th day after receiving the MMR, Client experienced fever (She didn't take her temperature),chils,
Y 5/11/2009
sore throat5/23/2009
and tiredness. These
h after injection the patient woke upYwith loss of function in her left arm. Went to ER and for therapy.
Y She 6/5/2008
was told it was
7/4/2008
nerve damage, un
Was hospitalized with meningococcal meningitis Y and bacteremia. 6/24/09
3 Hospital ER records
Y received DOS### 3/29/09.
3/28/2009
Assessment: Menin
p given, employee experienced nausea, vomiting, dizziness, palpitations, pain @site. No swelling. Y 5/14/2009 5/14/2009
d smallpox vaccination on June 6, 2009,Y a Saturday. On the following Tuesday, his right armUstarted to hurt 6/6/2009
and gradually
6/9/2009
worsened. On Fr
10 p.m. - phone call from cl reporting he woke up at 3 a.m. this morning with severe muscle and joint pain6/2/2009 in shoulders,6/3/2009
elbows and hips. E
N 6/4/2009 6/5/2009
ollowing 1st gardasil injection patient reports muscle weakness or pain, non-progressing. Also N c/o fatigue. 3/25/2009
Medical records
4/27/2009 received DOS 5
len, Painful, warm to touch. Symptoms started one hr after administration and continued for Y 7 days. 6/10/2009 6/10/2009
as given Hepatitis A vaccine instead of Hepatitis B vaccine Y 6/16/2009 6/16/2009
am: Two days after vaccination, patient reported that site of injection was red, swollen and warm Y to the touch.6/10/2009
Pt reported
6/12/2009
that size of area o
l asleep on the car ride home (very unusual at that time of day). He then became feverish and Y fell asleep6/10/2009
for the night
6/10/2009
at 7:00--two hours af
ot his vaccinations on Thursday
Y morning.
Y Then Y
on Saturday night he2was sleeping, started vomiting,
U when
5/21/2009
I went to 5/23/2009
clean him up he was sta
reddened, swollen and painful some Y itchy. Mother stated notice swelling last evening 6/16/09Y at about 8.00pm.
6/15/2009 Mother
6/15/2009
did not massage ar
ccines on 6-5-09, and on 6-14-09 child began to have a rash that looked like clots on back, Y no drainage or 6/5/2009
raised areas.
6/14/2009
It is now everywhe
es child has been seizure free sinceY8/08. Has had 10 seizures since start of rabies vaccine Y series - Has5/28/2009
2 doses left.6/1/2009
1st dose given here o
en around 11am 6-12-09. Mom called Y around 2pm- patient crying, unable to console. Eft egYinjection site 6/12/2009
swollen, red.
6/12/2009
Advised to apply he
a to injection site- Rt. leg (upper) started 9 days after vaccines. U 6/5/2009 6/13/2009
n has been received from a 63 year old female patient who was on 17-DEC-2008 vaccinatedNwith the first 2/18/2009
dose of GARDASIL 0.5 ML on bu
n has been received from a 36 yearYold female patient who in 2006 was vaccinated with the Nthree doses4/25/2007 of GARDASIL. The patient was no
n has been received from a nurse concerning her daughter a 14 year old female with amoxicillin Y allergy and 3/6/2008
no other3/6/2008
medical history who in
G AND REDNESS ON RIGHT THIGH,LATERAL ASPECT MEASURING 55cm X 70cm. Y 6/10/2009 6/11/2009
Y Y N
er had a seizure with vomiting. Date immunization Y given rash on back 1 and abdomen. No prior Y fever. 8/26/09 6/8/2009
Hospital
6/10/2009
records received DO
5/29/2009 N 5/27/2009 5/29/2009
### N ### ###
mbness, tingling, burningYof feet, progressing
Y toYcalves and near knees.8 8 days hospitalization.
Y N Immunoglobulin
10/1/2008 - 5 days.
12/6/2008 7/13/09 Hospital
ep shot on 4-22-09. it was put in my right arm. still today it still hurts and has pain in it. neverUhad a problem 4/22/2009
until i got
4/23/2009
the shot.
ng gardasil shots my daughter has complained of frequent headaches, hair loss, and joint pain.
ous chills and pain in the left arm with Y swelling and muscle aches. Low grade fever. Large 4x6" U round, raised,6/8/2009
indurated,
6/11/2009
red warm area aro
as sore for the remainder of the day after receiving his 2 shots on 6/12/09. He refused to allow Y me to look, 6/12/2009
and thinking6/13/2009
he was only sore (a
urs after immunizations patient developedY severe headache. At bedtime patient's mouth wasYdistorted to right 6/4/2009
and was 6/4/2009
numb and tingling.
as administered vaccine. Patient then began to have a vasovagal syncope reaction. Patient was Y immediately 6/16/2009
given oxygen.
6/16/2009 Patient was lay
after vaccine was given, onset of temperature
Y to 102 axillary and diarrhea. Illness resolved inY3 days total. ### ###
breath, extreme shortnessY of breath.Has
Y never experienced this before. Rash on upper torso. U Patient crawled
3/26/2009 to front
3/28/2009
door and opened do
ceived approx 8 hrslater edema andYitching at site. Returned to clinic approx 18 hrs later withY 3.5 x 3.5 cm 6/16/2009
warm, red, 6/16/2009
indurated itchy rather
4) reduced with acetaminophen, but resumed, red/warm/pain at injection site, arm is swollenYand slightly6/12/2009 hard/firm to6/12/2009
the touch.
Left brachial neuritis after HPV/Gardasil vaccinations..History of Illness: 1/20/2009 Y - Presented
N for initial 8/28/2008
evaluation by 8/31/2008
hand surgeon. By his
GIVEN VACCINES BECAME DIZZY AFTERWARD FEET ELEVATED AND GIVEN COOKIE.YDIZZINESS6/17/2009 ABATED AFTER 6/17/2009 FIVE MINUTES
veloped bacteremia without focus and tested positive Y for Neisseria meningitidis
2 from her blood.
Y 6/24/092/13/2008
Hospital records
3/25/2009received DOS 3/2
my Zostavax DS PWD #1 ON jANUARY 12, 2009. I feel fine 95% of the time. The other 5% U my shingles 1/12/2009
are on fire.2/1/2009
Kind of like a hot pok
r, greater than 103F, axillary. Gave Tylenol
Y and Advil with temp remaining elevated next dayUwhen grandparent 6/15/2009 placed
6/15/2009
call to vaccine admin
d to wait immediately after vacine. Felt Y ok for a minute or so, got onto the elevator started toYfeel dizzy and 6/17/2009
blacked 6/17/2009
out and face planted in
n: Had febrile illness within 24 hours for both vaccines. 1st episode required hospitalization.NDeveloped chronic ### headaches after 2000 dos
n: diffuse puritic rash 2 days post anthrax, HBV, and meningococcal vaccines. Comment: Initial VAERS 5/25/2003
completed Oct 03. Symptom: Le
n: Diffuse maculopapular rash of both Y UE/LE and trunk within 48 hours of anthrax #2 and yellow fever vaccines. 3/11/1999Symptom: Joint Pain, mu
mpetent w/ past - MMR rash. Decreased Y WBC count 1.7, ANC700. Resolved within 1wk. Y 5/29/2009 5/31/2009
received spv, yellow fever, typhoid, and flu vaccines.
Y On that day 29 after
Y the vaccinations, gradually started to feel###"exhausted ### and weak" - h
n on 06-11-09. Began having an elevated temperature on 06-12-09. Also c/o headache, stomach Y ache,6/11/2009
+ diarrhea.6/12/2009
Highest temperature w
redness and swelling from injection site to approx. 1 inch of elbow. Client not c/o pain or discomfort.
Y 6/15/2009 6/16/2009
and red reaction with induration approx. 10 cm in size less than 30 minutes following vaccination. Y These reactions
6/16/2009noted 6/16/2009
at VARIVAX vaccin
a phone call from patient 6-9-09 stating c/o fever, headaches, generalized body aches and nausea hours after receiving Tdap on 6-8-09.
d rash on face and upper body. Over in 3 days. Terribly itchy, hives, swelling right side eye-chin-collar
Y bone.
6/10/2009
lethargic.
6/11/2009
Took benadryl on
9 grandmother presented to Health YUnit and reported that health care professional went to pediatrician
Y today
6/9/2009
& was6/10/2009
sent to E.R. for "high f
Y Y 6/15/2009 6/15/2009
accine #1, #2, #3- no problems. 10/06/03- received Y anthrax #4- along 10 with Hep A #2 and Hep U B #2- few 10/6/2003
weeks later ("by the ###end of Octobe
seizure that evening after receiving vaccines in office. Dad report stiffening & shaking episode Y < 1 min while
2/17/2009
in highchair
2/17/2009at restaurant. The
Kinrix on 6/11/09, IM/L arm. Mom noted redness + swelling on 6/12/09, arm warm to touch Y in the upper6/11/2009
deltoid area; 6/12/2009
good ROM. Mom re
Kinrix on 6/10/09 IM/Larm; mom noted redness + swelling on 6/11/09. No impaired ROM, c/o sore to touch; 6/10/2009
arm red,6/11/2009
warm swollen from e
received ANTHRAX vaccine #1 - no problems 2/27/04 Y - deployed to7foreign country 4/21/04 - received ANTHRAX
4/21/2004vaccine
4/22/2004 #2 and HEP B va
e, fever, right hand swelling, arm, leg Y pain. N 6/12/2009 6/13/2009
n: 1/21/05- received primary FLUMIST- no problems. Y 1/23/05- "felt run
2 down". 1/24/05- c/o n/v,
U diarrhea,1/21/2005
fever (temp 1/23/2005
not taken), chills and n
not around injection site. Rxd Benadryl 25mg 1-2 a day LORATADINE 10mg 1 a day. Y 6/15/2009 6/16/2009
on site erythema, induration, tenderness lasting more than 1 month; worsening after each anthrax vaccination. Right sided axillary adenopa
administered 06/10/09 at about 11am. By 2pm child began to scream uncontrollable until about Y 7pm. No6/10/2009
treatment necessary.
6/10/2009 Was adminis
oke out on forehead, face and neck. Benadryl 12.5mg/ml given (PO). Y 6/17/2009 6/17/2009
, reproducible arthralgias after each anthrax vaccination. Currently stationed in Qatar. Joint Pain, multiple joints### Start: 5/22/2004 comment:
received smallpox vaccine on his left upper arm Y (3 jabs)- denies any 2 problems. 08/27/04 - onset
U 0600 while
8/27/2004
sleeping - bilat chest pain ("du
tous, non-fluctuant, indurated area. Warm to touch, no exudate or focus of fluctuance or purulence. Y 6/15/2009 6/15/2009
urated, mildly erythematous lesion over deltoid Y 6/15/2009 6/16/2009
ction to vaccine Y 6/15/2009 6/17/2009
d - swollen, red AMOXICILLIN RX started w/DTAP. 6/15/2009
area of erythema/swelling (L) biceps, 2 by 2 cm area of erythema/swelling (R) bicep low grade Y fever x 24 6/15/2009
hours. 6/15/2009
, induration, swelling, itching left deltoid! - treated for cellulitis with Keflex. U 6/15/2009 6/15/2009
hly circular red/warm/itching raised Y patch surrounding injection site. Few clear vesicles (central ) noted started
6/15/2009less 6/16/2009
than 24 hrs after injectio
received anthrax vaccine #1 along with SPV- about a week later, noticed rash on left inner thigh- c/o moderate 1/31/2003pruritus-
2/7/2003
was dx'ed with "poi
received from patient on 11/2/04 No problems with first three ANTHRAX vaccines 10/09/03 - received anthrax 11/1/2003
vaccine #4 (foreign country)-
ve L arm / shoulder pain with weakness. Medical records requested. Symptoms: Joint Pain, isolated start: 6/12/2003
6/12/2003 comment: left shoulde
n: 2/3/05- received SPV (3 pokes, left upper arm) along with flu vaccine (right upper arm)- states
U was "getting
2/8/2005
over a cold" (only sx= nasal c
n: SM developed, N&V, HA, diarrhea about 72 hrs post anthrax vaccination #1, which recurred U with second 7/8/2007
anthrax in Sept. Symptom: Fati
le, ADSM, presents as a referral fromY clinic for chest pain after smallpox vaccine. Symptoms:Y Chest pain,5/28/2009
fever, headache,
6/5/2009 general.
n : progressive fatigue, cognitive loss, anhedonia, myalgias, arthralgias after each anthrax vaccine Comment: ### med records requested Sym
n: This patient reports back pain, knee pain, headache, fatigue, memory loss, sleep disturbance, and hair 3/22/2003
loss since starting ANTHRAX vac
n: Headache, arthralgias, memory loss, fatigue, visual change, fever after anthrax vaccine #2. Symptom: Head,### general; Symptom: Joint P
ve, persistent bilateral shoulder pain, bilateral UE, numbness / fatigue, diffuse headaches failing to improve with ###
NSAID'S muscle relaxants,
n: Headache, Myalgias, UE/LE paresthesias worsening after each anthrax vaccine; SX beyond Y 30 days. Symptom:
2/2/2003 Headache, general star
n has been received from a medical assistant (MA) concerning a 41-day-old patient who on U 08-Apr-2008 4/8/2008
was inadvertently
4/8/2008 vaccinated with
Y concerning a 3 year old male who on 29 OCT U 2007 was vaccinated### with 0.5 ###ml, a second d
n has been received from a physician Y concerning a male with obsessive-compulsive disorder N diagnosed7/23/2007
prior to vaccination on 23-JUL-200
n has been received from a registered nurse concerning a 1 week old infant who on 21-MAY-2008 U was vaccinated
5/21/2008 at 5/21/2008
the pediatrician's offic
n has been received from a physician concerning a 11 year old male with no pertinent medical Y history or drug
7/1/2007
allergies who in July 2007, w
n has been received from a consumer who is the mother of the patient, reported that her sonUwent in for his 2 month immunization shots an
n has been received from a physician concerning a 2 year old male who on 24-JUN-2008 was N vaccinated 6/24/2008
with VAQTA 6/24/2008
vaccine, 0.5 ml, IM
n has been received from a nurse concerning a male who was vaccinated with VAQTA. It was U reported that the patient developed hepatitis
n has been received from a registered nurse concerning a 36 year old female patient who onU28-FEB-2008 2/28/2008
was vaccinated
2/28/2008 with an 0.5 mL
n has been received from a consumer Y concerning Y a approximately 15 1 months old male with Y egg allergy,10/1/2007
peanut allergy
10/1/2007
and beef allergy wh
Y a female with allergy to nuts who on 06-JAN-2006
Y was vaccinated
1/6/2006with1/6/2006
the first dose of VAQ
n has been received from an office manager concerning a female who on 06-AUG-2008 wasUvaccinated with 8/6/2008
a dose 8/6/2008
of VAQTA. On 06-AUG
n has been received from a registeredY nurse with no allergies or medical history who on 26-JUL-2004
U and
1/31/2005
on 31-JAN-2005
n has been received from a physician concerning a 6 day old patient who was intended to receive U RECOBIVAX
10/3/2008 HB,10/3/2008
was inadvertently adm
n has been received from a nurse practitioner concerning a female patient who was vaccinated U with a dose of VAQT. The patient showed
n has been received from a physician Y concerning a patient who on 04-NOV-2008 was vaccinated N with VAQTA
11/4/2008vaccine. Subsequently the p
n has been received from a physician concerning a 14 year old female who on 19-JAN-2009Nwas vaccinated 1/19/2009
intramuscularly
1/19/2009with a first dos
n has been received regarding a case Y in litigation concerning a 49 year old female who on 19-Nov-2007
N was vaccinated
### with
### first dose of h
n has been received from a registered nurse concerning a patient's uncle who on an unspecified U date was vaccinated with MMR II. Subseq
n has been received from a physician concerning Y a "very old" female0 who was vaccinated withU MMR II. The patient recently received MMR
n has been received from a physician Y concerning a 14-year-old male with type 1 Ydiabetes mellitus,
Y no known
8/5/2008
drug allergies,
8/6/2008and a family hi
n has been received from a physician concerning Y a 4 year old male 0with egg allergy and a history
U of asthma
8/8/2008
who on 8/8/2008
08-AUG-2008 was vac
n has been received from a consumer concerning Y her 32 year old daughter
0 who recently received
U a booster dose for MMR II. It was reporte
n has been received from a physician concerning a 5 year old female who received her first Y dose of MMR II at 15 months of age (approxim
n has been received from Y a physician concerning Y his wife, who as a0child
Y was vaccinated
Y with
Y MMR II. Subsequently the patient experienc
n has been received from a consumer concerning her now 6 year old son with "family genetic N history (predisposition)
8/1/2003 8/1/2003
of motor skill problem
n has been received from a medical assistant concerning an adult male who was vaccinatedUwith a dose of MMR II as a child. The patient h
n has been received from a healthcare worker concerning a nurse regarding MMR II. The nurse U was cut on shattered vials of vaccine recei
n has been received from a nurse practitioner concerning a 32 year old male who on 09-DEC2008 N was vaccinated
12/9/2008 with MMR ### II SQ, 0.5ml.
n has been received from a consumer concerning her 12 month old son who was vaccinatedYwith a dose of MMR II (lot# not provided) 0.5m
n has been received from a physician Y concerning a female with DEMEROL allergy, arthritis, Uosteoporosis,4/3/2006
hyperlipidaemia### and hypothyroid
rmation has been received from a pharmacist and follow-up information was received from aUregistered nurse 3/12/2007
concerning
3/25/2008
a 34-year-old fem
n has been received from a consumer Y concerning her daughter with no pertinent medical historyN or drug8/10/2005
on 01-MAR-2001 an
n has been received from a registered nurse concerning a 22 year female health worker withUno pertinent medical ### history
3/28/2008
who, on 16-Sep-1
n has been received from a licensed practical nurse (LPN) concerning a patient who on approximately
Y 20-MAR-2008
3/20/2008 ("in the last 2 weeks")
n has been received from a nurse practitioner (NP) concerning a 19 year old female, with noUprior medical conditions, who was vaccinated
n has been received from a PharmD. Y concerning a 5-year-old male with an allergy to porcineY and bovine gelatin who in approximately 2006
n has been received from a pharmacistY concerning a 19 year old female with a history of convulsions
N in childhood
### who on### 19-NOV-2007 w
n has been received from a 47 year old female pharmacist reporting on herself with an unknown N medical history and unknown drug allergie
n has been received from a physician Y concerning a 1-year-old male with a history of stroke andN heart problems
4/10/2008 who4/10/2008
on 10-APR-2008 was
n has been received from a physician Y concerning an approximately 28-year-old female with no medical history or allergies who as a child w
n has been received from a physician concerning a white male who, on an undisclosed date,Nwas vaccinated 8/17/2004
with a10/1/2004
second dose of MMR I
Y concerning a 15 month old female no pertinent medical N history, drug4/3/2008
reactions 4/15/2008
or allergies who on 03
n has been received from a registered nurse concerning a now 25 year old male medical studentU who on 8/3/1995
10-Apr-2008 8/3/1995
was vaccinated with
Y concerning a 12 month old male with no pertinent medicalY history, drug
4/3/2008
reactions
4/3/2008
or allergies who on
n has been received from a registered nurse concerning a male with no pertinent medical history and no8/24/1999
4/1/2008 who on 09
n has been received from a physician concerning a 12 month old female who was vaccinated U with MMR II. Concomitant therapy included V
Y concerning a 14 month old female with a history of urinary
U tract infection
4/16/2008 and 4/22/2008
no known drug reaction
n has been received from a health professional concerning an adult patient who was vaccinatedU with MMR II as a child and had a negative
Y concerning a 15 month old female with a penicillin
Y allergy
1/31/2008
who on 31-JAN-2008
Y concerning a patient who was vaccinated with 2 dosesUof MMR II. Subsequently,
9/2/2003 3/7/2008 the patient develop
n has been received from a registered nurse concerning a female allergic to porcine who "atU5 years of age", in approximately 2001, was va
n has been received from a pharmacist concerning a female who in the past was vaccinatedUwith a dose of MMR II. Subsequently the patie
Y concerning a 12 month old male who, in February 2008, Y was vaccinated
2/1/2008 with MMR
2/1/2008II. Concomitant th
n has been received from a physician concerning a patient who on 01-MAY-2008 was vaccinated U with a second
5/1/2008 dose5/1/2008
of MMR II. Concomit
n has been received from a registered nurse concerning an approximately 27 year old male N consumer with no known allergies or pertinent
n has been received from a consumer concerning a 12-month-old male who, on an unknownNdate, was vaccinated subcutaneous with 0.5 m
Y concerning a 5 year old female on 06-MAY-2008U was vaccinated
5/6/2008with5/6/2008
MMR II (lot number 6
Y concerning a 4 year old female, with no pertinent medical
N history, 4/25/2008
drug reactions 5/4/2008
or allergies who on
n has been received from a pharmacist concerning an approximately 30 year old female whoU was vaccinated with her second dose of MMR
n has been received from a physician concerning a 24 month old female who was vaccinated U with MMR. Concomitant therapy included VA
n has been received from a physician concerning a 5 year old female who was vaccinated with U MMR II. Suspect therapy included VARIVAX
n has been received from a licensedY practical nurse concerning a 5 year old female with no Upertinent medical
4/25/2008history or drug allergies who,
Y 20-MAR-2008
Y 20-MAR-2008
Y concerning a 12 month old female who, in February 2008, Y was vaccinated
2/1/2008with2/1/2008
MMR II. Concomitant
n has been received from a consumer concerning her male son with allergies to eggs, soy, wheat,
U mustard, peaches, maple syrup, milk, sh
Y concerning a 51 year old female with drug allergies
N to penicillin,
2/11/2008 iodine
4/23/2008
and Acetaminophen
n has been received from a NP concerning
Y a male with no known medical history or allergiesU who on 07-MAY-2008
5/7/2008 5/20/2008
was vaccinated sc with
n has been received from a physician concerning a 9 year old male patient who in 2003 wasUvaccinated with 1/1/2003
a second
5/22/2008
dose of MMR II (Me
n has been received from a nurse practitioner concerning a 13 month old female with no pertinent
N medical
4/28/2008
history or4/28/2008
drug allergies who on
n has been received from a pharmacist concerning a patient (age, gender unspecified) who U thought the patient was vaccinated with a dose
Y concerning a 4 year old male child who on 25-FEB-2008 U was vaccinated
2/25/2008 with4/12/2008
a second dose of MMR
n has been received from a physician concerning an "approximately 12 or 13 month old" male Y child with egg
5/1/2008
allergy, 5/1/2008
"very allergic and atop
Y concerning a 9 year old male who sometimeUin 2000 was 6/9/2008
vaccinated6/9/2008
with his first dose of M
n has been received from a physician concerning a 26 month old female patient who was vaccinated
U with a dose of MMR II vaccine and th
Y concerning her "approximately 2 year old" son who onUan unspecified date was vaccinated with MMR
n has been received from a licensedY practical nurse concerning a male patient with sulfa eyeNdrop hypersensitivity
8/1/1991 and 6/2/2008
a history of migraine
n has been received from a health professional concerning an adult patient who was vaccinatedU with MMR 1/1/2007
II as a child
1/1/2007
and had a negative
n has been received from a health professional concerning an adult patient who was vaccinatedU with MMR 1/1/2007
II vaccine1/1/2007
as a child and had a n
n has been received from a registered nurse concerning a patient who on 17-JUN-2008 wasUvaccinated IM 6/1/2008
instead 6/16/2008
of SC with a dose of MM
Y concerning a 4 year old female patient who was vaccinated
U with a dose
7/3/2005of MMR II at 16 months of ag
n has been received from a medicalYassistant concerning a 21 month old female child with no Y known allergies,
6/10/2008 or pertinent
manager concerning a 12 month old male child with no knownY allergies,
6/10/2008
benign 6/14/2008
heart murmur and ecze
ported that her daughter experienced fever about 7 days after vaccination with her first doseYof MMR II, injection, when the child was 3 and
n has been received from a physician concerning a 19 year old female with penicillin allergyNand AUGMENTIN allergy who had two doses o
n has been received from a physician concerning a 13 month old female old female with portNwine naevus 6/23/2008
and sensitivity
6/23/2008to OMNICEF who
n has been received from a nurse practitioner concerning a 4 year old female with a history Uof eczema who 9/4/2004
on 04-SEP-2004 was vaccinate
Y and healthcare worker concerning a 21 yearUold female who 11/1/1996
on 01-NOV-1996 was vaccina
Y concerning a female patient with an "autoimmune disease"Y who on 1/5/1998
an unspecified2/1/2008
date was vaccinat
Y nurse concerning a 50 year old female employee withYpenicillin and 6/6/2008
codeine allergies
6/8/2008and an unspec
n has been received from a physician concerning a 15 month old male patient who in approximately
Y July 7/1/2003
2003, was vaccinated
7/1/2003 with a first d
Y nurse concerning a 42 year old female patient who onUan unspecified date was vaccinated with MMR
n has been received from a medical assistant concerning a female who (on an unreported date) U was vaccinated with7/1/2008 MMR II (Lot # not rep
n has been received from a licensed practical nurse concerning a male patient with no known U allergies or pertinent medical history who on
n has been received from a pharmacist concerning a patient who received her primary series U received a third dose of MMR II about four ye
Y from a physician concerning a 4 year old female patient
Y with a protease
7/23/2008sensitivity
7/24/2008 and no pertinen
n has been received from a CMA and physician's assistant concerning a 38 year old female Nsmoker with6/17/2008hypertension, penicillin allergy, co
n has been received from a pharmacist concerning a pregnant female who is "due any day now" N that was vaccinated with MMR II and is te
n has been received from a physicianY concerning a female patient in her "mid 40's" with no allergies
N or pertinent
7/7/2008 medical
7/19/2008
history who on 07
n has been received from a consumer Y concerning his adult wife, who was undergoing fertilityUtreatments, whom he believes was vaccinated
n has been received from a physicianY concerning a female who has negative titers for RubellaU after she was already given 2 doses of MMR
n has been received from a physician concerning a 33 year old male, affiliated with another Uunspecified 7/29/2008
practice, who 7/29/2008
on 29-JUL-2008 was
Y concerning a 46 year old female who on approximately N 19-JUL-2008, 7/19/2008"about7/19/2008
3 weeks ago" was vac
n has been received from a physician concerning a 5 year old male patient with congenital heart
Y disease who was vaccinated at an unspec
n has been received from a physicianY concerning a 55 year old female with a history of breast
N cancer who 7/29/2008
on approximately
8/7/200829-JUL-2008 w
n has been received from a healthcare worker concerning a 1 year old female who, on 06-JUL-2008,
U was6/6/2008
vaccinated with MMR II (lot numb
n has been received from a certifiedYmedical assistant concerning a 22 year old male who on U an unspecified date ###was 7/1/2008
vaccinated with a fir
n has been received from a registered nurse concerning a 45 year old male who on 31-JUL-2008 N was vaccinated
7/31/2008SQ8/3/2008with the first dose of
n has been received from a physician concerning a 4 year old female with no medical historyUwho, in 2004, 7/23/2008
was vaccinated
7/31/2008 with a first dose
n has been received from a pharmacist concerning a "post menopausal" female volunteer atUher facility who was vaccinated as a child with
follow up information has been received from a mother concerning her son with a history of N premature birth10/8/2007
who on 08-OCT-2007### was vac
n has been received from a female Y consumer with penicillin, naproxen and ezetimibe (MSD)Nallergies who "14 years ago" in 1994 was vacc
n has been received from a 30 year old female with a history of adhesions in 1997 who on 17-JUL-2008
N 7/17/2008
with MMR II (lot# n
n has been received from a medial Y assistant concerning a 4 year old male who received theNsecond dose8/4/2008 of MMR II 8/6/2008
(rHA) (Lot # 655380/13
n has been received from a medicalYassistant concerning a 5 year old male patient with no known
Y allergies
8/12/2008
or pertinent
8/14/2008
medical history who
n has been received from a physicianY concerning a 12 month old female with no medical history
N or allergies, 8/5/2008
who on8/15/2008
05-AUG-2008 was va
n has been received from a patient's mother concerning a 5 year old female with peanut oil allergy
U who in approximately 2006 was vaccina
n has been received from a certifiedYmedical assistant concerning an 18 month old male, who Y is otherwise 7/23/2008
healthy, 7/30/2008
who on 23-JUL-2008 at
n has been received from a female nursing student who was vaccinated in the past (unsure U of how many doses she was given) with MMR
Y nurse concerning a 36 year old female with drug reaction
U to NORGESIC 8/4/2008 FORTE
7/30/2008
which causes naus
n has been received from a consumer concerning a female child who was vaccinated with aUdose of MMR II on an unspecified date. Subse
n has been received from a consumer concerning a male child who was vaccinated with a dose U of MMR II on an unspecified date. Subsequ
n has been received from a consumer via the internet concerning her healthy toddler child whoU on an unspecified date was vaccinated with
n has been received from a physicianY concerning
Y a now 29 year old female
Y patient, who in 1980,
Y at age one1/1/1980
was vaccinated
n has been received from a physicianY concerning an approximately 5 year old female who inUNovember 11/1/2007
2007 (when 6/1/2008
she was 4 years old),
n has been received from a physician concerning a male who on 26-AUG-2008 was vaccinated U with the8/26/2008
MMR II. Suspect thera
n has been received from a physician concerning a male who was vaccinated with MMR II. The Y patient developed erythema after getting M
n has been received from a nurse atY a health department concerning a 39 year old male, who Y on 17-JUL-2008,
7/17/2008 was8/10/2008
vaccinated with MMR
Y a male with no known allergies and reported noU pertinent medical history who was vaccinate
n has been received from a physician concerning a 23 year old male with no known allergiesUor medical history who 6/6/2006 in approximately 1986
n has been received from a consumer Y concerning a 14 year old female who was vaccinatedYwith a dose of MMR II when the patient was a
n has been received from a physician concerning a 12 month old male with a history of kidney Y transplant7/30/2008
waiting list,7/31/2008
feeding tube, congeni
n has been received from a patient's mother concerning her 7.5 year old daughter with no allergies
U or pertinent
9/26/2005 medical
8/1/2008
history who was va
Y an adult female who on 29-AUG-2008 was vaccinated
N with8/29/2008
a booster9/10/2008
dose of MMR II. On 10
n has been received from a nurse concerning a 42 year old male with allergy to Prozac whoNreceived dose 1/2/2008
1 of MMR 8/18/2008
II as a child tested ne
Y nurse (RN) concerning a 30 year old female with no allergies
U or medical history 9/5/2008
who was vaccinated
n has been received from a pharmacy student concerning a 48 year old female with drug reactions/allergies
N 6/1/2008
to NSAIDS, lidocaine, morphin
n has been received from a consumer concerning her 35 year old son who received MMR IIUwhen he was a young child. It was reported tha
n has been received from a registered nurse concerning a 36 year old female who has received U two doses 9/18/2008
of MMR9/18/2008
II in the past (date not r
n has been received from a consumer, who is a nurse, concerning her 15 month old male son Y with no medical9/9/2008history
9/10/2008
or allergies who on 0
n has been received from a certified medical assistant (CMA) concerning a 5 year old male whoN around the 8/1/2008
second9/25/2008
or third week of August
n has been received from a physician concerning a 19.5 year old female patient with penicillin
N and AUGMENTIN allergy who had two dose
n has been received from a pharmacyY student concerning a 4 year old male who on 23-SEP-2008 U was vaccinated
9/23/2008 with9/23/2008
MMR II (lot # 66179
n has been received from a consumerY concerning her 3 year old son with no pertinent medical Y history or8/27/2008
on 27-AUG-2008 wa
n has been received from a licensed practical nurse concerning a 34 year old pregnant female U with seasonal
7/30/2008
allergy8/15/2008
and thyroid disorder b
n has been received from a physician concerning a male patient with no medical history andUno drug reactions/allergies who on an unspeci
n has been received from a nurse at a physician's office that a "12 month old" patient with noU medical history,
10/3/2008
received a dose
### of MMR II, in
Y concerning a 12-month-old female who in September N 2008, was vaccinated
9/1/2008 with 9/1/2008
MMR II, Hep A (ma
n has been received from a pharmacist concerning a patient who was vaccinated with MMRUII. It was reported that the patient was given M
n has been received from a consumer concerning her older son who on an unspecified dateUwas vaccinated with a dose of MMR II (lot num
n has been received from a 31 year old female licensed practical nurse with no medical historyN or allergies who on an unspecified date whe
n has been received from a consumerY concerning a 1 year old female who on 10-OCT-2008Nwas vaccinated via ###injection with
### MMR II. Seco
n has been received from a consumer concerning his son who was vaccinated with a dose of U MMR II. Subsequently the patient developed
Y a male who was vaccinated with both doses ofY MMR II and 4/13/2006
subsequently, the ###patient develop
n has been received from a patient who was vaccinated with MMR II (route and site not reported).
U The patient had a previous experience w
n has been received from a patient's
Y mother concerning her 15 month old son with hypersensitivity
Y to Amoxicillin
1/31/2006who 2/15/2006
on 31-JAN-2006 was
Y a patient who in 2007 was vaccinated with a doseU of MMR II, RECOMBIVAX HB (MSD) (lot #
Y concerning a 31 year old female student with Y depression and9/26/2008
no drug10/7/2008
reaction or allergy who
Y a female patient who on 24-DEC-1999 was vaccinated
N with a dose
###of MMR II (lot #625634/0
Y nurse concerning a male adult patient who on 20-NOV-2007 U was vaccinated
### subcutaneously with a
n has been received from a Doctor Y of pharmacy concerning an adult female patient who in September
N 2008
9/1/2008
was vaccinated with a dose of
n has been received from a registered nurse concerning a 4 year old female with no medicalNhistory who on 10-NOV-2008
### ###
was vaccinated
n has been received from a consumer concerning her child with a history of anaphylactic reaction
U to latex who on an unspecified date was
Y concerning a patient who was vaccinated with a dose Uof MMR II "years ago". It was reported that the
n has been received from a certified medical assistant concerning an unidentified patient who U on unspecified date in the past "may" have b
Y concerning a 5 year old "healthy" female with a historyYof skin irritation at### injection site
###(onset 24-OCT
n has been received from a pharmacist concerning a patient who was vaccinated with MMRII. U The pharmacist reported that the patient exp
n has been received from a caller concerning a 14 year old male patient with allergy to GEODONN and a 12/3/2008
history of slight
12/3/2008
emotional difficultie
n has been received from an adult female
Y consumer who in her childhood was vaccinated with U a dose MMR II. In approximately
1/1/2009 January 20
n has been received from a consumer concerning her a 36 month old son who, "probable when Y he was 18 7/1/2007
months to 2 1/2 years old", was
n has been received from a consumer concerning her son, a 12 month old male with allergies Y to formaldehyde
1/10/2006and 1/11/2006
fragrance mix and histo
n has been received from an office Ymanager concerning a 14 month old female who on 13-JAN-2009
Y was
1/13/2009
vaccinated1/13/2009
with a dose of MMR
n has been received from a registered nurse who on 14-JAN-2009 was administering MMR N II and some vaccine splashed1/14/2009into her eyes. Th
Y concerning a patient who "several months ago" was vaccinated
Y with a dose of MMR II (lot# not provi
Y nurse concerning a 30 year old male patient with no pertinent
U medical history and no drug reactions
n has been received from a consumer concerning her son with reaction to all vaccines and medications
Y he
5/7/2001
has received
5/7/2001
that contain gelatin
n has been received from a medical assistant concerning an 18 year old female who in approximately
U 1991, "when
### she was 1 year of age"
n has been received from a physician concerning a 5 year old male with drug reaction to flu Y shot a year ago who on12/1/2008
unspecified date was v
n has been received from a nurse practitioner concerning a now adult male who was, on unspecified
U date, vaccinated with 2 doses of MMR
Y concerning a now 36 years old male who on unspecified
U dates was vaccinated with two dose
n has been received from a consumer concerning his 9 year old son with attention deficit disorder
U (ADD) diagnosed when he was very you
n has been received from a consumer concerning her 4 year old daughter with no medical historyY and drug
1/19/2009
allergies1/26/2009
who on 19-JAN-2009
n has been received from a nurse concerning an approximately 28 year old male student who U was possibly vaccinated with MMR II and ha
n has been received from a physician concerning a 5 year old patient who on an unknown date U was vaccinated with the second dose of MM
Y nurse concerning a 35 year old female with problemsUwith fertility11/5/2008
and a miscarriage### in July 2007 and
n has been received from a consumer concerning her son who was vaccinated with MMR II.USubsequently the patient experienced severe
n has been received from a consumer concerning his daughter who was vaccinated with MMR U II. The consumer reported that the patient h
Y Nurse concerning a patient who was vaccinated withUall three doses of MMR II. The patient's antibo
n has been received from a consumer concerning her four and a half year old son with no pertinent
Y medical
8/1/2005
history and no known allergies
n has been received from a consumer whose husband on an unspecified date was vaccinated U with MMR II and had reactions like fever and
Y concerning an approximately 12 month old (reported as U "1 year of age")
2/6/2009
patient who on approximate
n has been received from a licensed visiting nurse concerning a 30 month old male patient withY a history2/13/2009
of jaundice2/13/2009
at 3 weeks old who on
n has been viewed on the internet concerning a 15 month old female who was vaccinated with U a dose of MMR II. Concomitant vaccination
Y nurse concerning a 27 year old female who in 1981 was U vaccinated 9/10/1981
with a first dose of MMR II, in 19
n has been received from a consumer concerning her now a 5 years old son who in approximately Y 2005 ("when he was 1 year old") was va
Y worker concerning a 30 year old male who was vaccinated U with a dose of MMR II when he was a ch
Y nurse (R.N.) concerning an 8 year old male with 1 siblingY who on 6/29/2001
29-JUN-2001 2/2/2009
was vaccinated subc
n has been received from a consumer concerning his 6 year old son who on an unknown dates U was vaccinated with both doses of MMR II.
n has been received from a consumer,
Y who is the uncle of the approximately 24 months old N male patient with no previous medical history w
n has been receive from a registered
Y nurse concerning of himself a 27 year old male with sulfonamide
U allergy
8/9/1982
who in 1983 was vaccinated
umer reported that 10 years ago, in 1999 her son had a very severe reaction. He experienced Y a seizure and a high fever. The consumer sta
n has been received from a health care worker concerning himself. It was reported that in 1947U the patient was vaccinated with 2 doses of
n has been received from a consumer concerning her 8 year old son who was vaccinated with U a dose of MMR II. It was reported that the pa
n has been received from a consumer concerning her son who on an unspecified date was vaccinated
U with MMR II. It was reported that he
n has been received from a registered nurse concerning her daughter with frequently injection Y site reaction after unspecified vaccination wh
n has been received from a licensed practical nurse concerning a female with no medical history
U or drug allergies
9/1/1983who was vaccinated with
n has been received from a nurse practitioner concerning a 12 month old female who on 19-FEB-2009
N was
2/19/2009
vaccinated
2/23/2009
with a dose of MMR
n has been received from a nurse practitioner concerning a female infant with allergies to seafood
Y and shellfish who was vaccinated with a
Y and a nurse concerning a 13 month old female who on N 23-FEB-2009 2/23/2009
was vaccinated
3/4/2009 with MMR II. Th
n has been received from a consumer concerning her now 4 year old son with an intolerance N to gluten and 1/1/2006
a history 1/1/2006
of "GI Issues" who "wh
n has been received from a nurse practitioner concerning a female who on an unspecified date U was vaccinated with a dose of MMR II (dos
n has been received from a patient concerning his wife who on an unspecified date, was vaccinated
U with a dose of MMR II vaccine. The re
n has been received from a consumer concerning her now 15 year old daughter who was vaccinatedY with "one dose" of a MMR II "when sh
n has been received from a case inYlitigation for WAES #0610USA022225 from a physician U via medical records concerning a 55 year old fe
n has been received from a consumer concerning her 12 month old daughter with no pertinent Y medical history
12/1/2008
or drug
12/1/2008
n has been received from a consumer concerning her 10 year old son who on an unspecified Y date was vaccinated with a dose of MMR II (L
U with a dose of MMR II. It was report
n has been received form a consumer concerning her 5 year old daughter with no pertinent Y medical history 8/1/2005
and no drug8/1/2005
reactions or allergi
Y concerning a 12 month old male with no pertinent medical N history 2/25/2009
and no drug3/13/2009
reactions or allergies w
n has been received from a consumer concerning her 12 month old son who was vaccinatedNwith a dose of MMR II. Concomitant therapy i
n has been received from a consumer concerning her daughter 4 years old who at 15 months U old (2005) was vaccinated with a dose of MM
n has been received from a consumerY concerning her 6 year old son who on an unknown date N was vaccinated with the first dose of MMR I
n has been received from a consumer concerning herself (a "37 year old" female) with food N allergies who received MMR II series as a child
n has been received from a physician concerning a male patient with unknown drug reactions U and asthma who was vaccinated with a seco
n has been received from a pharmacist concerning a patient who was vaccinated with a dose U of MMR II on an unspecified date. Subseque
n has been received from a Physician Assistant concerning an 8 week old patient who on 20-MAR-2009
U 3/20/2009
was vaccinated
3/20/2009
with MMR II due t
n has been received from a consumer concerning her approximate 14 month old daughter with N no drug allergy
3/31/1999who on 31-MAR-1999 was v
n has been received from a consumerY concerning a friend's 19 month old daughter "who went Y to the emergency room 1/1/2009
with a 105 degree fe
n has been received from medical assistant
Y concerning a 35 year old female with asthma, seasonal
N allergy
8/28/2008
and tetracycline
3/16/2009 and erythromy
n has been received form a consumer via e-mail, who was vaccinated with a dose of MMR IIU(lot# not reported), on 5 different occasions an
n has been received from a Registered Nurse concerning a 47 year old male with benign prostatic
U hyperplasia
2/20/2009
and no drug allergies who o
n has been received from a consumer concerning a male who on an unspecified date was vaccinated
U with a dose of MMR II (dose, route a
Y Nurse (R.N) concerning her 4 year old son with no pertinent
N medical
2/1/2006
history and
2/1/2006
no known drug alle
n has been received from a consumer concerning her child who on an unspecified date wasUvaccinated with a dose of MMR II. It was repor
n has been received from a consumer concerning her child who on an unspecified date wasUvaccinated with a dose of MMR II. it was repor
n has been received from parents via e-mail concerning their son who was vaccinated with aUdose of MMR II on an unspecified date. The p
U with MMR II. The consumer reporte
n has been received from a medical assistant concerning a 13 month old male who on 17-MAR-2009Y was
3/17/2009
with MMR II (lot # 66
n has been received from a female consumer who was vaccinated with a dose of MMR II (HSA) U over 20 years ago. Over 20 years ago the
n has been received from
Y a physician
Y concerning a female patient who was vaccinated
Y with NGARDASIL. The patient received the first dose
n has been received from
Y a registered
Y nurse (R.N.)
Y concerning her daughter nowY18 year old, Y with drug hypersensitivity
6/1/1998 7/1/2008 to PHENERGAN w
was received on 09-June-2009 from Y a consumer. A male patient of unknown age received the N following vaccination
6/1/2009 on 6/9/2009
01-June-2009: sma
ort was received 11 June 2009 fromYa health care professional. A 35-year-old female patient with a history of chronic hepatitis B had receiv
ENTED TO MEDICAL C/O RASH AND SWELLING X 1 DAY. PT STATES THAT RASH STARTED Y APPROXIMATELY
3/18/2009 3/18/20095 HRS AFTER HE R
Y 6/16/2009 6/17/2009
oke out with shingles in his eye and Yon scalp 102 weeks after receiving vaccine. Y 6/5/2007 4/22/2009
ceived pneumococcal vaccine on 5/13/09.Y On 5/14/09, developed pain, redness, warmth, erythema Y at injection
5/13/2009 site.5/14/2009
WBC elevated at 11.8
Fainting episodes x2 after vaccinesYgiven. Recovered x1 after glass of water given. Second Y time it was6/17/2009
difficult to 6/17/2009
wake her, shallow breat
6/17/2009 6/18/2009
d vaccine 9/11/08 and became pregnant Y in 2/09. She then had a fetus that "was not thriving"Y and she had 9/11/2008
a D&C done 5/26/2009
5/26/09. Please no
ted to our office on 6/18/09 with left Ysided rash. Rash began one day after varivax was administered in the6/9/2009 left arm. 6/10/2009
Rash is present on the
after vaccine patient complained to parents
Y that her R arm was hot and redness and swellingNwere noted.6/15/2009 She was given 6/16/2009
Ibuprofen and col
accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed.6/4/2009 6/4/2009
hroat 10 minutes after the injection Y got dry and felt like an object was in it, and his left arm atYthe shoulder 6/18/2009
felt like it 6/18/2009
was numb. Had a little h
d papule rash and itching face,upper and lower body. I took the vaccine 2/24/09, but since then N as a RN I2/24/2009
have administered
6/17/2009at least 30-40
accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed.6/1/2009 No harm 6/1/2009
done to patient.
done to patient.
accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed. No harm done to patient.
ng of continued pain and soreness in the muscle of the left arm in the deltoid region. Pain with deep palpation 6/7/2009of the6/18/2009
lymph nodes under the
sters on lt arm where varicella vaccineY was placed. Pt also has erythema/induration of 4cm xY5cm surrounding 6/16/2009 area6/16/2009
where varicella vaccine
have the following symptoms about 3 hours following the shot: high Fever, Hallucinations, soreness,Y joint
7/20/2006
pain, aches 7/20/2006
and fatigue. Once th
alled stating that he was running a fever up to 101 on day 10 of small pox vaccine and was complaining
Y of6/7/2009
discomfort 6/17/2009
under the arms from
mergency room twenty-four hours after Y vaccinesY were administered with 1 apenic spells and cyanotic
U episodes,
5/22/2009along 5/23/2009
with fever. 7/7/09 Hosp
done to patient.
as entered into the electronic medical record as a female. The nurse gave the patient an HPV Y as indicated 5/4/2009
for female patients. Upon return
lls, muscle aches, sore joints, swollen glands, headache, fatigue all started the day after the Yvaccines were 6/16/2009
given. Patient
6/17/2009
had to leave work
, body aches, blotchy redness, and severe swellingY to right upper arm
2 especially near & surrounding
N PPSV6/15/2009
injection6/17/2009
site. 7/2/09 Hospital r
walk 5 hours after shot was given. Limped
Y on leg where shot was given. Gave tylenol and was Y able to walk 6/17/2009
again after
6/18/2009
2 hours. Expected th
dministered, vaccine 2 weeks out of date; No adverse event observed in patient. 6/16/2009
sted that these side-effects be reported. DTAP given at Left Deltoid (IM). Mother reported Left Y arm red, sore,
6/15/2009
had hard 6/17/2009
knot, and warm to to
ollen, red, + bump Dxper Dr L leg cellulitis
Y vaccine Rxn. Y 6/16/2009 6/17/2009
igh with induration, red 4x4 cm. U 6/16/2009 6/17/2009
OC onset about 10 minutes post injection with 10-15 seconds tonic posturing. Patient recovered Y consciousness6/18/2009 in less
6/18/2009
than 30 seconds - B
arm pain and swelling. Noted arm, area red slight swelling confined to injection site, size of U .50 cents piece.
6/15/2009
Able to6/16/2009
move extremity well. S
Y Y 9/23/2008 10/7/2008
and swelling onset 1 day after immunization given. 2/24/2009 2/28/2009
given left Deltoid on 2-7-09 On 2-9-09 pt had small welt at site. On 2-10-09 it had increasedUin size to 4.5"2/7/2009 X 3" with warmth
2/9/2009& swelling at th
01 degrees, - fever at 5:00 p.m day of vaccine given 2/11/09. Next morning 2/12/09 arm very Y sore at site2/11/2009
and hand 2/11/2009
swollen. Had rings cute
as in her car seat, after grandparents Y had come out of the grocery store. Grandparents noted Y child was twitching.
12/3/2008 Unresponsive ### & had som
n has been received from parents, aY physician Yand a medical assistant 2 concerning a 19 yearUold female 2/20/2009with anxiety, 2/20/2009
depression, asthma, t
ay of vaccine 17 hr HA and arm hurt at injection. Took EXCEDRIN - no relief. No redness at injection U site.6/10/2009
Pain L arm 6/10/2009
with movement at inje
and ZOSTAVAX on 5/4/09. Y He started experiencingY numbness/tinglingY (R) feet and hand with U weakness 5/4/2009
one week5/15/2009
later which has been p
nutes of injections, pt became acutely droopy, nauseated and vomited profusely. He was flushed Y and sweating.
6/17/2009 3x4 6/17/2009
cm. Wheal at site of VA
ns (seizures) approx. 1 day after shots. 6/26/09 Y Received hospital medical
1 records for 6/18-6/19/2009
U admit.
6/15/2009FINAL6/16/2009
DX: seizure-like spells
ching and drooling Y N 6/3/2009 6/15/2009
ter injection. No adverse affects. Y 5/28/2009 5/28/2009
d, swollen red lesion on Rt, posteriorY upper arm. U 6/16/2009 6/17/2009
er 4 month shots, developed raisedYrash all over body. Change in personality -> lethargic, decrease N in babbling
3/12/2009 and3/14/2009
cooing, screaming, dec
LA complications: None - mild illness with rash, no fever 6/19/2002 6/10/2009
aria. ZYRTEC. N 5/6/2009 5/8/2009
d Tdap @ 9:30 am on 6/10/09. At 12 00 pm on 6/11/09 pt developed nausea. Had to lie down Y for 15 hrs6/10/2009
and fell asleep.
6/11/2009
Woke up 3am on 6
oid where Tdap administered on 6/6/09 became indurated, erythematous, swollen, warm, painful. Y On Monday 6/6/20096/8 patient
6/6/2009
seen in office and
nt received DTaP vaccine IM in left thigh on 6/10/09. Patient was seen in the office on 06/12/09 U with a 3 6/10/2009
cm x 3 cm irregular
6/11/2009 area of redness
ticed the injection site was red and swollen
Y on 6/16/09, mother marked the swelling with a pen U and over 6/15/2009
the course of 2 days it was increas
nting episodes with 1st dose of GARDASIL on 4/7/09. With this 2nd GARDASIL & within seconds Y pt. got6/15/2009
pale, as she 6/15/2009
was laying down her
Y Y 5/22/2009 5/23/2009
me to IMMs complaining of redness rash, itching and soreness under arm of ACAM2000 vaccination site.5/5/2009
me to IMMS complaining of rash, redness, and itching at and around ACAM2000 vaccination site. 5/5/2009
eported "it looked like hives all over"Y - Rash-1wk- after MMR II, VARIVAX, HAVRIX given. Red Y itchy papules3/18/2009
2mm-1cm3/28/2009
varying site and loc
7, 2009, I noticed a rash on my back Y (right side). Two days later, the rash was spreading withU blisters and 3/5/2009
itching. Saw
3/7/2009
doctor, confirmed
ES EVERY TIME HE RECEIVES ANTHRAX VACCINE SINCE 1999, HE SUFFERS TEMPORARY Y MEMORY7/11/2008
LOSS.7/12/2008
HE RECEIVED 5 SER
given at about 12:15 PM June 16. Headache began immediately upon leaving the clinic. At 10:00 Y PM her 6/16/2009
R arm began6/16/2009
significant muscle tw
n has been received from a nurse practitioner, for the pregnancy Registry for VARIVAX (Merck), U concerning 7/3/2008
a 25 year7/3/2008
old female with a his
Y a 31 year old male with anaemia macrocytic,
Y aNhistory of immune
6/8/2009 thrombocytopenic
6/9/2009 purpura
n has been received from a pharmacist Y concerning a 48 year old female who on 08-JUN-2009 Y was vaccinated6/8/2009with a6/9/2009
dose of PNEUMOVA
n has been received from a physician's office. The physician's office reported that they read Uan article about GARDASIL (MSD) and at the e
n has been received from a consumer concerning his 5 year old son who on 01-JUN-2009 was Y vaccinated 6/1/2009
with a second
6/8/2009
dose of MMR II 0
n has been received from a physician's office. The physician's office reported that they read Uan article about GARDASIL (MSD) and at the e
n has been received from a physician Y for the Pregnancy Registry for GARDASIL concerningYa 22 year old 11/8/2007
female who11/8/2007
on 06-SEP-2007 wa
n has been received through the Merck pregnancy registry for GARDASIL from a registeredYnurse concerning ### a female
2/1/2009
patient who on 17-J
n has been received from a physician who heard from the mother of one of his patients that U she was told by a pediatric rheumatologist that
n has been received from a 25 yearYold femaleYwith a history of overgrowth
0 bacterial and "ZIPORO"
N (therapy
3/1/2009
unspecified)
3/1/2009
allergy who in Ma
n has been received from a Registered Pharmacist Y (R. Ph.) concerning
0 a 96 year old femaleUwho was vaccinated subcutaneously with a 0.
n has been received from Y a medicalYassistant concerning a 11 week old male patient with oxygenY therapy6/12/2009
since birth
6/12/2009
and a history of prem
ving client home. Client c/o not feeling well, became hot, eyes rolled back and head went down. Y Mother6/18/2009
called the6/18/2009
EMS. When the squad
accine exceeded the recommended temperature range. Shipping and Handling requirements Y were discussed.
6/2/2009 No harm
6/2/2009
done to patient.
6/2/2009 No harm
6/2/2009
done to patient.
6/2/2009 No harm
6/2/2009
done to patient.
6/3/2009 No harm
6/3/2009
done to patient.
her called clinic on 6/19/09 after child received third dose of the HPV vaccine on 6/17/09. Per U Grandma,6/17/2009
the child had
6/18/2009
no immediate proble
o upper right arm noted that evening . Continued to spread and covered entire upper arm. Tx- Y cool cloths, 6/15/2009
tylenol for
6/15/2009
discomfort. At presen
nd swelling at site of vaccination in right arm that started on the day of vaccination. U 6/16/2009 6/16/2009
ness and swelling on site. Tender and Y hard subcutaneous tissue. No other symptoms. Prescribed U Motrin 6/15/2009
and told to 6/15/2009
soak area in warm wate
ability, muscle/joint aches, headache, diarrhea X4 days U 6/15/2009 6/16/2009
U 6/16/2009 6/16/2009
welling and redness. No fever. Recommended ice, motrin and benadryl. Three patients within U one week6/16/2009
with reaction
6/16/2009
to Varivax.
6/3/2009 No harm
6/3/2009
done to patient.
njection site, Left upper arm erythema and edema surrounding and below immunization injection Y site (13.5/10cm)
6/17/2009 6/18/2009
welling and redness. No fever. Recommended ice, motrin and benadryl. Three patients seenUwithin one 6/17/2009 week with reaction
6/17/2009 to varivax
6/3/2009 No harm
6/3/2009
done to patient.
dministered 6/16 @ 10am then on 6/17 in late afternoon, pt noticed L head tenderness in hair Y and tender 6/16/2009
glands in 6/17/2009
neck on L side. This oc
6/3/2009 No harm
6/3/2009
done to patient.
EACTION TO VACCINE U 6/16/2009 6/18/2009
veloped Shingles on 1st branch right Y trigeminal. Patient has pain, swelling, itching, redness N
to right side 6/11/2009
of face and6/14/2009
forehead. Temp 99.0.
6/3/2009 No harm
6/3/2009
done to patient.
6/4/2009 No harm
6/4/2009
done to patient.
7 pm on 6/17/09, client had small bruise on R deltoid where 1 of the vaccines was administered. On 6/18/09, 6/17/2009
redness
6/17/2009
was noted to R delto
ceived Pneumo vaccine right deltoid mm post alcohol swABBING. c/o small amount reddness Y - @ 1 " in 6/15/2009
area with a6/17/2009
small 1"" track towards
6/4/2009 No harm
6/4/2009
done to patient.
6/4/2009 No harm
6/4/2009
done to patient.
ODE ENLARGED ON L INGUNAL REGION ABOUT 1CM IN DIAMETER MMR GIVEN SQ IN L THIGH 6/2/2009 6/19/2009
e of the flu shot there is a 5cm areA of macular erythema with multiple confluent vesicles . Across
Y the mid
12/9/2008
chest large patches
### of macular e
ollowing administration of Hepatitis A, Meningococccal and HPV vaccine, 6-18-09, patient ran Y a fever of 100.6
6/17/2009
degrees
6/18/2009
F and complained o
eceived Havrix (Peds Hep A) vaccine Y on 6/16/2009. Developed fevers to 101+ farenheit thatYevening. Had 6/16/2009
acute mental
6/17/2009
status changes th
d varivax on 11-21-1997, pt presented in our office on 6-17-2009 with scattered 10-15 nacular U lesions some sl ### papular
6/15/2009
without vesicles 2 da
6/15/2009 6/19/2009
ed the prescription for the Oral Typhoid vaccine from the Health Dept on 6/15/09. Ct started U the capsules6/16/2009
on Tuesday, 6/19/2009
6/16/09. Ct took her
orts back on 6-18-2009, one day after Y receiving dose #3 of HPV, that she now has Knots on back of head 6/17/2009
that are tender
6/18/2009to touch. No prob
IVED VARIVAX ON 1-14-2002 AND 3-3-2009. PT PRESENTED IN THE OFFICE ON 6-17-2009 U WITH 25-303/3/2009
SCATTERED
6/15/2009 MACULAR LES
R on 6/11/09. Kristin states had bumps on face and right knee 6/15/09 about the size a dimeYwith a little head 6/11/2009
in center.
6/15/2009
Exam on 6/19/09 fe
veloped afebrile Seizures Y on 05.23.2008, was Y diagnosed with Infantile
11 Y Spasm. Now
Y has SeizureN disorder5/17/2008
and global 5/23/2008
developmental delay.
shot was uneventful. After scab fell off while overseas wound started to heal up. Wound didYnot heal like 8/23/2007
everyone else.
4/1/2008Scar did not hard
came faint, diaphoretic and was eased onto the floor. Her VS stayed normal, she was givenYO2 and within 6/16/2009
1 minute 6/16/2009
was conscious and or
vaccine 6/16/09, each day following the site of injection became increasingly redder, more painful U and swollen.
6/16/2009 By 6/18/2009
6/19/09, began itching,
rsistent low grade pain since time. No Y functional ROM deficits, pain 1-2 of 10 in nature. ClinicalY exam normal 9/19/2008
w/palpation
4/3/2009
of deltoid. No palp
@ 2:30 pm immunization given. 6.17.09 @ ~ 5:30 pm --> fever (1m 104) - Hives @ 11:00 pm.UNo facial swelling 6/17/2009or difficulty
6/17/2009 breathing. Histor
9 patient felt generalized joint pain. Noticed swelling both ankles. Reported as non-pitting. DeniseY treatment.
6/9/2009
Joint pain
6/10/2009
resolved by 6/11/09
swelling at injection site (lower deltoid at left arm). Recommended Diphenhydramine 25mg and U Ibuprofen. 6/16/2009 6/17/2009
at site of injection - 6/17/09 2hrs. Body ache and joint pains 6/18/09. High fever. Y 6/17/2009 6/17/2009
redness and edema around the injection site, significant swelling of leg even 2 days, later, warm Y to touch6/17/2009
advised parents
6/12/2009 to put warm com
was reported by a physician,Y via a GSK representative
Y and described
4 the occurrence
Y of intussusception
Y 5/27/2009
in a 4-month-old
6/4/2009male subject who
d zoster PCR confirmed. Y Y 9/28/2005 4/9/2009
htness in throat, pale, wheezing
Y andYcollapsed Y in clinic lobby. Mom took
1 him right to ER. He Y had anaphylaxis 6/2/2009
to vaccines.
6/2/2009
Received Epinep
- 04-24-09 = left arm, shoulder,
Y neckY and rib pain
Y with muscle spasms. 2 No treatment. 04-27-09 N - severe pain
4/20/2009
in left side
4/27/2009
of my back, more p
6/7/2007
t pain in her back on 6/10/09. Patient Y didn't realize that she had a rash till 6/14/09. The rash Uwas approx.5/22/2009
6" in diameter
6/10/2009
in a circular pattern
VRIX in prefilled syringe in the left thigh with 1" needle. After immunization given, realized that Y it was an adult
6/9/2009
dose. Evaluated child for 20 m
swelling at site of injection. Red, swollen, warm to touch. Ranging 3 in by 1 in by 1 in. Encouraged
U mother
6/18/2009
to place 6/19/2009
ice pack, give appropria
t 6.18.09 Acute URI 4 mo check-up vaccines given see below- Return visit 6.19.09. Fever within 24 hrs of 6/18/2009
vaccine administration
6/19/2009 probably v
d 1/2 dollar size hive around area of injection - c/o pain & itching. Y 6/18/2009 6/18/2009
ped localized redness and swelling over (L) Vastus Lateralis sites within 24 hrs. Now 2 wks later Y has an erythematous
6/4/2009 6/4/2009
ring about 10 cm with
soon after immunization followed by vomiting some hours later symptoms resolved within 48 Yhours never had 3/4/2009
fever. 3/4/2009
and swelling at injection sites. Fever 99.3. Y 6/9/2009 6/10/2009
hemic area approx 3cm diameter, LYdeltoid. Y 6/17/2009 6/19/2009
d with C. difficile on 2/27/09 and 4/21/09 Y 2/6/2009 2/15/2009
6/11/2009
, Redness around injection site right thigh area, warm to touch. Tx-Infant TYLENOL liquid, Hydrocortizone
Y 6/16/2009
0.5% 2x 6/17/2009
a day for few days
cough.. mother brought child to car - before leaving child c/o itching all over and turned brightYred. Brought 6/10/2009
back into6/10/2009
office c/o cough sweati
welling/redness, pain and blister at the injection site. U 6/17/2009 6/19/2009
ven a DTaP rather than a Tdap. He had no adverse reactions. 5/20/2009
4/29/2009
hargy began 24 hrs after shots. The entire upper R arm swollen, red, hot, tender not localized Y abscess. 6/16/2009 6/17/2009
ular raised red area at (R) thigh. Y 6/17/2009 6/18/2009
opal reaction minutes after vaccination. Hypotensive + bradycardia immediately after near syncopal Y episode
6/17/2009
and cool,
6/17/2009
pale, diaphoretic. La
s, started 11 hours after the injection. Fever 101 deg; shaking chills; no localized reaction; noYparathesias.6/8/2009Severe headache.
6/8/2009
ema (notable lips & (L) eye), SOB. BENADRYL
Y & SOLUMEDROL given. Y 6/9/2009 6/11/2009
receiving Pneumovax & Zostavax, pt began having head fullness/pressure, ears tingling, walk Y fatigued. 5/28/2009
Some lightheadness.
5/28/2009 1 wk later st
iven 6/4/09. Pt developed within 24 Yhours fever, swelling, chills and generalized hives. She was U seen on 6/9/096/4/2009when6/5/2009
a large erythematous
on LUE with YF Vax 2:30pm 6/15/09Yafter screening. At approx. 2:35 pt c/o redness, swellingYand itching6/15/2009 at injection6/15/2009
site- 25 mg BENADRY
redness at site one day after vaccine administered. Knot under (L) arm two days after. U 6/12/2009 6/14/2009
swollen to shoulder & down to end of deltoid muscle observed in office. Dad reported red swollen Y - req. Abx.
6/10/2009
therapy.6/11/2009
at Gyn which came back positive forY high risk HPV types 16, 18, 31, 33, 35, 39, 45, 51, 52, 56 N after receiving
6/18/2007
3 dose 6/5/2009
GARDASIL 8/11/06, 1
6/9/2009
ame lethargic, flushed, diphoretic and vomited. A 3x4 cm eccentric wheal developed at the left Y arm site, followed
6/19/2009 by 6/19/2009
a wheal at the right arm
ur hours after the PPV vaccine (administered at 2:00 PM Thursday, 6/18 PCT)or Friday, 6/19Y around 5:00 6/18/2009
PM my temperature
6/19/2009 dropped per
; Severe and continuing headache;YUnusual and continuing sleepiness; Unusual tiredness, Yweakness (sudden 6/18/2009 and6/19/2009
severe); Severe and co
e, chills, unwell, slightly swollen glands.
ministered the Anthrax Vaccine
Y by the on 2 October 2006 due to the fact I was an Y active duty Nservice member 10/2/2006assigned10/4/2006
to a foreign country.
redess within 1 hour of vaccine. Within 2 hours of vaccine, headache and fever of 103 degrees N F. Fever 6/19/2009
and headache 6/19/2009
reduced by Motrin
eal hipertension after 1.5 months afterY the secon Y dosis and finally results
8 in neuropatic painY( 1 week after 3/9/2009
the first symptons)
5/25/2009
gerated reaction at site of injection.YRed, swelling, temp. 99.9, painful 6/19/2009 6/20/2009
RECEIVED HEP B, POLIO, PNEUMOCOCCAL DISEAS, DTAP, AND HIB. THE INJECTIONS Y WERE GIVEN 6/18/2009AT 4 PM 6/19/2009
ON 6-18-2009, WIT
ad his 4th dose of DTAP and his 3rd of Polio on June 18,2009 at appr. 3:30pm. He was fine Ybefore the shots 6/18/2009and the 6/19/2009
evening after. First th
n has been received from a pediatrician
Y concerning a 15 month old male patient who on 14-APR-2008
N was
4/14/2008
with a dose of MMR
n has been received from a physician concerning a 1 year old female who on 02-OCT-2008 Nwas vaccinated 10/2/2008
with the10/2/2008
first dose of MMRII. S
n has been received from a consumer concerning her 6 year old daughter who was vaccinated N with a dose of MMRII (lot number not provid
Y Y Y N 12/9/2008
was received from a health professional
Y on 09 June 2009. A 49-year-old male patient, with aNhistory of seasonal ###allergies,### received an inje
was received from a health care professional
Y on 09 June 2009. A female patient received anUinjection of FLUZONE ### SV '2005-'2006 USP (l
n has been received from a physician Y concerningY a 6 month old male 8 patient who on 06-JAN-2009
Y was vaccinated
1/6/2009 with 1/6/2009
one dose of ROTA
n has been received from a 17 yearYold female, for the pregnancy registry for GARDASIL, with Y asthma and 3/21/2008
VICODIN 3/21/2008
allergy, who in Janua
n has been received through the pregnancy registry for GARDASIL from a registered nurse Y concerning a8/18/2008
14 year old 8/18/2008
female with no pertine
n has been received from a consumer Y concerning her approximately 17 year old Ydaughter with N no medical 3/31/2008
history or 9/1/2008
allergies who was vac
ng after receiving the vaccine (06/18/2009) she woke up with severe body aches, felt like the Y flu, and Rt.6/17/2009
deltoid warm 6/18/2009
and tender to the tou
for doctor's visit and was ordered Gardasil
Y vaccination. Patient received vaccination and wasY instructed 6/19/2009
to remain in6/19/2009
waiting are for 20 minu
ately 2 to 4 days after 2nd rabies vaccine, pt developed widespread, wheal-like rash to lowerUarms, lower6/15/2009 legs, back6/17/2009
of neck, & upper chest
me in 6/22/09 stating that child has been fussy, running a low grade fever and unwilling to take U a bottle since
6/19/2009vaccines6/19/2009
given. No fever toda
6/11/2009 N 5/21/2009 6/11/2009
ng of lesions on right wrist, hand, andY genital region 8 days after small pox inoculation. Instructions
U on keeping
6/12/2009 lesions
6/20/2009
convered, good han
esented with red, swollen, painful area on arm where vaccine was administered approximately Y 72 hours after 6/8/2009
shot was 6/9/2009
given. We told her to
ely after Pt received second vaccine: Twinrix, Her head went forward towards knees. Pt wasYreturned to 6/18/2009 sitting position6/18/2009
and regained aware
amined - tender, urticarial type reaction distal to injection site. Large tender, raised urticaria,Uwith central6/19/2009
dusky discoloration
6/19/2009on forearm, w
out 3-4 hours I had a tight chest and nagging cough when I took a deep breath. Little dizzy on N day 2 and6/19/2009
blood spot6/19/2009
in my eye (never had t
n 4/07/09- she developed a rash onYtrunk 6 days Y later on 4/13/09-it 2was scattered over her upper trunk area- 4/7/2009
she called
4/13/2009
Employee Health o
a (from knee to buttock) of redness and swelling. Warm to touch. Starte >36 hours after injection Y 6/15/2009 6/17/2009
ved HPV and had fingerstick for hemoglobin.
Y left exam room and was sitting alone in conference
Y room began
6/22/2009 to feel
6/22/2009
light headed and was
2009, ONE DAY AFTER RECIEVING DTAP, MOTHER REPORTED MODERATE TO LARGE Y AMT. OF SWELLING
6/16/2009 6/17/2009
AT INJECTION SITE. R
& throbbing headache Y 6/22/2009 6/22/2009
derness and swelling over posterior Y aspect of left upper arm on 5/28/09 @16:53. Treatment: Y Ice to area 3-45/14/2009
times daily,
5/14/2009
Medrol dose pack,
tified office approx 45 minutes to 1 hour after vaccination that patient was having chills and wasY shaking.6/15/2009
Denies pain 6/15/2009
in arm. Instructed m
pneumococcal vaccine trial, with severe COPD, was hospitalized on 02/23/2009 with COPDYExacerbation. Vaccination ### 2/23/2009 took place on 10/1
ax 23 was given 6/17/09. Within 24 Y hours, he began to feel some discomfort in that arm and Ydeveloped a6/17/2009macular red 6/20/2009
rash around the injec
WAS GIVEN ALONE IN DELTOID YAREA. NEXT DAY PT RETURNED WITH SWELLING, PRURITUS Y OVER
6/15/2009 WHOLE 6/16/2009
DELTOID AREA.
as given a HPV injection and within Y seconds she fell over with loss of consciousness and jerkingY movements. 6/9/2009Fell off6/9/2009
of exam table. Pt. wa
o Pneumovax with the sweeling, induration,erythema,
Y warthm and pain in the R arm and forearmY 5/20/2009
d with Win. 9/29/09. Hospital records receivedYDOS 4/8/09 to 4/9/09. Assessment: Idiopathic Y Thrombocytopenic
3/28/2009Purpura. 4/8/2009 Child presents w
ned she had warm facial cheeks and red rash on facial cheeks - both facial cheeks - warm toYtouch. Received 6/15/2009 vaccine6/19/2009
on 06-15-09.
MR given Left arm. 2nd in series #/MMR 5/14/09. 6/20/09 Noticed bruising, swelling, tender. 6 inch oblong 6/19/2009
area of redness
6/19/2009 and warm to tou
ncopal event after administration of 4 vaccines (see below). Was caught before fell to floor, Ywas sat on chair, 6/16/2009 as soon6/16/2009
as sat, her eyes ope
tavax was administered in the R deltoid area, Ms. Cubelic has had intermittent intense itching in the right arm distal ### to the ### injection site. Th
easles vaccination rash. Red, raised areas over all of body. Low Grade temp. Y 1/20/2009 1/29/2009
lling of from deltoid to just above elbow
Y with redness and increased heat to palpitation. plus increased
Y bleeding
4/3/2009 at injection
4/5/2009 site with subseq
2 days post injection. Left deltoid area became swollen and inflamed with a 1/2 dollar red lump Y that was6/12/2009
painful and6/14/2009
warm. Generalized mu
h rash (small red dots) in diaper area 06/19/09) on 06/20 and 06/21/09 had red checks, low N grade temp.6/18/2009
slow progression6/20/2009of rash up abd to
feeling well. Generalized weakness. Cold hands and goose bumps noted. V/S HR 88/minute Y RR 20; B.6/15/2009
P 90/60. Placed 6/15/2009
in supine position
ing dizzy. V/S - HR 100/minute, RR 20, BP 100/60. Pt placed in supine position with feet elevated.Y Observed
4/13/2009for other
4/13/2009
reactions. Pt reporte
ed pain and swelling of 3" x 3" in L tricep
Y area. Site showed no redness, duration x 2 days, character
U is constant,
6/17/2009alleviating
6/17/2009 factors: nothing
came faint for about 15 seconds then woke up fine. Was checked (provider) then discharged. Y Was watched 6/15/2009
for 30-456/15/2009
minutes. Pt had clon
se events reported by patient. Y 6/9/2009
cm, overlying cellulitis. U 6/14/2009 6/14/2009
eived MMR and Hep A on 4-10-08,Yat age 2. - Mom noticed increase bruising 1 wk prior to office N visit for4/10/2008
the same. 5/20/2008
She was seen on 5-20-
n has been received from a healthcare worker who worked with 15 patients with no medical U history who were vaccinated with a dose of MM
3.8) and febrile seizure 12 hours after vaccines administered. Y 6/8/2009 6/9/2009
ult diphtheria/tetanus vaccine on 06/16/2009. The following day experienced headache, muscle and joint6/16/2009 aching, flushing
6/17/2009
of skin, and mala
sized red area back of right arm. U 6/9/2009
13 1/2 cm x 17 1/2 cm, swelling at left deltoid, upper arm Y 6/8/2009 6/10/2009
eltoid 10 cm bruise. Warm/Induration, Rash. Y 6/9/2009 6/11/2009
pt states she developed a hive on her face approx 48 hrs after receiving vaccines. Then 12Nhrs later developed 6/12/2009 hive-like
6/14/2009
rash on arms, but
's left deltoid was red + swollen. Redness measured 4cm, swelling measured 3-4 cm. Y 5/28/2009 5/28/2009
8/09. Vaccines were administered and the patient remained in the exam room in a supine position Y for 15 5/28/2009
minutes, with5/28/2009
an additional 10 minu
ys ago. No pain or fever. Itching @ site - no one else has had reaction very large redness & U swelling right
6/15/2009
ant thigh6/16/2009
10.5 cm X 9 cm
DASIL given 5/11/09. She called my office on 6/17/09 to say she had itching in her fingers and Y water blisters
5/11/2009
after inj.
5/11/2009
She gets same rxn w
his am with shot area painful - per mother.
Y U 6/17/2009 6/18/2009
ed LPN to give Hep A and PREVNAR. Y PENTACEL given by LPN instead of PREVNAR. Patient Y recalled 6/15/2009
same day /6/15/2009
stable / no adverse effe
ARICELLA left deltoid on 6/15/09 approximately
Y 9:30 am, child noticed redness, induration and
Y hard bump 6/15/2009
36 hr later
6/16/2009
as he showered, deni
5-8/day) for 2 weeks following the vaccine. Finally changed from Soy to Alimentum and so far Y is better. 6/5/2009 6/5/2009
o 103.3 within 24 hours of 2nd set of immunizations Y 6/16/2009 6/16/2009
he day of the vaccine, had diarrhea for the week after reported to me 6/22/09 Y 4/20/2009 4/20/2009
lands on left side of neck. 6/18/2009 6/22/2009
check-out area stating "i just don't feel right". Skin clammy patient escorted to exam room, had Y her lay down,6/19/2009
lower 6/19/2009
extremities raised. Oran
after PPD placement and GARDASIL Y < 10 second witnessed ?generalized tonic/clonic seizure. Y No post ictal6/19/2009
no incontinence.
6/19/2009
with dizziness and SOB Y 6/22/2009 6/22/2009
a hospital. I was informed about the meningitis vaccine which is a series of 3 shots. It was suggested that I3/8/1989have the vaccines.
3/8/1989 After the first
as given ZOSTAVAX on May 22, 2009. Developed Zoster from neck to wrist on June 8, 2009. 5/22/2009 6/9/2009
ema erythema hyperemia from elbow extending to shoulder. 6/19/2009 6/20/2009
en; red and 3 in x 4 in area- warm to touch. Today blisters on leg. Using MOTRIN and ice onUleg. 6/19/2009 6/20/2009
er called 6-19-09 reporting redness, swelling and warmth to touch at injection site on right arm. Y She stated 6/17/2009
not sure how
6/19/2009
long, but patient jus
B vaccine booster administered @ 3:45 PM. At approx. 8PM, health care worker (HCW) began Y to experience5/20/2009
numbness,
5/20/2009
tingling @ injectio
left arm red and swollen. Treatment - Benadryl 1/2 tsp TID U 6/10/2009
ecking out after check-up appointment Y and fell to the floor, white and pale. After 5 minutes, pt's
Y color is good6/17/2009
and pt6/17/2009
is A and O. Pt's vs norm
d rash c/w very mild VARICELLA Y 5/14/2009 5/19/2009
lla given, supposed to be HAV. No reaction seen. 6/22/2009
m red area (L) Thigh. DTaP and Varicella given on 6-19-09. Y 6/19/2009 6/19/2009
d redness/swelling, fatigue 2 days after
Y PNEUMOVAX injection. U 6/15/2009 6/15/2009
orted a rash that developed on back, neck and arms. Rash cleared up the same day. Y 6/11/2009 6/12/2009
cine 6/3/09. Fever 101 degrees 6/4/09. 101 degrees-103 degrees 6/5/09. Pain at vaccine site. Y 6/3/2009 6/4/2009
ess starting 6/11/2009. R arm 8cm x 9cm redness, warmth, slight indurated area, faint bruise Y under erythema
6/10/2004
able6/11/2009
to move arm. Ice/tylen
dasil 1st dose on Aug 23, 2007, 2nd dose on Oct 23, 2007. I got pregnant in JanY2008. MyNunborn baby then ### diagnosed
1/22/2008with ring chromos
ort was received 10 June 2009 from a newspaper Y article: A female college freshman student had received an unspecified meningococcal va
ort was received 10 June 2009 fromYa newspaper article: Two college students (one identified Y as a male and the other unidentified), had rec
n has been received from a 21 yearYold female patient with a history of previous miscarriageYand anaemia2/1/2009 who in February
2/1/2009 2009, was vacc
n has been received from a physician concerning a 15 year old female with depression who Uin November5/1/2008 2007 was vaccinated
8/1/2008 with her firs
n has been received from a pharmacist Y concerning his friend's daughter who on unspecifiedNdate was vaccinated with a dose of GARDASI
n has been received from a pharmacist concerning two patients who within the last 30 days U were vaccinated5/9/2009
with ZOSTAVAX
5/9/2009 (Merck) (sub
103 degrees - diarrhea -Yloss of appetite
Y - severe
Y stomach pain - weight
3 loss - weak/pale - lasted
Y over 75/11/2009
days. Hospital
5/14/2009
stay was 3 days, tre
Pt c/o pain in feet; 112508 pain cont, Y now can'tYpick up objects with44hands; 112608Y requires Yassist to walk 11/7/2008
into ER; 112708### is now bedboun
ceived ZOSTAVAX vaccine on 5/26/09 and began having adverse reactions on 5/28/09 of body U aches, headache
5/26/2009and 5/28/2009
fever.
(Dtap) whole arm swollen noticed 6/16/09 received imm on 6/15/09 4pm gave Rx Dermatop Y- watch give6/15/2009 tylenol Benadryl
6/16/2009as needed.
urticarial lesion w/o any systemic symptoms. Non pruritic papular lesion surrounds the punctum U where MMR 6/16/2009
was given.
6/16/2009
eddened, feverish knot with redness going to axillary area. Itchy 3 1/2X2 " knot redness 7 1/2" U X 4 1/2" no 6/16/2009
streaking down arm (bubbly look
dministered 6/17. Arm turned pink immediately following, then cleared. Several hours later arm N turned red 6/17/2009
and slightly6/17/2009
swollen in a 3" diame
iven to early per manufacturer. 5/22/2009
TDAP on 6/9/09 noticed hives to injection site and just below injection site to anterior upper Y arm. Had swelling
6/9/2009blotchiness
6/11/2009 to areas and mu
der swelling. U 6/15/2009 6/16/2009
ed and swollen. Y 6/10/2009
d swollen, warm, red and hard to touch-client
Y mother encouraged to seek help at MD or ER. No U drainage noted6/9/2009 at injection
6/9/2009 site.
c/o L upper arm redness Y 4/29/2009 5/2/2009
OUR OFFICE FOR 4 YEAR OLD WELL Y CHILD VISIT. RECEIVED 4 YEAR OLD BOOSTERS: Y Dtap, MMR, 6/17/2009
IPV, AND 6/19/2009
Varivax ON 6/17/09.
nt is a 46-year-old man who had Pneumovax
Y vaccine here on June 17. Within 1 or 2 days, he Y developed6/17/2009
localized redness
6/20/2009 and irritation tha
days after receiving MMR, Prevnar Yand Varivax vaccinations. U 5/13/2009 5/22/2009
ceived the shingles vaccine on Monday, and she came back today on 6/11/09 due to allergic reaction. She 6/8/2009
was told6/11/2009
if she had any problem
other reports 3 to 4 hours after reciving
Y immunizations yesterday, child started running fever U ranging from6/22/2009
99 to 101,6/22/2009
Child very fussy and cr
er called pt complained of soreness Y at the site and feeling cold. The next day she c/o her heart Y racing and 6/17/2009
feeling some 6/18/2009
discomfort in her ch
by Father, stated school nurse called Y that daughter face was swollen. Father instructed to take U daughter 6/22/2009
to ER. 6/23/2009
a Shingles vaccination at 2:30 PM last Friday (06/19/09) and am STILL experiencing headaches N today, Tuesday
6/19/2009(06/23/09).
6/20/2009 I was told at t
e vaccine around 9:00 am, became tired, and went to sleep from 5 to 7pm, then back to bed Y later that night.
6/18/2009
Complained6/18/2009
of excessive night
ble crying, would not nurse or drink. Seen by physician within 4 hours of onset of symptoms.Y Eposide lasting 6/19/200924 hours.
6/19/2009
Physican dx pertu
dap immunization yesterday. At 1100 Y pm she developed onset of HA/dizziness/chills/ nauseated. Y She also
6/22/2009
reported6/22/2009
to her mom some lowe
N OF REDNESS, WARMTH, AND SWELLING TO RIGHT ARM 1 DAY AFTER RECEIVINGYVACCINES. 6/17/2009
REDNESS 6/18/2009
COMPLETELY AROU
2/21/2009 N 2/19/2009 2/21/2009
eloped a few small, raised, red dots on the face and in the hair line area. U 6/23/2009 6/23/2009
er and Grandmother after receiving second series of vaccinations "child will not play as before". U 4/1/2009 4/15/2009
earing Loss and balance problems 5 days after injection. MRI and MRA normal. ETN Y doctors
N (started week 5/7/2009
folowing5/12/2009
SHL) put me on sterio
/1:32pm-Anthrax vax rec'd IM L. Delt. 13 Jun 09/2:00am-Sore throat/fever/chills/flu-like symptoms Y noticed.
6/12/2009
Went to6/13/2009
ER later in the day wh
e fever, polymorphous rash, bilateral bulbar conjunctivitis, cervical lymphadenopathy, erythematous U palms4/30/2009
and soles, 6/21/2009
swelling of hands and
of both ankles, purple/red color on heals.
Y Extreme pain in left ankle/ achillies tenden/ lower leg.
N Began December
11/6/200808-12/1/2008
Present. Can not stan
d the initial left bicep muscle aches toY a common reaction to injections; however deep throbbing U and aching 9/8/2006
in left bicep
9/8/2006
continued; and eve
d a headache shortly after receiving vaccine 3/10/09. He also experience throbbing of the head Y and near3/16/2009
his left eye4/12/2009
thereafter. On 04/12
omplains of "severe itching" from head Y to toe. Member given Benadryl + Clairton by Doctor.Y 6/22/2009 6/22/2009
omplains of "severe itching" from head Y to toe. Member given Benadryl and Claritin by doctor.Y 6/22/2009 6/22/2009
omplains of "severe itching" from head-to-toe.
Y Member given Benadryl and Clartin by doctor.Y 6/22/2009 6/22/2009
omplains of "severe" itching head-to-toe.
Y Member given BENADRYL & CLARITIN by doctor.Y 6/22/2009 6/22/2009
omplains of "serve itching" from head-to-toe.
Y Member given Benadryl and Claritin by doctor.Y 6/22/2009 6/22/2009
omplains of "severe itching" head-to-toe.
Y Member given BENADRYL and CLARITIN by doctor. Y 6/22/2009 6/22/2009
Y Member given BENADRYL and CLARITIN byYdoctor. 6/22/2009 6/22/2009
Y Member given BENADRYL & CLARITIN by doctor. Y 6/22/2009 6/22/2009
935 Upon rising client stated "feeling dizzy, laid client down B/P 108/80 P64, R14, skin w/d appropriate
Y for
6/23/2009
race, c/o 6/23/2009
legs feeling week", able
d c/o pain + swelling (LD) area. Observed
Y redness, swelling at area warm to touch. Y 6/17/2009 6/17/2009
hours post administration of HPV 1st seizure - no other risk factors. 7/9/09 Hospital ED records Y received6/15/2009
DOS 6/15/09. 6/15/2009
Assessment: New
t- MENACTRA 5/21/2009
ot- MENACTRA 5/11/2009
the typhoid vaccine on 26 May 1982. He was seen Y in the clinic the50following day Yfor a reaction
N to typhoid5/26/1982
with a temperature
5/27/1982of 100.6; diagn
ot-MENACTRA 5/12/2009
as shaking violently for less
Y than 20 seconds accompanied by pallor & diaphoresis. No loss of Y consciousness.
6/23/2009 7/14/09
6/23/2009
Records rec'd from P
ately equal to 2 hours after eye and cheek swelling. No dyspnea, no vomiting. Y 6/12/2009 6/12/2009
doses of varicella on 2-17-04 and 2-19-08. Pt dx today with chickenpox. Y 2/19/2008 6/23/2009
tes that after the receipt of all three AVA vaccinations she experienced a "knot" at the injection site the day of the ###vaccination.### Additionally
t induration, redness, tenderness atYinjection site (13 cm), fever 102. Y 6/9/2009 6/10/2000
vaccinations 6/8/2009, developed quarter-sized
Y reaction at injection site. Progressed to aboutY grapefruit sized
6/8/2009reaction,
6/8/2009
took BENADRYL a
ven at the site of redness and swelling. Y 6/18/2009 6/19/2009
e she received Tdap is red, swollen and warm to touch on Wed 6-17-09. 6/16/2009 6/17/2009
ports an itching bump at site of injection. She says that she didn't notice it until 3 days after U receiving vaccine.
6/18/2009 I advised
6/21/2009
her to use Benadr
, 2009 12:04 PM After pt was given TDAP and MENACTRA vaccines he jumped off the bedYand sat next 6/19/2009
to his mother,
6/19/2009
while his brother re
other, patient c/o headache on 6/6/09 Y - spent 6/7/09 in bed with nausea, h/a - diarrhea beganYon 6/8 - 6/10. 6/5/2009
Seen in hosp
6/6/2009
on 6/10 - dehydra
ntly gave PEDIARIX at same visit as PENTACEL. Infant's mother aware - informed of possible Y increase local
6/18/2009
reaction per CPC, and to repo
X given inadvertently @ same visit as PENTACEL. Infant's mother aware. Spoke to her 6/22, Y reports no6/18/2009
adverse reactions, no site redness
ogressive body aches. Then weakness + dyspnea. ER visit x1 MD x3. Y 6/16/2009 6/17/2009
t swelling involving the whole L deltoid where vaccine was injected. Y 5/12/2009 5/13/2009
adaches - Given medication for headaches,
Y bed rest. Y 6/15/2009 6/17/2009
episode after MMR vaccine and TBYskin test. While checking out of clinic with parent struck tile floor resulting 6/22/2009 in laceration
6/22/2009 to head and 10
ocal erythema of skin approx 10 cm in diameter, no induration. Y 4/1/2009 4/1/2009
elling from elbow to neck. TX - BACTRIM Y 4 tsp po BID. Y 6/17/2009 6/19/2009
, given & explanation of possible Rx. Took infant home & 2 hours post shots started crying almost Y non stop.
6/22/2009Brought6/22/2009
back to clinic & right
h ~ 2" diameter with corresponding Y axillary lymphadenopathy. Y 6/1/2009 6/2/2009
ollowing vaccine pt - had swelling and Y redness @ injection site with itching. Saw MD. ? cellulitis Y - no tx other6/17/2009
than cold/hot
6/18/2009 packs, resolved w
, deltoid region : 4x6 cm indurated. Pink, non-tender, itchy. 6/16/2009 6/17/2009
ke up screaming @ 2am. Patient had raise red spots over body. They called ER- Couldn't say Y without seeing
6/15/2009her. They
6/16/2009
put her in Aveno ba
utes after intramuscular; injections of PEDIARIX and PREVNAR vaccines to anterior and latYsides of left6/15/2009 thigh, patient's
6/15/2009
left thigh became w
ceived VARIVAX 5/21/09 patient had Y rash 6/17/09 was seen in office 6/18/09. 5/21/2009 6/17/2009
econds after vaccines given. Started on L leg extending to Abd (Very mild). Benadryl 12.5 1/2 Y tsp given &6/4/2009
rash resolved 6/4/2009
after 45min period
tous circular area around site of injection on (L) deltoid. This rash showed the day after shot Y was given. No 6/9/2009
fevers. 6/10/2009
d lump at injection site. Y 5/11/2009 5/11/2009
macular rash trunk, limbs and face. U 6/19/2009 6/23/2009
ite pain after 20 mins. 2 weeks laterYdevelopedYsevere headaches, treated1 with percocet.
Y gained
N 40lbs in1/28/2000
the months 1/28/2000
that followed. extreme
ave two knot very swollen and red around the shot site in his two arms and fever 100.7 for two U days. It wont6/21/2009
go away 6/21/2009
wit tylenol or motrin .w
was received from a physician on 18 Y June 2009. A 14-year-old female patient, with no reported U medical3/26/2009
history, received
4/26/2009the following vacc
n has been received from a certifiedYmedical assistant, for the pregnancy registry for GARDASIL, Y concerning a### 20 year
3/31/2009
old female with a hi
n has been received from a lawyer Y concerning Yher approximately 6 0year old grand daughter Uwho on an unspecified date was vaccinated wi
n has been received from Y a nurse concerning
Y aY4 month old female 1who on 15-APR-2009 was Y vaccinated 4/17/2009
with a first6/4/2009
dose of ROTATEQ (L
n has been received from a physician Y concerning Y an approximately1514-week-old male patient N who was vaccinated
4/1/2009 with 5/1/2009
the first dose of RO
he felt sinus congruent with sore throat, muscle aches allover, Temp, congestion (sinus), general Y malaise6/16/2009
swollen lymph 6/16/2009
Glands @ neck.
s legs + arms heaviness arm R where shot administered nausea + dizziness. N 10/4/2007 10/6/2007
o injection site 3x3 round raised. Orapred + Altabax Y 6/11/2009 6/11/2009
ame pale and lightheaded at clinic, Ybut recovered on own. Mother called in this AM to reportYtaking client 6/19/2009
to ER on 6/19/2009
06/19/09 PM near midn
warmth and swelling at administration site. Y 6/17/2009 6/17/2009
d with ACAM 2000 (lot VV04-003A)Yvaccinia live virus vaccine on June 12 2009. Normal take U documented 6/12/2009
on June6/22/2009
18, 2009. No adverse s
reamed inconsolably for 3.5 hours. Y He also apparently went limp for a few seconds, but did not Y turn blue.3/23/2009
He had a 3/23/2009
fine pinpoint rash and s
nt inadvertantly received a Hepatitis A vaccine instead of the appropriate Hepatitis B #1 vaccine Y at 3 months 6/16/2009
of age.6/16/2009
The patient had no ad
ceived 4 immunizations in the officeYat approx. Y 3:15 PM. Mother called
1 after hours at7:23 to Yreport the child 5/21/2009
was grey/pale
5/21/2009 and limp. No re
en 1st varicella on 06/12/2009 pt returned to the office 6/24/2009 with the c/o spots on belly,Yfever, vomiting. 6/12/2009
Pt was6/24/2009
dx with chicken pox.
ceived Rabies Post Exposure Vaccine (Imovax)Yfor Dose #2/Day 3, 6on 6/18/2009 at 10:00 a.m. U At 1:35 am, 6/18/2009
patient 6/19/2009
was transported to hos
ght parotid gland without fever. chills, malaise, myalgias or fatigue. Y 6/3/2009 6/18/2009
fter administration of zostavax patient stated she had redness at injection site about the size of a quarter, 6/22/2009
3rd day after6/24/2009
injection, site is red,
edness and swelling approximately 4 inches in diameter. Warm to touch, fever 2 days post vaccination.Y Dr.
6/22/2009
saw pt. Advised
6/23/2009 parents to ice a
r i recieved the vaccination i did not Yfeel well and slept all afternoon i recieved the shot in theYmorning. I was 6/18/2009
vomitting,
6/19/2009
almost fainted, swea
ng of immunizations he threw up 2 times,
Y became chilled, spiked a fever, and began having U breathing difficulty
6/22/2008 similar
6/23/2008
to the reaction at 2 m
site the day after immunization. Warm Y red rash extending 5-7 cm around site 6 days after immunization.
U 6/17/2009
No fever, 6/18/2009
chills, drainage. Seen i
immunizations on 06.16.09. Fever and Y vomitingY started on 6.17.09. 3Ataxia started on 6.20.09. N Hospitalized 6/16/2009
from 6.20.09
6/17/2009
- 6.22.09. Post inf
ed Pt developed hearing loss to both ears Dec 07 shortly after completing GARDASIL Y series.UDose #1 1/23/078/6/2007- Dose#2
12/1/2007
3/29/07 - Dose#3 8
009 center was notified by hospital Y of a vaccineY adverse event following
3 involving this patient.
Y The event4/29/2009
occurred in5/11/2009
May 2009. Review of r
ed Tdap and then GARDASIL. she was sitting on end of exam table talking. She stopped talking Y fell forward 6/24/2009
into my6/24/2009
arms and I laid her bac
ates "bumpy rash" to both arms & legs Y 1 day after vaccine. Followed up with pediatrician & dermatologist
N 5/13/2009
who Rx cream 5/14/2009
& rash subsided te
male who presented as walk-in to clinic Y reporting development of itchy red rash over bilateral Y hands evening 6/7/2009
of 6/16/2009;
6/16/2009possibly spreadin
. Soreness at site (L arm). Hives/rash - legs & ankles. Stable no other SX. Y 6/23/2009 6/24/2009
3PM increased fussiness & strangeY eye movement. "Out of it" & fever started. 6/20/09 - Tired Y & diarrhea. 6/19/2009
6/21/09 - "Very out of it". Limited
rts that approximately 7 hours after vaccine was administered, infant became very irritable and Y cried inconsolably.
6/22/2009 Infant6/22/2009only slept 1 1/2 ho
n upper arm swelling, warm to touchYwith some induration. Pt c/o some itching, denies pain. Advised Y to use
6/16/2009
cold compress
6/16/2009 and take BENAD
PNEUMOVAX (L) deltoid 6/23/09. PtYhad pain later same day (+) redness of skin. Rash spread U (+) tender6/23/2009
(-) drainage 6/23/2009
(+) felt warm (-) chills
ash involving mainly the axilla and groin area appearing 48 hrs after vaccine. No associated U fevers. BENADRYL
6/22/2009 3/46/24/2009
Tsp every 4-6 hours.
RN at Dr's office called stating pt had
Y a Hepatitis B shot at our clinic and now was having a Y reaction. Complains
6/22/2009 of 6/22/2009
nausea, "feeling woozy
ened skin from elbow to shoulder onYL UE. Benadryl if needed. Y 6/19/2009 6/21/2009
ed "low grade fever" the evening of 6/19/09
Y -> reported warmth pain and redness at site of the Y PNEUMOVAX 6/18/2009
vaccination
6/19/2009on 6/20/09. Repo
rmth eryth and 1 vesicle just inferiorYto injection site. Itchy, no fever, no malaise. Y 6/23/2009 6/24/2009
ing of day she received vaccines, developed fever, left deltoid redness, swelling and warm to touch and 6/22/2009 soreness. 6/22/2009
vaccine at 830 AM and by 1030 AM left deltoid swollen, hard to touch and soreness. 6/24/2009 6/24/2009
ythematous plaque to L deltoid posterior to injection site. No heat, no streaking, no tenderness, no s/s of6/17/2009infection. Pt 6/23/2009
denies pain, has FRO
pprox 2 pm ZOSTAVAX given approx 1:30 am. Pt experienced rapid pulse of 80-93; BP 146/84, Y went down 6/11/2009
to normal 6/12/2009
after 2 hours, reporte
n has been received through the Merck pregnancy registry from a physician concerning a 23Yyear old female 9/10/2007
who on 12-JUL-2007### was vac
n has been received from a 16 year old female consumer for the Pregnancy Registry for GARDASIL Y concerning
3/19/2008 herself
3/19/2008
who on 19-MAR-20
n has been received from a medical assistant concerning a female in her 20's, who in December Y 2008, was12/1/2008
vaccinated12/1/2008
Y concerning her 13 year old daughter who on 16-JUN-2009
Y 6/16/2009
was vaccinated
6/16/2009 with the first dose
oke-like symptoms such Yas muscle Y weakness on Y one side, slurred speech,
3 confusion,
Y sent toN Emergency Room ###
- Brain scan ###- no stroke, se
ven a flu shot on Monday. Y On Thursday,
Y pt experienced
Y muscle weakness4 on oneYside, slurred
N speech, confusion,
11/3/2008 trouble
11/6/2008 swallowing. He w
PNEUMOVAX 0.5 ml IM 6/5/09. Seen Y @ ER 5/7/09.Y DX: cellulitis (R)
3 upper arm. Treated in Yhospital till 6/10/09.
6/5/2009 Discharge
6/7/2009 6/10/09. 7/2/09
o hospital for routine medical check Yup. 14 y/o female no past medical hx. Pt rec'd three immunizations
U GARDASIL-Merck
6/19/2009 6/19/2009 Lot 0389U Exp 2
given in high left shoulder 6-8-09. (Patient is 65 and should have received plain DT.) Patient developed general 6/8/2009pain & stiffness in left sho
y, cranky, clingy, sl. decreased appetite
Y and developed rash on abdomen, neck, legs overall U scattered on6/20/2009
body incl. 6/21/2009
hands/feet consistent w
swelling, warm to touch at injection site. Pt also has low grade temps. Y 6/15/2009 6/18/2009
econds after injection, patient became pale, diaphoretic and fainted. LOC about 10-15 seconds. Y Responded 6/22/2009
to stimuli
6/22/2009
and had no other pro
h erythema, swelling, warmth to touch Y area of erythema 9x9 inches. 6/18/2009 6/20/2009
and redness, tenderness in area of shotsY on (R) Leg/thigh very large approx. 10x12 cm redness. Y Went to ER-placed
5/7/2009 on 5/8/2009
antibiotics.
d patient reports that patient felt depressed about two weeks after receiving GARDASIL. Also N reports that6/10/2008
she had mood 6/1/2008
swings. Did not se
leg pain and refusal to walk 48 hrs after 5 yr vaccines given in legs. Lasted several hours without Y parents 1/16/2009
being able1/18/2009
to see redness, tende
akness, SOB on exertion (mild) left arm felt tingling & cold however felt warm to provider, no U edema. 6/17/2009 6/18/2009
d on 5-27 and stated child developed Y rash and fever several days after imm - mom states rash Y was very5/12/2009
bad and on 5/20/2009
May 23 they took him
n 6-10-09 c/o headache then at 01:00 Y c/o "whole body shaking" last 1/2 hour then c/o "heaviness Y in the legs
6/9/2009
". Ran 6/10/2009
low grade fever x 4days
exam table - gave MENACTRA im to LD then HPV im RD. A few second later patient feels dizzy Y and passed 6/17/2009
out and 6/17/2009
lying on exam table, f
the shingles vaccine hoping it would help me - I have had 2 episodes a year for about 5 years, after the vaccine that accelerated to 5 episo
Y 6/11/2009
Y 6/17/2009
Y 6/11/2009
esented with Bell's Palsy on 4/28/09. Symptoms. Symptosm began on the 27th with right sided Y facial paralysis,
4/16/2009 blurred
4/27/2009
vision, excessive te
eumococcal vaccine in the ER on 6/18/09 in the Lt posterior arm. Left posterior arm noted with Y red raised 6/18/2009
erthema, swollen and very warm
Y 6/15/2009
Y 6/17/2009
d temp 100.3, unable to work, numbnessY of hands & feet pupils dilated, moaning. BP 120/70Y RR rapid 40, 6/17/2009
headache 6/18/2009
(+) Blood sugar 70. P
3/23/2009 N 3/13/2009 3/23/2009
njection site, feels tender and is somewhat reddened but not warm or infected feeling. U 6/2/2009
atient felt some pain in her upper left arm and felt a small bump.Seen at this office 6/25/09. She U has a 1 cm 5/19/2009
soft cyst-like
6/19/2009
nodule which is in
3, 2009, client returned to health department for PPD reading. During visit, she c/o redness and Y warmth in6/1/2009
her left arm. Visual inspection o
N RED PATCH ON RIGHT DELTOID. U 6/23/2009 6/24/2009
a 61 year old MALE who presents to Y clinic with a 4 day history of R upper arm pain/swelling Y which started6/8/2009
after he received
6/10/2009 the Zostavax o
ever of 102, vomiting, and congestion. Y Was seen in emergency room 6/18/09 because symptoms Y persisted,
6/15/2009
diagnosed
6/15/2009
with pneumonia.Pat
ven VFC DTAP. No adverse reaction. Y 6/15/2009 6/15/2009
recieved 4 vaccines, Hep B, Td, MMR, Y and PPD. 30mins after, she came back complainingYof dizziness6/22/2009 and light headedness.
6/22/2009 Employee
red 2 doses of hepatitis B vaccine on the same date of service Y 6/25/2009 6/25/2009
ceived Hep A and Tdap vaccinations. Y Approximately 1 minute later patient complained of nausea U and she 6/25/2009
was pale. 6/25/2009
Patient lost conscious
e myalgias after injection. On 6/24/09 Y (6 d after inj). Woke up itchy, indurated, local injection site 4 x 8cm.6/18/2009
(B) wrist edema.
6/24/2009Hurt with arthralg
es listed given at 29 days old. 5/1/2009
KINRIX on 6.22.09. Per mom, noticed Y swelling, increase - after 24 hours - 6.23.09, went to ER Y around 11 6/22/2009
pm. Thought6/23/2009
insect bite caused s
lled @ 10 am 6/24/09 to say pt had large reddened area on R upper arm ~ about 4" in triangular U shape -6/22/2009
indurated and6/23/2009
sensitive to touch. C
asovagal reaction abut 5 mins. after administration. Pt responded immediately to verbal commands. Y She6/16/2009
was oriented6/16/2009
- kept pt until her mo
6/23/2009 6/24/2009
by T-99. Red, swollen at site. Advised TYLENOL, cool compresses. Y 6/23/2009 6/24/2009
ould present himself off & on with anger outbursts, mood swings & getting in his "zone" whichUwas like he4/22/2009 couldn't process what I said until a
of right thigh and bruising. U 6/17/2009 6/18/2009
dness, heat, tender, firm area 5" horiz Y and 3" vert just below site of injection in (L) upper arm....2
U days after 6/9/2009
injection6/10/2009
- (started itching 1 day
macular rash started 2 days after vaccine
Y was given & a fever of ? degree was reported by U his mother. He had no fever when seen 6/19/09
ve decreased motor skills LE >> VE Dxd - " transverse Y myelitis". 7/2/09
5 Hospital records received
U DOS 5/29/09
5/4/2009 to 6/2/09.
5/28/2009Assessment: Tra
ontacted by pt mid-Jun 2009 & reported Y recurrent headache, dizziness, nausea, blurred vision, N & fatigue 3/31/2009
which developed
4/13/2009about 2 weeks fo
after administration of vaccine, patient developed erythema, pain, vesicle at site of innoculation/fever
Y of 102
6/16/2009
degrees6/18/2009
approximately 48 hrs a
f injection: Chills, Nausea, Diarrhea & fatigue. 2nd day vomiting & fatigue persists. Y 6/10/2009 6/10/2009
Y 6/11/2009
Y 6/15/2009
Y 6/17/2009
lar rash at injection site - (R) SQ-thigh.
Y U 6/15/2009 6/24/2009
d AM of 6/25/09 L upper arm redness, induration, swelling, and increase warmth. Suspect cellulitis. N Tx with
6/23/2009
KEFLEX6/25/2009
250/5ml one tsp TID x
ceived from a physician on 23-APR-2009 (via a sales representative). The reporter is also the patient. A 3/25/2009 male patient3/27/2009
(initials: EF, age unkn
Migraine with loss of central vision. Y Felt sickly. Diarrhea. Slight headache. Fatigue. Chills. Aches.
Y Report received ###from a consumer
### on 05-N
ceived from a nurse on 03-11-2008. An 80 year-old male patient received AFLURIA 0.5 ml pre-filled U syringe on### 14-Oct-2008.### Concomitant
ceived from a paramedic/fire fighter on 05-Nov-2008. Reporter stated that four (4) patients experiencedU flu-like ###symptoms
11/1/2008
(nasal congestion
ceived from a paramedic/fire fighter on 05-Nov-2008. Reporter stated that four patients experienced U flu-like symptoms
### 11/1/2008
(nasal congestion, ch
ceived from a paramedic/fire fighter on 05-Nov-2008. Reporter stated that four (4) patients experiencedU flu-like###symptoms
11/1/2008(nasal congestion
ceived from a paramedic/fire fighter on 05-Nov-2008. Reporter stated that four (4) patients experiencedU flu-like ###symptoms
11/1/2008
(nasal congestion
ite pain lasting 3 months U ### ###
n has been received from a consumer Y concerning her cousin's 15 year old son who was vaccinated N with MMR II (lot number not available)
n has been received from a physician Y for the pregnancy registry for GARDASIL concerning aY 22 year old 8/5/2008 female with 8/12/2008
a history of papanicol
n has been received from a Physician Y Assistant (P.A) concerning a 15 year old female
Y patient
Y who on 13-JUN-2009
6/13/2009 6/13/2009
information received from the healthcare provider upgraded the case to serious. It also provided U additional
5/18/2007
concomitant
4/9/2009
vaccines, test resu
given MMR and Varicella. Y Whelps atY 5 mins after given. Benadryl given, whelps smaller. Sleeps Y no wheeze, 6/18/2009
cry when6/18/2009
woke 30 minutes afte
rying baby in severe pain- can't calm down, mom can't put baby down. Y 6/22/2009 6/22/2009
me to health dept today and reported Y the following: Client left building where she received IZY"body went6/19/2009
stiff, eyes 6/19/2009
were open x 2-3 minute
Y 4/22/2009
child spiked temp of 101.4 tues. 6/16/09 after vaccinations received Mon. 6/15/09. Fever broke tues afternoon. 6/15/2009 Symptoms
6/16/2009 include runny no
Bright red blood in stool - size: about
Y a quarter occurred twice in the evening on the day sheY received her2/9/2009 2 months 2/9/2009
vaccinations. I took he
nd throat swelling, chest pain 1 1/2-2 Y hours after vaccine was given IV BENADRYL and PEPCID Y given in6/17/2009
ER. 6/17/2009
phenhydramine N
ever, went to ED -> Dx with otitis media. Y Y 5/19/2009 5/20/2009
d elbow and knee burning joint pain. One month after vaccination had Parvovirus infection. Pain Y continues, 2/21/2008
no other3/30/2008
rheumatologic disease
pain in left arm after receiving flu shot. U 10/9/2008 ###
r reported to me that 3 days ago he started with some numbness to left axilla and lateral upper arm. 6/17/09 5/18/2009
50% better.
6/12/20096/22/09 90% bett
nny nose, coughing Dx 6/1/09 with pneumonia
Y Rx AMOXICILLIN. Y 5/29/2009 5/30/2009
fussy, screaming, inconsolable for 2 days. Mom could not put baby down. Y 6/12/2009 6/12/2009
@ injection site Y 6/17/2009 6/18/2009
ely after varicella vaccine, which was given last, client c/o nausea & dizziness. BP 100/60 x2.YJuice was given.6/23/2009
Remained
6/23/2009
seated for 15 min
unization client developed hives thatYitched until she scratched and drew blood. They covered N neck to toe6/10/2009
of her body. 6/12/2009
fter shot, arm swell up, turn red, working down to forearm, painful ! 6-13-09 Medical office provider:
Y PA =6/11/2009
Fexofenadine 60mg = Benadryl =
, pt. called & left a message that following having received VARIVAX, she developed a rash Yon her arm.5/21/2009The message was misplaced, but
ted about 6 to 8 hours after HIB and Prevnar vaccine. Temperature 103 degrees. ContinuedYfever 101 to 6/5/2009 103 for 3 additional
6/5/2009 days. Evaluat
6-3-09. Severe pain in arm,shoulders,knees,back
Y and fever of 103.7 6-4-09. ER on 6-5-09 wasN given Levaquin,
6/3/2009 Vicoden,Ultram.
6/3/2009 6-6-09 pa
d symptoms of dizziness with near Y syncope, sensation of throat constriction with tightness atYthe base of6/20/2009
his neck. 6/21/2009
This was then accompa
ht hours after vaccine administration,Y at about 4:00 AM, patient experienced sensation of throatY constriction6/24/2009
and inability
6/25/2009
to breathe deeply.
d nausea and vomiting, insomnia and mild fever approx. 10 hours after vaccine administration. Y Vomited repeatedly
6/23/2009 during
6/24/2009night. Able to eat
esents to clinic at approximately 1745Y on 6/25/09 for MMR immunization - enrolled in medical Y assistant program
6/25/2009 at local
6/25/2009
school, cannot find
s given a Dtap/Polio IM injection in the left deltoid on Wednesday 6/24/2009. Client and mother U returned 6/24/2009
to clinic at 9:00AM
6/24/2009 on Friday 6/26/2
HAD KINRIX ON 06-23-2009.DEVELOPED RED RAISED SWELLING AT INJECTION SITEUON 06-24-2009.SEEN 6/23/2009 6/24/2009
BY DR.KALIL ON 06-2
welt, larger then usual Y 6/25/2009 6/26/2009
a of erythema with a slight hemorrhagic
Y appearance, encompassing almost entire L thigh U 6/23/2009 6/23/2009
hy, hard, swollen around the injection site. 4-inch diameter around the injection site. Localized U 6/24/2009 6/26/2009
d swollen area approx 4x4 inches bendryl taken Y 6/19/2009 6/25/2009
ours after receiving Oral RotaRix vaccine,
Y 2 month old baby developed fever (100.9-101.2) for U four days,6/22/2009
acute onset 6/22/2009
copious watery non-b
hours after the vaccination, I felt my head starting to ache. Then later I felt like there was anNelephant on6/24/2009
my chest. 6/24/2009
I was having difficulty b
was swollen all the way down to elbow. It is really sore and she had very back headache and joint pain 6/23/2009 6/23/2009
accine administered inadvertantly. Y 4/17/2009 6/26/2009
accine administered inadvertantly. Y 6/24/2009 6/26/2009
ceived Menactra and varivax injection. Patient fainted 3-5 minutes after injection was given Y while in the elevator.
6/26/2009 6/26/2009
ely following vaccine, patient
Y began Y to complainYof mild symptoms (my 5 shoulder hurts,
Y my wrist
N hurts, look at these### spots on ###
my leg. On the
WINRIX 1ml, Tdap 0.5 ml, IPV 0.5 ml, Y MMR 0.5 ml and PPD 0.05 ml. Pt passed out in 1 minute Y and was 4/8/2009
given smelling 4/8/2009
salt and recovered
as given an MMR by agency while was 5 weeks pregnant. 6/9/2009
sweats, dizziness. Y 6/24/2009 6/24/2009
ticaria that started about 12-24h after vaccine administration. Treated with diphenhydramine.U 6/22/2009 6/22/2009
ng - 1 1/2 cm circumferential difference, irritable. Shoulder --> wrist, dorsum of hand slight edema.
Y 6/23/2009 6/23/2009
er of child: See attachment telephone Y conversation 6/25/09 3:30 PM. Y 5/20/2009 5/20/2009
en 6/24/09. 6/26/09 woke with painful, red and swollen arm. Y 6/24/2009 6/26/2009
s after receiving GARDASIL vaccineY Pt. developed dyspnea, dysphagia, stabbing, sharp pain Y (R) arm and 6/12/2009
hip, neck6/12/2009
pain. Dx: Allergic react
minutes of MMR + Varicella vaccines administration child's right thigh became red and indurated. Y 6/25/2009 6/25/2009
3hr prolonged crying episode. Started roughly 3hrs after getting vaccines. Resolved with warm Y compresses 6/23/2009
to the thighs.
6/23/2009
imms. 6/9/09. On 6/10/09 was achy and 102 degrees fever. On 6/13/09 pt again at clinic c/oYnausea, abd6/9/2009 cramping,6/10/2009
and fever.
with warmth ~ 6-7 cm diameter no induration. 6/24/2009 6/25/2009
24,2009 received injection of Zostavax
Y and byYApril 8th, experienced 15 Yextreame anxiety, inability
N to sleep, 3/24/2009
and by May4/8/2009
7th was hospitalized
s of appetite, fever as high as 102.9 after having pneumococal conjugate and hepA vaccinesUon 6/23/08.6/23/2009 6/27/2009
thma attack, no fever, sinus infection.
Y pt treated with iv decadron followed by po taper of prednisone
Y 5/29/2009 6/5/2009
STARTED WITH A FEVER 6/27 ON THE MORNING OF 6/28 BROKE OUT WITH A RASH U WHICH CONSISTED
6/18/2009 OF 6/27/2009
ABOUT 10-20 ERYT
n has been received from a healthcare professional through a Pregnancy Registry for GARDASIL Y concerning
4/21/2008
a 17 year
4/21/2008
old female with dep
n has been received from a physician concerning an 18 year old female who on 18-JUN-2009 Y was vaccinated
6/18/2009IM, 0.5
6/18/2009
ml with the first dose
n has been received from Y a healthcare
Y student concerning a 19-year-old female patient whoYwas vaccinated 4/20/2009
with the4/20/2009
n has been received from a consumer Y concerningY his fiancee who on 0 22-JUN-2009 was vaccinated
U with6/22/2009
the first dose6/22/2009
of GARDASIL. Subs
perienced two episodes of debilitating inflammatory arthritis after the second andYthird rounds Y of Hepatitis8/29/2008
B vaccination. The ### interval of ons
s, pt experience moderate intense muscle tightness and aching and a sense of limps feeling Ylimp. This interfered 2/9/2009with2/9/2009
her ability to play spo
ed Merck first to report adverse effects. Merck faxed notification to agency and nurse calledYto follow up4/28/2009
with pt. Pt had reported to Merck
ives...They were first noticed around mid January 2009. We first saw our pediatrician who thought
N it was6/11/2008
viral. Then 1/15/2009
we went to see an All
pt called to report GI sxs: nausea, upset stomach. Day later, she reported swollen lymph node Y in armpit 6/23/2009
of left arm where
6/24/2009she got vaccine
7 TO 100.8 FOR 2 DAYS, INCREASE ON SLEEP, INCREASE SPIT UP, RUNNY DIARRHEA/STOOL U 6/25/2009 6/26/2009
started getting red over 24 hrs with lump
Y forming underneath skin. By 36 hrs, arm swollen toNsize of tennis 6/25/2009
ball with 6/26/2009
red color & warmth at to
ection site, R leg "hundred-ish tiny bumps with white pink tips"; later rash appeared on face and U neck; T 6/18/2009
max 102 F;6/20/2009
diarrhea. the night of 6
t 4 days after vaccine (2nd) dose...vaginal
Y lesions,
Y nausea,vomitting, 3 headache -E.R visit diagnosed
Y with1/24/2009
herpes, all1/28/2009
subsequent tests nega
DTaP, MMR, IPV, Varivax on 6-17-2009. Y Had Yhad brief joint pain and
2 mild rash approx 5 daysY prior and6/17/2009
only faint pinpoint
6/18/2009 macular rash on
eived Menactra, Gardisil, Adacel, and, and Havrix. She became pale and nauseated. Her skin Y was cool and
6/29/2009
clammy. 6/29/2009
Her head went down a
2009 CLIENT NOTICED THAT LEFT ARM WAS SORE AND WARM TO TOUCH ALSO REDYAND SWOLLEN, 6/25/2009 INSTRUCTED
6/27/2009 TO TAKE BE
hes in joints, especially injected arm. Began severe headache, nausea, vomiting. Body wasUquivering, jaw 6/23/2009
quivering6/26/2009
bad pretty bad. Did no
able crying, arching back and restlessY no sleeping, High fever N 6/25/2009 6/25/2009
ed that she developed hives on both arms and had a headache approximately 1 hour after receiving Y the6/22/2009
vaccine. She 6/22/2009
called her doctor's o
HY BUMPS ON BADY NOW SPREADING U 6/30/1999 6/29/2009
ceived Zostavax vaccine on 6/17/09. Y States symptoms of pain in upper thighs began on 6/19/09, U pain then
6/17/2009
elevated6/19/2009
to lower back. Visited
er vaccination temp. - sore throat, cough. This lasted 2 1/2 weeks. Then on the 30th of May N I awoke to a5/14/2009
painful left 5/30/2009
knee. This got worse o
Right hand swollen, numb - its mainly in my pointer finger, middle finger & thumb now. I've had N my left arm5/14/2009
go numb5/27/2009

Vaccine Adverse Reaction Reporting System Data 1 Pub 23oct09

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VAERS_IDRECVDATESTATE AGE_YRS CAGE_YR CAGE_MOSEX RPT_DATESYMPTOM_TEXT DIED

336349 1/2/2009 CA U ### Information has been received from

hs, patient had rash at location of immunization.

ight sweats 3/12/09 + 3/13/09. Y 3/12/2009 3/12/2009

generalized. Benadryl 6.25 BID X 5 days ; weak 2y in Y 5/6/2009 5/11/2009

ite is reddened and raised. Circumference is approx. 2 inches in diameter. U 6/9/2009

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