|
| VAERS ID: |
899533 (history) |
| Form: |
Version 2.0 |
| Age: |
12.0 |
| Sex: |
Male |
| Location: |
Texas |
| Vaccinated: | 2020-12-01 |
| Onset: | 2020-12-01 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-01 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
U6745AA / 1 |
RA / IM |
| TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS |
U6706AA / 1 |
LA / IM |
Administered by: Public Purchased by: ?
Symptoms: Cold sweat,
Electrocardiogram,
Eye movement disorder,
Hypotonia,
Pallor,
Seizure,
Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Systemic lupus erythematosus (broad), Convulsions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Mom reported that patient has ADHD
Current Illness: Mom reported that patient has ADHD
Preexisting Conditions: Mom reported that patient has ADHD
Allergies: NKDA
Diagnostic Lab Data: EMS was present in the clinic and performed vital signs, and EKG. Patient became stable enough and mother decided to drive patient to local ER approx. 2 miles away.
CDC Split Type:
Write-up: Patient present in the clinic today to receive 12 yr. vaccines of Tdap and MCV4. Paperwork filled out and completed by mother and patient and mother explained the procedure. Patient noted to be calm and relaxed and showed no signs of being afraid of shots. First Tdap was administered IM into the left deltoid, approximately one min later MCV4 was administered into right deltoid IM. Nurse turned her back to get band aid to apply to site when patient began to go limp and shake with eyes rolled in the back of his head. Nurse grabbed patient''s head and guided him to the floor. Patient seemed to have what looked like a seizure for approx. 30 sec before being able to speak. instructed to call 911. Patient reported "I need to throw up". Nurse helped patient to a sitting position and given a waste basket where he spit up. Patient rested his head against the wall where it seemed he was going out again. Nurse grabbed defibrillator from hall, and Benadryl and epi pen in case any was needed. Patient skin became cold and clammy, skin color pale. Patient kept saying "I do not want to die". Mother began praying for child until EMS arrived. No defibrillator or emergency medications was used. EMS present and performed vital signs and EKG. Patient was taken to local ER approx. 2 miles away via mother''s private car, per mother''s request |
|
| VAERS ID: |
899628 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Female |
| Location: |
Unknown |
| Vaccinated: | 2020-12-01 |
| Onset: | 2020-12-01 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-01 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
R027946 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Dizziness,
Syncope,
Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft buspar clonidine
Current Illness: none
Preexisting Conditions: depression anxiety adhd
Allergies: none
Diagnostic Lab Data:
CDC Split Type:
Write-up: dizziness fainting vomiting - onset within 15 seconds of admin |
|
| VAERS ID: |
899737 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Female |
| Location: |
North Carolina |
| Vaccinated: | 2020-12-01 |
| Onset: | 2020-12-01 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS |
B23EA / 1 |
LA / IM |
| MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS |
ABXA94AA / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Headache,
Influenza A virus test negative,
Influenza B virus test,
Myalgia,
Nausea,
SARS-CoV-2 test negative,
Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), COVID-19 (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: negative covid-19 ag negative influenza a and b
CDC Split Type:
Write-up: muscle aches, headache nausea and vomiting |
|
| VAERS ID: |
899843 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Pennsylvania |
| Vaccinated: | 2020-12-01 |
| Onset: | 2020-12-01 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. |
T028093 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Asthenia,
Chest pain,
Erythema,
Induration,
Neck pain,
Pain in extremity,
Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Hypersensitivity (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: none
CDC Split Type:
Write-up: Hours after vaccination developed pain and swelling of upper arm that caused extreme pain, developed weakness of right arm. Pain extending up neck, into chest and down forearm. Small area of erythema and induration. |
|
| VAERS ID: |
899856 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Male |
| Location: |
Kentucky |
| Vaccinated: | 2020-12-02 |
| Onset: | 2020-12-02 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. |
P100247208 / N/A |
LA / IM |
| IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR |
R1F97M / N/A |
LA / IM |
| MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS |
AMAA262A / N/A |
RA / IM |
| TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS |
525NP / N/A |
RA / IM |
Administered by: Military Purchased by: ?
Symptoms: Immediate post-injection reaction,
Loss of consciousness,
Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Write-up: The patient experienced a Syncopal episode immediately after receiving these immunizations and regained consciousness without intervention |
|
| VAERS ID: |
899886 (history) |
| Form: |
Version 2.0 |
| Age: |
18.0 |
| Sex: |
Unknown |
| Location: |
California |
| Vaccinated: | 2020-12-01 |
| Onset: | 2020-12-02 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLUZONE HIGH-DOSE QUADRIVALENT) / SANOFI PASTEUR |
4500 / N/A |
OT / SYR |
| HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS |
2250 / 7+ |
MO / PO |
| RV1: ROTAVIRUS (ROTARIX) / GLAXOSMITHKLINE BIOLOGICALS |
700 / N/A |
NS / IN |
| UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER |
740 / UNK |
RL / SC |
| UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER |
4412 / N/A |
RA / SYR |
Administered by: Unknown Purchased by: ?
Symptoms: Unevaluable event
SMQs:
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: 2 X TIME IS MORNING AND NIGHT
Current Illness: ONLY 2 MONTH FOR DESCRIPTIONS
Preexisting Conditions: HIGHT PLESURE SHAKE HEWAD BREFFING ISVRY HIGH AND COLASE
Allergies: NO APLICATIONS ALERGY REACTIONS SKING OR READ RED SKIN PLESURE ANTI SPAT
Diagnostic Lab Data: TEST NEW MEDICAL
CDC Split Type: 42250-4450-5555
Write-up: INFAKT HIGH PLE SURE |
|
| VAERS ID: |
899891 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Washington |
| Vaccinated: | 2020-12-01 |
| Onset: | 2020-12-01 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
S031287 / 2 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Pruritus,
Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:
Write-up: within 2 hours patient had total body hives and intense itching. no throat swelling, cough, or vomiting. Took 25 mg of benedryl and her symptoms have improved. took a second dose 6 hours later. |
|
| VAERS ID: |
899901 (history) |
| Form: |
Version 2.0 |
| Age: |
13.0 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 2020-12-02 |
| Onset: | 2020-12-02 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS |
4BH32 / 1 |
RA / IM |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
1637642 / 2 |
LA / IM |
Administered by: Public Purchased by: ?
Symptoms: Dizziness,
Headache
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Write-up: Pt reported headache and dizziness after vaccines were administered. Pt was advised to sit down for 15 minutes. Pts BP was taken and pt was given a Pedialyte Popsicle . After 15 minutes pt reported feeling better and BP was taken again. Pt able to ambulate safely and without assistance. Nurse walked pt to Clinic front door to make sure pt was okay . |
|
| VAERS ID: |
899985 (history) |
| Form: |
Version 2.0 |
| Age: |
12.0 |
| Sex: |
Female |
| Location: |
Oklahoma |
| Vaccinated: | 2020-12-02 |
| Onset: | 2020-12-02 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-03 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. |
MH2203 / UNK |
NS / IN |
Administered by: Private Purchased by: ?
Symptoms: Medical observation,
Unevaluable event
SMQs:
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Bronchiectasis chronic obstructive pulmonary disease liver replaced by transplant
Preexisting Conditions: Bronchiectasis chronic obstructive pulmonary disease liver replaced by transplant
Allergies:
Diagnostic Lab Data: none
CDC Split Type:
Write-up: Observation if patient develop any Flu like symptoms to start Tamiflu ASAP |
|
| VAERS ID: |
900074 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Michigan |
| Vaccinated: | 2020-12-01 |
| Onset: | 2020-12-03 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-03 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLUR4: INFLUENZA (SEASONAL) (FLUBLOK QUADRIVALENT) / PROTEIN SCIENCES CORPORATION |
UJ446AA / 1 |
RA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Erythema,
Pain of skin
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Spironolactone 25mg
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient called and indicated that she has red patches that are sore when touched on the arm of injection but lower than injection site |
|
| VAERS ID: |
900098 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Female |
| Location: |
Michigan |
| Vaccinated: | 2020-12-03 |
| Onset: | 2020-12-03 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-03 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
S023476 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Mass,
Pain
SMQs:
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Zoloft
Current Illness: N/A
Preexisting Conditions:
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:
Write-up: subcutaneous mass about 1.5cm in size, initially painful, pain has now resolved |
|
| VAERS ID: |
900206 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Female |
| Location: |
Arizona |
| Vaccinated: | 2020-12-01 |
| Onset: | 2020-12-03 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-03 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS |
ABXA93AA / 2 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Erythema,
Skin warm,
Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Mononessa, Flonase, Zyrtec, Epi-pen
Current Illness: N/A
Preexisting Conditions: Sleep Apnea
Allergies: N.K.D.A
Diagnostic Lab Data: N/A
CDC Split Type:
Write-up: Redness, swollen area hot, treatment start Keflex and ibuprofen. |
|
| VAERS ID: |
900227 (history) |
| Form: |
Version 2.0 |
| Age: |
13.0 |
| Sex: |
Male |
| Location: |
Missouri |
| Vaccinated: | 2020-12-01 |
| Onset: | 2020-12-02 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-04 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
1687290 / 2 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Abdominal pain,
Chills,
Diarrhoea,
Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: ADHD
Allergies: No allergies
Diagnostic Lab Data: none
CDC Split Type:
Write-up: Within 1 and 1/2 days pt had chills, vomiting, abd pain, and diarrhea. he was fine by the next day and no residual issues. |
|
| VAERS ID: |
900269 (history) |
| Form: |
Version 2.0 |
| Age: |
12.0 |
| Sex: |
Male |
| Location: |
North Carolina |
| Vaccinated: | 2020-12-03 |
| Onset: | 2020-12-03 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-04 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR |
7P5BE / N/A |
LA / IM |
| HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS |
B23EA / 1 |
LA / IM |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
1637651 / 1 |
RA / IM |
| VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. |
S024362 / 2 |
RA / SC |
Administered by: Public Purchased by: ?
Symptoms: Disorientation,
Dyskinesia,
Eye movement disorder,
Hyperhidrosis,
Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:
Write-up: Pt. fainted when leaving office. Noted on floor by nurse. No notification of changes in feeling to staff or visitors prior to fainting. Jerking movements , eye roll, sweating, disorientation noted. Duration less than one minute. |
|
| VAERS ID: |
900368 (history) |
| Form: |
Version 2.0 |
| Age: |
14.0 |
| Sex: |
Female |
| Location: |
Virginia |
| Vaccinated: | 2020-12-05 |
| Onset: | 2020-12-05 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-05 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS |
5332L / 1 |
LA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Hyperhidrosis,
Loss of consciousness,
Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Paleness, sweating, loss of consciousness. Patient was rested in immunization room, breathing and pulse monitored. Parents deemed unnecessary to call 911 or ambulance. Lasted approximately 5-10 minutes. |
|
| VAERS ID: |
900377 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Male |
| Location: |
Maryland |
| Vaccinated: | 2020-12-05 |
| Onset: | 2020-12-05 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-05 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. |
MH2203 / UNK |
NS / IN |
| HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS |
R031056 / 3 |
LA / IM |
| HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS |
ZJ3G3 / 2 |
RA / IM |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
T007035 / 1 |
RA / IM |
| IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR |
RIG101M / 3 |
LA / IM |
| MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS |
ABXA14AA / 1 |
RA / IM |
| TD: TD ADSORBED (TDVAX) / MASS. PUB HLTH BIOL LAB |
A122A / 3 |
LA / IM |
Administered by: School Purchased by: ?
Symptoms: Dizziness,
Hyperhidrosis,
Immediate post-injection reaction,
Nausea,
Pallor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: no
Preexisting Conditions: no
Allergies: no
Diagnostic Lab Data: none
CDC Split Type: 8160
Write-up: Student was given the above immunization.He immediately start c/o nausea and dizziness.Skin noted to be pale, diaphoretic. VS B/P 100/70, HR -74, pulse Ox -98%, no loss of consciousness.Student remained alert and oriented X3.Water given, cold compress applied ot neck and forehead. Student verbalized feeling better after drinking water. Escorted to another room to rest and to be observed. Steady gait, student stated " I am OK ". VS rechecked after 15 minutes ,B/P 105/70, HR-82, pulse Ox 98%. Student denies any dizziness or nausea. Home with his Dad. |
|
| VAERS ID: |
900415 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Male |
| Location: |
Kansas |
| Vaccinated: | 2020-12-05 |
| Onset: | 2020-12-05 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-06 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. |
P100255599 / 1 |
LA / IM |
Administered by: Military Purchased by: ?
Symptoms: Pruritus,
Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: N/A
CDC Split Type:
Write-up: Hives throughout Arms, legs, trunk, face. Slight itching. Denies trouble breathing, swelling, or any other symptoms. |
|
| VAERS ID: |
900828 (history) |
| Form: |
Version 2.0 |
| Age: |
13.0 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 2020-12-07 |
| Onset: | 2020-12-07 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-07 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS |
4BH32 / 1 |
LA / IM |
| HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS |
N592C / 1 |
LA / IM |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
1637642 / 1 |
RA / IM |
| IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR |
R1D97 / 3 |
LA / IM |
| TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS |
BR352 / 2 |
RA / IM |
Administered by: Public Purchased by: ?
Symptoms: Unevaluable event
SMQs:
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: Asthma
Allergies: NONE
Diagnostic Lab Data: NONE
CDC Split Type:
Write-up: Pt sat for 15 min, had some water, after 15 minutes pt reported feeling better. BP and HR was checked before discharge. |
|
| VAERS ID: |
901012 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Male |
| Location: |
Michigan |
| Vaccinated: | 2020-12-08 |
| Onset: | 2020-12-08 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-08 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR |
UT7011MA / 1 |
LA / IM |
| MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS |
ABXA66AA / 2 |
AR / IM |
Administered by: Private Purchased by: ?
Symptoms: Face injury,
Loss of consciousness,
Skin abrasion
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None known
Current Illness: None known
Preexisting Conditions: None known
Allergies: None known
Diagnostic Lab Data: None
CDC Split Type:
Write-up: Patient was fine in the office and then upon exiting the facility passed out while getting out the door to the car. Patient was helped by another nurse from another office and then brought back to our office via wheelchair where he was examined and placed on the table with feet up . Had many facial abrasions. was given juice and some cookies and crackers . Was given cold wash cloth for face. B/P was initially 70/60 . Continued to monitor until about 4:15 pm at which time he was up and sitting and then was able to walk to the door without dizziness or nausea. He was then place in wheelchair and brought out to the car . He walked into the car with minimal assist and said he felt fine. |
|
| VAERS ID: |
901027 (history) |
| Form: |
Version 2.0 |
| Age: |
18.0 |
| Sex: |
Female |
| Location: |
New York |
| Vaccinated: | 2020-12-08 |
| Onset: | 2020-12-08 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-08 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. |
P100250933 / 1 |
LA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Blindness,
Dizziness,
Nervousness,
Rash,
Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: At age 2, mother states patient fainted after 3 vaccines
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:
Write-up: Patient experienced a syncope episode with lightheadedness, feeling faint and vision closing in. She was very nervous before the vaccination. 15 minutes post vaccine she developed a rash on her inner crook of her elbows and forearms, face and legs. Patient states she experiences these rashes when under extreme stress or heat conditions such as final exams, long distance running track or hot tubs. She did not experience any tingling or swelling of the face lips or tongue. She was observed in pharmacy for 1 hour and rash dissipated. Patient states that most of the rash had gone away once she got home approximately 90 minutes after vaccination. |
|
| VAERS ID: |
901035 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Male |
| Location: |
Minnesota |
| Vaccinated: | 2020-12-08 |
| Onset: | 2020-12-08 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-08 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR |
UT7115NA / 1 |
LA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Blood glucose normal,
Cold sweat,
Dizziness,
Hypotension,
Immediate post-injection reaction,
Seizure,
Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Generalised convulsive seizures following immunisation (narrow), Hypersensitivity (narrow), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Gardasil vaccine, second dose (vaccination date/age unknown)
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: 12/8/20 blood glucose- normal (according to paramedics) blood pressure- low (according to paramedics)
CDC Split Type:
Write-up: Patient started having a minor seizure immediately after the flu shot was injected. He was shaking, dizzy, and his skin began to feel clammy and cold. The shaking would stop and start again. He was breathing and upright the whole time. The ambulance was called right after the reaction began. When paramedics arrived they tested the patients blood glucose, which was normal. His blood pressure was very low, but I don''t know the exact numbers. They monitored blood pressure for several minutes and said they weren''t leaving until his blood pressure came up. The patient said he was not on any medications and had not had anything to eat since breakfast. He admitted that he was not very well hydrated. He said he had a similar reaction to one of his Gardasil shots, but has never had a reaction to any other vaccine including the flu shot. The patient eventually left the pharmacy area on his own will after about a half an hour, the paramedics said that they needed his brother to take him to urgent care right away since he did not want to go in the ambulance. That is all the information I have at this time. |
|
| VAERS ID: |
901399 (history) |
| Form: |
Version 1.0 |
| Age: |
18.0 |
| Sex: |
Female |
| Location: |
Pennsylvania |
| Vaccinated: | 2020-12-07 |
| Onset: | 2020-12-07 |
| Days after vaccination: | 0 |
| Submitted: |
2001-12-21 |
| Days after onset: | 6926 |
| Entered: |
2020-12-09 |
| Days after submission: | 6928 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. |
279843 / UNK |
RA / - |
Administered by: Other Purchased by: Private
Symptoms: Injection site erythema,
Injection site pruritus
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: (1) Redness / itching night of vaccination @ injection site applied Benadryl cream + took Benadryl tablet (2) symptoms lessened over next couple days |
|
| VAERS ID: |
901523 (history) |
| Form: |
Version 2.0 |
| Age: |
14.0 |
| Sex: |
Female |
| Location: |
Colorado |
| Vaccinated: | 2020-12-10 |
| Onset: | 2020-12-10 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-10 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
2SM24 / UNK |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Fall,
Head injury,
Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: Report of seizures
Preexisting Conditions: Unknown
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC Split Type:
Write-up: Patient left the exam room and proceeded to faint in the lobby, falling and hitting her head |
|
| VAERS ID: |
901605 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Massachusetts |
| Vaccinated: | 2020-12-10 |
| Onset: | 2020-12-10 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-11 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
U6785AA / 2 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Injection site erythema,
Injection site swelling
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: None
Preexisting Conditions: None
Allergies: None Known
Diagnostic Lab Data: None
CDC Split Type:
Write-up: Redness and swelling at the injection site started a few hours post injection. |
|
| VAERS ID: |
901657 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Male |
| Location: |
Missouri |
| Vaccinated: | 2020-12-10 |
| Onset: | 2020-12-10 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-11 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
T007035 / 3 |
RA / IM |
| MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
AT1920 / 1 |
LA / IM |
| MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
U6560BA / 2 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Erythema,
Peripheral swelling,
Pyrexia,
Tenderness
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:
Write-up: Patient Developed a fever to 101.2 F, with redness, swelling, tenderness of the left arm. Mom called from Grandmothers house. He was given 2 Aleve tablets and a cold compress. Later on that evening he was given two 200 mg Ibuprofen. On the following day, Mom repotted that he still had pain and fever. He was referred to the emergency department for evaluation and treatment |
|
| VAERS ID: |
901713 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Male |
| Location: |
North Carolina |
| Vaccinated: | 2020-12-07 |
| Onset: | 2020-12-07 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-11 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS |
AMVA416A / 2 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Condition aggravated,
Focal dyscognitive seizures
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamotrigine, Epidiolex, Klonopin, Briviact, Fycompa
Current Illness: 9. Vimpat, Gabapentin
Preexisting Conditions: Lennox-Gastaut Syndrome, Autism, Partial Complex Seizures
Allergies: None
Diagnostic Lab Data:
CDC Split Type:
Write-up: Increased seizure activity since shot. Neurology prescribed three days of medication to reduce. |
|
| VAERS ID: |
901759 (history) |
| Form: |
Version 2.0 |
| Age: |
13.0 |
| Sex: |
Male |
| Location: |
Unknown |
| Vaccinated: | 2020-12-08 |
| Onset: | 2020-12-11 |
| Days after vaccination: | 3 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-11 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS |
3SN5B / N/A |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: PT was given an expired vaccine. Vaccine was 4 days past the expiration date on the vial. GSK was called and event reported. |
|
| VAERS ID: |
901857 (history) |
| Form: |
Version 2.0 |
| Age: |
13.0 |
| Sex: |
Female |
| Location: |
Illinois |
| Vaccinated: | 2020-12-09 |
| Onset: | 2020-12-09 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-13 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
R026716 / 1 |
AR / IM |
Administered by: Private Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: none
CDC Split Type:
Write-up: brief episode of syncope; resolved within 1-2 min |
|
| VAERS ID: |
902126 (history) |
| Form: |
Version 2.0 |
| Age: |
13.0 |
| Sex: |
Female |
| Location: |
Arizona |
| Vaccinated: | 2020-12-04 |
| Onset: | 2020-12-04 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-14 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
S028738 / 2 |
LA / SYR |
Administered by: Private Purchased by: ?
Symptoms: Pallor,
Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:
Write-up: PT GOT VERY PALE AND FAINTED |
|
| VAERS ID: |
902131 (history) |
| Form: |
Version 2.0 |
| Age: |
12.0 |
| Sex: |
Female |
| Location: |
Unknown |
| Vaccinated: | 2020-12-11 |
| Onset: | 2020-12-11 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-14 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR |
UT7115LA / UNK |
- / IM |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
1637648 / 1 |
- / IM |
| PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. |
S029542 / 1 |
LA / IM |
Administered by: Unknown Purchased by: ?
Symptoms: Dizziness,
Headache,
Injection site erythema,
Injection site pain,
Injection site swelling
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Vestibular disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Shortly after administration 5pm, pt reported feeling dizzy/lightheaded. Had pt lie down, feet elevated. Provided ORS. Repeated BP and pulse after 10 minutes and pt reported feeling better. BP and pulse nl. Mom called 2 days later to report that same day pt reported pain at the injection site were PPSV23 and flu were administered (LD) and dizziness, vomiting, and HA. Now improved however, redness and swelling at the site persists. |
|
| VAERS ID: |
902161 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Maryland |
| Vaccinated: | 2020-12-03 |
| Onset: | 2020-12-04 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-14 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR |
UT7102MA / 1 |
LA / IM |
| MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
CW3116 / 1 |
LA / IM |
| MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
U6826AB / 2 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Injection site swelling,
Injection site urticaria,
Pharyngeal swelling,
Swelling face,
Urticaria
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Sprintec daily Lisinopril 10 mg a day
Current Illness: none
Preexisting Conditions: Hypertension - followed by cardiology
Allergies: Amoxicillin and Cefzil - rash to both
Diagnostic Lab Data: none
CDC Split Type:
Write-up: The day after vaccines were given, she had swelling at injection site of Trumenba, hives on that arm, swelling of the face, hives on arm/head/face, and throat swelling. She was given a dose pack of methylprednisolone and was feeling better the next day. |
|
| VAERS ID: |
902292 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Male |
| Location: |
Washington |
| Vaccinated: | 2020-12-14 |
| Onset: | 2020-12-14 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-14 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR |
UT7102JA / 1 |
RA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient received the flu shot. Has gotten it every year and has experienced no issues. Patient asked for a copy of the vaccine, went to go receive it from the printer and patient passed out and fell to the ground. He regained consciousness within seconds. Patient was okay with no injury or bruising. checked blood pressure and it was within range: 126/72 with a heart rate of 79. Patient drank some water and said he was feeling much better, |
|
| VAERS ID: |
902371 (history) |
| Form: |
Version 2.0 |
| Age: |
14.0 |
| Sex: |
Male |
| Location: |
Missouri |
| Vaccinated: | 2020-12-10 |
| Onset: | 2020-12-12 |
| Days after vaccination: | 2 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-15 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS |
55RB7 / 7+ |
LA / IM |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
7007024 / 2 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Injection site induration,
Oedema peripheral
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vyvanse 50 mg
Current Illness: none
Preexisting Conditions: obesity
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:
Write-up: nearly 48 hours after vaccines, woke with marked swelling of axillae bilaterally, more on L than R, but more induration at vaccine site on R. No systemic symptoms. Was given benadryl. When examined 48 hours later, was reported as improved, but still marked axillary swelling, with palpable lymphadenopathy on L, induration of vaccine site on R. |
|
| VAERS ID: |
902373 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Kentucky |
| Vaccinated: | 2020-12-04 |
| Onset: | 2020-12-05 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-15 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
U6576AA / UNK |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Injection site erythema,
Injection site swelling,
Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: next day injection site became reddened, warm to touch, and swollen. mother put ice to area and gave her Tylenol which helped |
|
| VAERS ID: |
902416 (history) |
| Form: |
Version 2.0 |
| Age: |
18.0 |
| Sex: |
Female |
| Location: |
Wisconsin |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-15 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-15 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS |
AMVA383A / 2 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 1st series of Menveo
Other Medications: None
Current Illness: Localized Hives
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: N/A
CDC Split Type:
Write-up: Adverse events: Hives Treatment: Ice and Oral Benadryl Outcome: Minimal Hives in localized area |
|
| VAERS ID: |
902487 (history) |
| Form: |
Version 2.0 |
| Age: |
14.0 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 2020-12-14 |
| Onset: | 2020-12-14 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-15 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. |
P100271298 / 1 |
RA / IM |
Administered by: Unknown Purchased by: ?
Symptoms: Dizziness
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient became dizziness about a minute after vaccination |
|
| VAERS ID: |
902652 (history) |
| Form: |
Version 2.0 |
| Age: |
13.0 |
| Sex: |
Male |
| Location: |
Oregon |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-15 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS |
G2RX7 / 1 |
LA / IM |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
S028738 / 2 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/a
Current Illness:
Preexisting Conditions: Mild Scoliosis Seasonal allergic rhinitis Eczema Reactive airway disease Keratosis pilaris Localized Hives
Allergies: Keflex, Amoxicillin
Diagnostic Lab Data: Vital signs taken in clinic , monitored by RN, MD notified in clinic
CDC Split Type:
Write-up: Per MA report, patient fainted after HPV vaccine administration. |
|
| VAERS ID: |
902661 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Female |
| Location: |
New York |
| Vaccinated: | 2020-12-14 |
| Onset: | 2020-12-15 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS |
ABXA14BA / 1 |
AR / IM |
Administered by: Private Purchased by: ?
Symptoms: Injection site erythema,
Injection site swelling,
Injection site warmth,
Lip swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: COVID-19
Preexisting Conditions: None
Allergies: Peanuts, soy, scallops, wheat and dog dander
Diagnostic Lab Data:
CDC Split Type:
Write-up: Lip swelling, swelling erythema and warmth at injection site |
|
| VAERS ID: |
902774 (history) |
| Form: |
Version 2.0 |
| Age: |
14.0 |
| Sex: |
Male |
| Location: |
Michigan |
| Vaccinated: | 2020-12-08 |
| Onset: | 2020-12-08 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLUR4: INFLUENZA (SEASONAL) (FLUBLOK QUADRIVALENT) / PROTEIN SCIENCES CORPORATION |
QFAA2020 / UNK |
LA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: No adverse event,
Unevaluable event
SMQs:
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: no adverse event |
|
| VAERS ID: |
902775 (history) |
| Form: |
Version 2.0 |
| Age: |
14.0 |
| Sex: |
Male |
| Location: |
Michigan |
| Vaccinated: | 2020-12-08 |
| Onset: | 2020-12-08 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLUR4: INFLUENZA (SEASONAL) (FLUBLOK QUADRIVALENT) / PROTEIN SCIENCES CORPORATION |
QFAA2020 / UNK |
LA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: No adverse event,
Unevaluable event
SMQs:
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: NO ADVERSE EVENT |
|
| VAERS ID: |
902801 (history) |
| Form: |
Version 2.0 |
| Age: |
15.0 |
| Sex: |
Male |
| Location: |
California |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. |
R1B25 / 2 |
LA / SC |
Administered by: Private Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data: NO adverse reaction
CDC Split Type:
Write-up: The vaccine that was given to patient was expired on 08/08/2020 Patient was monitored for 15 minutes, NO adverse reaction, provider in office informed, and we are currently contacting parents to let them know. |
|
| VAERS ID: |
902804 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Arizona |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEP: HEP B (HEPLISAV-B) / DYNAVAX TECHNOLOGIES CORPORATION |
933842 / 1 |
LA / IM |
Administered by: Other Purchased by: ?
Symptoms: Nausea,
Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: *xanex, lamotrigine, paxel, buspar.
Current Illness: NA
Preexisting Conditions: ANXIETY-BULIMIA-OCD-DEPRESSION-BIPOLAR DISORDER
Allergies: NA
Diagnostic Lab Data: NA
CDC Split Type:
Write-up: five min after immunization , started experiencing nausea, single episode of vomiting , |
|
| VAERS ID: |
902805 (history) |
| Form: |
Version 2.0 |
| Age: |
15.0 |
| Sex: |
Female |
| Location: |
Arizona |
| Vaccinated: | 2020-12-14 |
| Onset: | 2020-12-14 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. |
- / 1 |
AR / IM |
Administered by: Private Purchased by: ?
Symptoms: Anxiety,
Chills,
Dyspnoea,
Fall,
Feeling abnormal,
Headache,
Pain in extremity,
Pallor,
Respiratory rate increased,
Visual impairment
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: tylenol
Current Illness: none known but had a headache and chills right before it ocurred
Preexisting Conditions: Healthy
Allergies: none known
Diagnostic Lab Data: ordered an EKG but no results yet **** of note, flu vaccine gotten somewhere else and I do nto have the above info - brand, lot number etc.
CDC Split Type:
Write-up: Patient received the flu vaccine yesterday around 3:30pm . she felt fine after getting it except her arm felt a little sore. around 8 pm patient went on a walk with mom and started to feel a little "chiiled" a little later she had a mild headache. when she got home she had to go to the bathroom and when she got up from the toilet she started to see dark spots both eyes and darkness in her lateral vision bilaterally. Because of this , and she had never experienced this before, he called out to her mom. Dad heard her and went to go see what was going on. He states when he saw her she was pale and looked a little dazed . She then proceeeded to fall into his arms and he took her to the couch . the episode lasted very briefly and there was no seizure like activity . she was a little anxious after the episode and states she had a little dyspnea - dad states she was anxious and breathign fast but no trouble breathign . when she calmed down she then felt fine and was back to her nml self . |
|
| VAERS ID: |
902807 (history) |
| Form: |
Version 2.0 |
| Age: |
15.0 |
| Sex: |
Male |
| Location: |
California |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-16 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. |
S003861 / 2 |
LA / SC |
Administered by: Private Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: no
Current Illness:
Preexisting Conditions:
Allergies: no
Diagnostic Lab Data: none
CDC Split Type:
Write-up: Patient was given vaccine that was was expired on 08/08/2020 Patient was monitored for 15 min, no adverse effect. Dr. in office was informed, and Patient parents are going to be contacted in regards, to f/u |
|
| VAERS ID: |
903068 (history) |
| Form: |
Version 2.0 |
| Age: |
13.0 |
| Sex: |
Male |
| Location: |
Unknown |
| Vaccinated: | 2020-12-07 |
| Onset: | 2020-12-07 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HPV4: HPV (GARDASIL) / MERCK & CO. INC. |
- / 1 |
- / - |
Administered by: Unknown Purchased by: ?
Symptoms: Dizziness,
Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075132012USA007212
Write-up: the patient passed out and felt dizzy upon waking soon after receiving his first dose of GARDASIL; the patient passed out and felt dizzy upon waking soon after receiving his first dose of GARDASIL; This spontaneous report was received from a consumer via company representative and refers to a 13-year-old male patient. He was the company representative''s nephew. There was no information about the patient''s concurrent conditions, concomitant therapies or medical history provided. On 07-DEC-2020, the patient was vaccinated with the first dose of quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) (exact dose, route of administration, anatomical location, lot # and expiration date were not reported) for prophylaxis. On the same day, soon after receiving the vaccination, he passed out and felt dizzy after waking up. The events occurred in the doctor''s office, but a nurse or doctor were not present and the events were not reported to any health care professional. The consumer was instructed to call the physician to report the events and ask whether a second dose of the vaccine should be administered. No treatment was given for the adverse events. The outcome of the events was reported as unknown. The causal relationship between the events and quadrivalent human papillomavirus (types 6,11,16,18) recomb. vaccine (GARDASIL) was unknown. Upon internal review, the event of loss of consciousness was considered to be medically significant. |
|
| VAERS ID: |
903080 (history) |
| Form: |
Version 2.0 |
| Age: |
15.0 |
| Sex: |
Female |
| Location: |
Ohio |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-17 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
S033308 / 2 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Hypoaesthesia,
Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Sexual dysfunction (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: No Known Allergies
Diagnostic Lab Data: None
CDC Split Type:
Write-up: Approximately 15 minutes after receiving the HPV vaccine patient reported some numbness in her left hand. Patient is well appearing. She reports no dizziness or injection site pain. She states that she has "the smallest amount of tingling" at the base of her index, 3rd, and 4th fingers. She denies any numbness in her hand, arm or shoulder. Denies any tingling at any other location. Hand grasp strength strong and equal bilaterally. Injection site without any redness or swelling and in the correct deltoid injection site location. Patient was able to stand without assistance and reported no dizziness upon standing. Provider notified. Mom to call office with any new or worsening symptoms. |
|
| VAERS ID: |
903087 (history) |
| Form: |
Version 2.0 |
| Age: |
14.0 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 2020-12-16 |
| Onset: | 2020-12-16 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR |
UT7102JA / 1 |
OT / IM |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
S031287 / 1 |
OT / IM |
| MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
U6827BA / 1 |
OT / IM |
Administered by: Private Purchased by: ?
Symptoms: Generalised tonic-clonic seizure,
Loss of consciousness,
Muscle contractions involuntary
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Dystonia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: SEIZURE 2/26/2019, TDaP, MMR, AND VARICELLA
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:
Write-up: GRAND MAL SEIZURE, COUPLES OF SECOND LOSS OF CONSCIOUSNESS AND MUSCLE CONTRACTION REFER TO PEDIATRIC NEUROLOGIST AND ALLERGY IMMUNOLOGIST |
|
| VAERS ID: |
903171 (history) |
| Form: |
Version 2.0 |
| Age: |
13.0 |
| Sex: |
Female |
| Location: |
Indiana |
| Vaccinated: | 2020-12-02 |
| Onset: | 2020-12-02 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS |
G2RX7 / N/A |
LA / IM |
| PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. |
S029542 / N/A |
LA / IM |
Administered by: Public Purchased by: ?
Symptoms: Injection site erythema,
Injection site swelling,
Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Nephrotic Syndrome
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Mother calls after the child received vaccines in the morning hours and then went to school. Mother states child''s are has a softball size area where vaccines were administered and is red and hot to touch. Mother denies any difficulty breathing, lip/tongue swelling. Mother states school nurse gave child oral Benadryl at school. Instructed mother to apply ice pack to site and call primary physician for further instruction and if symptoms worsened to seek medical treatment right away. Mother agrees and states will call PCP. A follow-up call was placed the next day on 12/3/20 and spoke to child''s mother. Mother states PCP stated to just watch child for any worsening of symptoms and seek treatment if needed. Mother states child returned to school that day and she had not received any calls from school nurse stating child had any further issues. Mother states child''s are was less swollen and red that morning when she left for school. |
|
| VAERS ID: |
903208 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Male |
| Location: |
Nevada |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-15 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-17 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS |
B223P / 4 |
RA / IM |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
1637642 / 3 |
LA / IM |
| MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS |
ABXA92AZ / 1 |
RA / IM |
| MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS |
AMVA400A / 2 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Ageusia,
Anosmia,
Dizziness,
Pain,
Pyrexia,
SARS-CoV-2 test negative
SMQs:, Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: none
Preexisting Conditions: none
Allergies: allergic to nuts and corn
Diagnostic Lab Data: COVID nasal swab- negative
CDC Split Type:
Write-up: Fevers, dizzyness, body aches, loss of sense of taste and smell severe symptoms lasted 24 hours, smell and taste returned in 48 hours, low grade symptoms all resolved in 5 days |
|
| VAERS ID: |
903299 (history) |
| Form: |
Version 2.0 |
| Age: |
13.0 |
| Sex: |
Male |
| Location: |
Maine |
| Vaccinated: | 2020-12-02 |
| Onset: | 2020-12-02 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-18 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
1637648 / UNK |
- / - |
Administered by: Unknown Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: GARDASIL 9 SYRINGE (DEVICE)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075132012USA003047
Write-up: No additional AE reported; 1 dose of GARDASIL was administered following the improper storage; This spontaneous report was received from a nurse referring to a 13 year old male patient. There was no information about the patient''s concurrent conditions, concomitant therapies or medical history provided. On 02-DEC-2020, the patient was vaccinated with an improperly stored dose of hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast)(GARDASIL 9) pre-filled syringe, lot # 1637648 expiring on 19-JUN-2022, for prophylaxis (dose, route and site of administration were not reported). The administered dose of the vaccine experienced a temperature excursion of 33F for 120 hours, as recorded by a data logger. The vaccine had not had any previous temperature excursion. There was no adverse effect reported and no product quality complaint involved. combinationproductreport: Yes; brandname: GARDASIL 9 SYRINGE (DEVICE); commondevicename: HPV rL1 6 11 16 18 31 33 45 52 58 VLP vaccine (yeast); productcode: FMF; devicetype: SYRINGE, PISTON (FMF); manufacturername: Merck Sharp & Dohme Corp.; devicelotnumber: 1637648; expirationdate: 19-JUN-2022; deviceage and unit: 0 ; malfunction: Unknown; deviceusage: Initial; reasonfornoneval: 81 Other; labeledsingleusedevice: No; mdcpreportability: No; mdcpreprationale: Case information does not meet the criteria for Reportability |
|
| VAERS ID: |
905136 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Arizona |
| Vaccinated: | 2020-12-11 |
| Onset: | 2020-12-11 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-18 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
U6596AA / 2 |
LA / IM |
Administered by: Unknown Purchased by: ?
Symptoms: Eye swelling,
Injection site erythema,
Injection site pain,
Injection site warmth,
Rash
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: 11/19/2020-sore throat/viral syndrome
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:
Write-up: Developed rash around neck evening after recieving vaccine. next day left arm inj site warm/red & tender. 3 days later left eye swelling |
|
| VAERS ID: |
904372 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Female |
| Location: |
Kentucky |
| Vaccinated: | 2020-12-19 |
| Onset: | 2020-12-01 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-20 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLUR4: INFLUENZA (SEASONAL) (FLUBLOK QUADRIVALENT) / PROTEIN SCIENCES CORPORATION |
UJ481AA / UNK |
RA / IM |
Administered by: Other Purchased by: ?
Symptoms: No adverse event,
Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: N/A
CDC Split Type:
Write-up: Pt should have recieved Fluarix but instead recieved FluBlok. Followed up with patient''s mother. No adverse effects or symptoms reported. Follow-up occured on 12/20/2020 at 1030 AM. |
|
| VAERS ID: |
905182 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Female |
| Location: |
Michigan |
| Vaccinated: | 2020-12-21 |
| Onset: | 2020-12-21 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-21 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
U6641AB / 3 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Extra dose administered
SMQs:, Medication errors (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: NKA
Diagnostic Lab Data:
CDC Split Type:
Write-up: Administration error; Pt was given an extra dose of Menactra instead of the dose of Men B she is due for. Currently has no symptoms of an adverse reaction. Parents were given information on adverse reactions to look out for. |
|
| VAERS ID: |
905290 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Female |
| Location: |
Michigan |
| Vaccinated: | 2020-12-18 |
| Onset: | 2020-12-18 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-21 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS |
ABXA95AA / 2 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Blindness,
Deafness,
Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluticasone prn, otherwise none
Current Illness: Had surgery day before vaccine.
Preexisting Conditions: None.
Allergies: No known allergies
Diagnostic Lab Data: N/A
CDC Split Type:
Write-up: Patient reported loss of hearing and sight about 5 minutes after the injection. Was in car with mother, who laid patient''s passenger seat back, patient pass out for a few seconds, then went she came to, felt fine. |
|
| VAERS ID: |
905460 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Pennsylvania |
| Vaccinated: | 2020-12-14 |
| Onset: | 2020-12-14 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-21 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS |
494S5 / 1 |
LA / IM |
| MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS |
ABXB02AA / 1 |
RA / IM |
| MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS |
AMVA416A / 2 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Blood glucose,
Full blood count,
Laboratory test,
Pregnancy test,
Presyncope
SMQs:, Anticholinergic syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: CBC w/ differential blood glucose Basic Metabolic panel Pregnancy test
CDC Split Type:
Write-up: pre-syncopal episode approximately 11 hours later |
|
| VAERS ID: |
905474 (history) |
| Form: |
Version 2.0 |
| Age: |
13.0 |
| Sex: |
Male |
| Location: |
Georgia |
| Vaccinated: | 2020-12-21 |
| Onset: | 2020-12-21 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-21 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
1687292 / 2 |
LA / IM |
Administered by: Public Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC Split Type:
Write-up: vaso vagal reaction. client lowered to floor when apparent he was having the reaction. Legs elevated. Head not hit. Sternal rub x 3 times during first minute to keep him awake. Each time he would say, "I''m OK, I''m OK". BP monitor brought to room by, RN. BP taken at 11:18 106/74 pulse 63. client now alert. BP at 11:24 106/69, pulse 85. BP at 11:31 103/63, pulse 85. Client stands and walks well to waiting room at 11:35. Leaves clinic at 11:45 with no further problems. Stated he had not eaten anything for breakfast. Crackers given. |
|
| VAERS ID: |
905938 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
New York |
| Vaccinated: | 2020-12-21 |
| Onset: | 2020-12-21 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-21 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER |
EKS730 / 1 |
RA / IM |
Administered by: Senior Living Purchased by: ?
Symptoms: Hypoaesthesia,
Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Sexual dysfunction (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: n/a
Current Illness:
Preexisting Conditions:
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:
Write-up: Passed out/numb arm |
|
| VAERS ID: |
905969 (history) |
| Form: |
Version 1.0 |
| Age: |
15.0 |
| Sex: |
Male |
| Location: |
Puerto Rico |
| Vaccinated: | 2020-12-21 |
| Onset: | 2020-12-21 |
| Days after vaccination: | 0 |
| Submitted: |
2020-12-21 |
| Days after onset: | 0 |
| Entered: |
2020-12-21 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS |
LB2KM / UNK |
LA / IM |
Administered by: Other Purchased by: Private
Symptoms: Blindness,
Deafness,
Dizziness,
Hyperhidrosis,
Lethargy,
Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: None
Preexisting Conditions: Penicillin Allergy, Asthma
Allergies:
Diagnostic Lab Data: BP: 116/70 Pulse: 78 Dextrose: 179 Temp: 36.5 degrees C O2: 98
CDC Split Type:
Write-up: Patient presented with Lethargy, Fainting, Dizziness, temporary loss of vision, sweatiness, temporary loss of hearing, 911 was called |
|
| VAERS ID: |
906197 (history) |
| Form: |
Version 2.0 |
| Age: |
13.0 |
| Sex: |
Female |
| Location: |
California |
| Vaccinated: | 2020-12-01 |
| Onset: | 2020-12-01 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR |
P1F491M / 1 |
LA / OT |
Administered by: Unknown Purchased by: ?
Symptoms: Expired product administered,
No adverse event
SMQs:, Medication errors (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: FLUZONE QUADRIVALENT; HEPATITIS A; HPV VACCINE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USSA2020SA346641
Write-up: 13 year old female patient inadvertently administered expired dose of IPOL, no AE; Initial information received on 01-Dec-2020 regarding an unsolicited valid non-serious case received from a other health professional. This case involves a 13 year old female patient who was inadvertently vaccinated with an expired dose of IPV (VERO) [IPOL] (expired product administered). Medical history, medical treatment, vaccination and family history were not provided. Concomitant medications included INFLUENZA VACCINE INACT SPLIT 4V (FLUZONE QUADRIVALENT) for Immunisation; HEPATITIS A VACCINE (HEPATITIS A) for Immunisation; and HPV VACCINE (HPV VACCINE) for Immunisation. On 01-Dec-2020, the patient received a 0.5 ml first dose of suspect IPV (VERO) (lot P1F491M and expiry date: 30-Nov-2020) via an intramuscular route in the left deltoid for prophylactic vaccination. It was a case of actual medication error due to expired vaccine used (latency on same day). Reporter relationship: HCP (health care professional), product used: used, first time product used: no and still using product: no At the time of report, no adverse event was reported. This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holder''s compliance with the requirements set out in Directive 2001/83/EC and Module VI of the Good Pharmacovigilance Practices. The classification as a medical error is in no way intended, nor should it be interpreted or construed as an allegation or claim made by the marketing authorization holder that any third party has contributed to or is to be held liable for the occurrence of this medication error. |
|
| VAERS ID: |
906236 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Male |
| Location: |
Puerto Rico |
| Vaccinated: | 2020-12-18 |
| Onset: | 2020-12-18 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS |
2235P / UNK |
LA / IM |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
1637651 / UNK |
LA / IM |
| MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
CW3112 / UNK |
LA / IM |
| MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
- / UNK |
- / - |
Administered by: Private Purchased by: ?
Symptoms: Erythema,
Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Corn, sensible skin.
Diagnostic Lab Data: N/A
CDC Split Type:
Write-up: Rash and flustering in the left arm extending almost to the elbow after receiving the fluarix and the gardasil 9 vaccine. |
|
| VAERS ID: |
906251 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Female |
| Location: |
North Carolina |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-15 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEPA: HEP A (VAQTA) / MERCK & CO. INC. |
T022333 / UNK |
- / - |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
1687291 / UNK |
- / - |
| MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS |
ABXB09AZ / 2 |
- / - |
Administered by: Private Purchased by: ?
Symptoms: Chills,
Fatigue,
Headache,
Nausea,
Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Mild arm swelling after HPV#1, mild nausea after HPV#2.
Other Medications: None.
Current Illness: None.
Preexisting Conditions: Allergic rhinitis.
Allergies: Latex
Diagnostic Lab Data: None.
CDC Split Type:
Write-up: About 5 hours after receiving this vaccine, this patient developed headache, chills, nausea, and fever of 102.9. She continued to have fever the next day. By day 3 her fever had resolved but she continued to have severe headache and fatigue until 5 days after the vaccine on 12/20. |
|
| VAERS ID: |
906371 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Massachusetts |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-15 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS |
7A2S2 / 1 |
RA / IM |
| MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
U6785AA / 1 |
RA / IM |
| TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS |
9AN49 / 1 |
- / IM |
Administered by: Private Purchased by: ?
Symptoms: Ocular hyperaemia,
Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Glaucoma (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Pt on Claritin, benzoyl peroxide and albuterol sulfate prn
Current Illness: none
Preexisting Conditions: mild asthma
Allergies: Allergic to amoxicillin
Diagnostic Lab Data: none
CDC Split Type:
Write-up: Pt described eye redness and swelling bilat |
|
| VAERS ID: |
906565 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Colorado |
| Vaccinated: | 2020-12-22 |
| Onset: | 2020-12-22 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
U6785AA / 2 |
RA / IM |
Administered by: Public Purchased by: ?
Symptoms: Interchange of vaccine products,
Wrong product administered
SMQs:, Medication errors (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:
Write-up: The patient was given Menactra when the Pt should of been given Bexsero. |
|
| VAERS ID: |
906633 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Louisiana |
| Vaccinated: | 2020-12-21 |
| Onset: | 2020-12-21 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
CN1583 / 1 |
LA / IM |
| MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
U6787AA / 2 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Dyspnoea,
Gaze palsy,
Influenza virus test negative,
SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Ocular motility disorders (narrow), COVID-19 (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Birth Control
Current Illness: 0
Preexisting Conditions: 0
Allergies: NKDA 0
Diagnostic Lab Data: COVID 19 test + flu test - Negative
CDC Split Type:
Write-up: Patient had severe headache, felt like throat was closing + hard to catch her breath. Went to E.R., they gave her Benadryl + Zofran + tested her for COVID19 + Flu which were both negative. E.R. physician said Adverse reaction to vaccine. Pt. felt better after an hour of Benadryl + Zofran + was D/C |
|
| VAERS ID: |
906895 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Male |
| Location: |
Indiana |
| Vaccinated: | 2020-12-22 |
| Onset: | 2020-12-22 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS |
N592C / 2 |
LA / IM |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
8023476 / 1 |
RA / IM |
| MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS |
ABXB05BA / 1 |
RA / IM |
Administered by: Other Purchased by: ?
Symptoms: Hyperhidrosis,
Loss of consciousness,
Pallor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: no known medications
Current Illness: no
Preexisting Conditions: no
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:
Write-up: Patient was administered the HPV, Bexero and Hepatits A vaccine. He became pale, diaphoretic and passed out. The episode lasted approximately 1 minute. Cold compresses and Sprite were supplied to the patient. Patient was moved to the floor. He completely recovered in approximately 15 minutes. |
|
| VAERS ID: |
907089 (history) |
| Form: |
Version 2.0 |
| Age: |
13.0 |
| Sex: |
Male |
| Location: |
Massachusetts |
| Vaccinated: | 2020-12-18 |
| Onset: | 2020-12-18 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-22 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (AFLURIA QUADRIVALENT) / SEQIRUS, INC. |
- / 1 |
- / SYR |
Administered by: Private Purchased by: ?
Symptoms: Asthenia,
Dyspnoea,
Migraine,
Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Asthma, migraines
Allergies: Peanut, tree nut, environmental allergies to dust, trees
Diagnostic Lab Data:
CDC Split Type:
Write-up: Around 5:00 pm, my son experienced labored breathing and wheezing. We administered his inhaler. The next day he felt weak and got a migraine. |
|
| VAERS ID: |
907168 (history) |
| Form: |
Version 2.0 |
| Age: |
12.0 |
| Sex: |
Unknown |
| Location: |
Ohio |
| Vaccinated: | 2020-12-04 |
| Onset: | 2020-12-04 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-23 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
S008153 / UNK |
- / - |
Administered by: Unknown Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: GARDASIL 9 SYRINGE (DEVICE)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075132012USA009909
Write-up: No additional adverse events reported.; a dose of GARDASIL 9 was administered during a temperature excursion; temperature 48.4F and 32.7F; This spontaneous report was received from a certified medical assistant and refers to 12-year-old patient of an unknown gender. There was no information about the patient''s concurrent conditions, concomitant therapies or medical history provided. On 04-DEC-2020, the patient was vaccinated with an improperly stored dose of HPV rL1 6 11 16 18 31 33 45 52 58 VLP vaccine (yeast) (GARDASIL 9) 0.5 ml, lot # S008153, expiration date 20-NOV-2021 (route of administration and anatomical location were not reported) for prophylaxis. The vaccine was administered during a temperature excursion, before the stability was known. Administered dose of the vaccine was stored in temperature of 48.4 degrees Fahrenheit (F) for 15 minutes and in temperature of 32.7 F for 47 hours. No previous temperature excursion occurred. Digital data logger was not involved. No adverse events were reported. combinationproductreport: Yes; brandname: GARDASIL 9 SYRINGE (DEVICE); commondevicename: HPV rL1 6 11 16 18 31 33 45 52 58 VLP vaccine (yeast); productcode: FMF; devicetype: SYRINGE, PISTON (FMF); manufacturername: Merck Sharp & Dohme Corp.; devicelotnumber: S008153; expirationdate: 20-NOV-2021; deviceage and unit: 0 ; malfunction: Unknown; deviceusage: Initial; reasonfornoneval: 81 Other; labeledsingleusedevice: No; mdcpreportability: No; mdcpreprationale: Case information does not meet the criteria for Reportability |
|
| VAERS ID: |
907261 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Male |
| Location: |
Indiana |
| Vaccinated: | 2020-12-22 |
| Onset: | 2020-12-23 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-23 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS |
ABXA93AA / 1 |
RA / IM |
| MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS |
AMVA390A / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: Sports related asthma
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:
Write-up: Hives size of quarters on buttocks and upper legs |
|
| VAERS ID: |
907474 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Massachusetts |
| Vaccinated: | 2020-12-23 |
| Onset: | 2020-12-23 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-23 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEPA: HEP A (VAQTA) / MERCK & CO. INC. |
T014835 / 1 |
LA / IM |
| MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS |
ABXB09AZ / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Dizziness,
Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Junel FE 1/20 (28) 1 mg-20 mcg (21)/75 mg tablet
Current Illness:
Preexisting Conditions:
Allergies: NKDA Seasonal allergies
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient had syncopal episode seconds after receiving vaccines. Regained consciousness after approximately 15 seconds. Pt states she felt lightheaded and like she was "going to pass out" prior to episode. Patient lied down on exam table, w/ feet elevated. Patient was given crackers and juice. BP was taken x 2. Physician performed exam. |
|
| VAERS ID: |
907519 (history) |
| Form: |
Version 2.0 |
| Age: |
15.0 |
| Sex: |
Female |
| Location: |
Louisiana |
| Vaccinated: | 2020-12-21 |
| Onset: | 2020-12-21 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-23 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR |
UT7065LA / 3 |
LA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Syncope,
Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: not sure - only after i vaccinated patient did she mention previous syncope & vomiting after previous documentataion but she did
Other Medications: unknown
Current Illness: unknoiwn
Preexisting Conditions: asthmatic
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:
Write-up: syncope and vomiting about 3 minutes post vaccination - applied wet paper towel and instant cold compress to forehead area and reassured patient - complete recovery by patient after about 10 minutes |
|
| VAERS ID: |
907579 (history) |
| Form: |
Version 2.0 |
| Age: |
15.0 |
| Sex: |
Male |
| Location: |
California |
| Vaccinated: | 2020-12-23 |
| Onset: | 2020-12-23 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-23 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
S031287 / 1 |
LA / IM |
Administered by: Other Purchased by: ?
Symptoms: Hyperhidrosis,
Pallor,
Somnolence
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:
Write-up: Patient became pale & diaphoretic, drowsy but responsive 2 minutes total time of episode |
|
| VAERS ID: |
907959 (history) |
| Form: |
Version 2.0 |
| Age: |
13.0 |
| Sex: |
Male |
| Location: |
Ohio |
| Vaccinated: | 2020-12-03 |
| Onset: | 2020-12-03 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-23 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR |
P1F49M / UNK |
RA / OT |
Administered by: Unknown Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VARICELLA VACCINE
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USSA2020SA357294
Write-up: expired dose of IPOL was administered to a patient, no AE; Initial information received on 11-Dec-2020 regarding an unsolicited valid non-serious case from a other health professional. This case is linked to case 2020SA357481 (same reporter). This case involves a 13 years old male patient who was vaccinated with an expired 0.5 ml dose of IPV (VERO) [IPOL](lot P1F49M and expiration date :30-Nov-2020) via intramuscular route in the right deltoid for prophylactic vaccination on 03-Dec-2020 (expired product administered). Medical history, medical treatment(s), vaccination(s) and family history were not provided. Concomitant medications included VARICELLA ZOSTER VACCINE (VARICELLA VACCINE) for prophylactic vaccination. It was an actual medication error case due to expired vaccine used (same day latency). No adverse event reported at the time of reporting. This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holder''s compliance with the requirements set out in Directive 2001/83/EC and Module VI of the Good Pharmacovigilance Practices. The classification as a medical error is in no way intended, nor should it be interpreted or construed as an allegation or claim made by the marketing authorization holder that any third party has contributed to or is to be held liable for the occurrence of this medication error. |
|
| VAERS ID: |
908094 (history) |
| Form: |
Version 2.0 |
| Age: |
14.0 |
| Sex: |
Female |
| Location: |
Washington |
| Vaccinated: | 2020-12-22 |
| Onset: | 2020-12-22 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-23 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR |
UT7102JA / 1 |
RA / IM |
| HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS |
B23EA / 1 |
RA / IM |
| MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
U6596AA / 1 |
LA / IM |
| TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS |
9L39Z / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Abdominal pain,
Blood pressure normal,
Dizziness,
Nausea,
Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None reported.
Current Illness: None
Preexisting Conditions: N/A
Allergies: NKA
Diagnostic Lab Data: Blood pressure was taken, which was normal, had pt lay down, and gave her crackers, juice, and water.
CDC Split Type:
Write-up: Few minutes after getting her vaccines, pt felt dizzy, nauseous, and felt faint. 5 minutes after getting vaccine, pt starting getting abdominal pain. 10 Minutes after vaccine, pt vomited. |
|
| VAERS ID: |
908826 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 2020-12-01 |
| Onset: | 2020-12-01 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-24 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR |
UT7065LA / N/A |
LA / IM |
| MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
CW3116 / 1 |
RA / IM |
| MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
U6877BA / 2 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Chest pain,
Heart rate increased
SMQs:, Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Dehydration (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness:
Preexisting Conditions: Asthma
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:
Write-up: About 1 hour after leaving the clinic, mom called and reported that Pt was having chest pain and feeling like her heart was beating faster than normal. No other symptoms. |
|
| VAERS ID: |
909845 (history) |
| Form: |
Version 2.0 |
| Age: |
14.0 |
| Sex: |
Male |
| Location: |
Florida |
| Vaccinated: | 2020-12-18 |
| Onset: | 2020-12-18 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-28 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEPA: HEP A (VAQTA) / MERCK & CO. INC. |
S032055 / UNK |
- / - |
Administered by: Unknown Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VAQTA SYRINGE (DEVICE)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075132012USA009640
Write-up: No adverse events; Expired VAQTA was administered; This spontaneous report was received from an office manager referring to a 14 year old male patient. There was no information about the patient''s concurrent conditions, concomitant therapies or medical history provided. On 18-DEC-2020, the patient was vaccinated with a dose of hepatitis a vaccine, inactivated (VAQTA) pre-filled syringe, lot # S032055, for prophylaxis (dose, route and site of vaccination were not provided) which had expired on 01-NOV-2020. The reporter stated that there was not confusion just human error. The dose was stored at the appropriate storage condition, specified in the product label, through the date of administration. There was no adverse effect reported. No product quality complaint was involved. combinationproductreport: Yes; brandname: VAQTA SYRINGE (DEVICE); commondevicename: Hepatitis A Vaccine, Inactivated; productcode: FMF; devicetype: SYRINGE, PISTON (FMF); manufacturername: Merck Sharp & Dohme Corp.; devicelotnumber: S032055; deviceage and unit: 0 ; malfunction: Unknown; deviceusage: Initial; reasonfornoneval: 81 Other; labeledsingleusedevice: No; mdcpreportability: No; mdcpreprationale: Case information does not meet the criteria for Reportability |
|
| VAERS ID: |
910322 (history) |
| Form: |
Version 2.0 |
| Age: |
14.0 |
| Sex: |
Male |
| Location: |
Nebraska |
| Vaccinated: | 2020-12-21 |
| Onset: | 2020-12-21 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-28 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU3: INFLUENZA (SEASONAL) (FLULAVAL) / GLAXOSMITHKLINE BIOLOGICALS |
- / UNK |
- / OT |
| FLUR4: INFLUENZA (SEASONAL) (FLUBLOK QUADRIVALENT) / PROTEIN SCIENCES CORPORATION |
- / UNK |
RA / OT |
Administered by: Unknown Purchased by: ?
Symptoms: No adverse event,
Product administered to patient of inappropriate age,
Wrong product administered
SMQs:, Medication errors (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: GARDASIL
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USSA2020SA367850
Write-up: 14 year old male patient was given FLUBLOK instead of Flulaval, no AE; 14 year old male patient was given FLUBLOK , no AE; Initial information received on 21-Dec-2020 regarding an unsolicited valid non-serious case received from a other health professional. This case involves a 14 year old male patient who inadvertently administered INFLUENZA QUADRIVALENT RECOMBINANT VACCINE [FLUBLOK QIV] instead of INFLUENZA VACCINE INACT SPLIT 3V [FLULAVAL] (wrong product administered and product administered to patient of inappropriate age). Medical history, medical treatment, vaccination and family history were not provided. Concomitant medications included HPV VACCINE VLP RL1 4V (YEAST) (GARDASIL) for Immunisation. On 21-Dec-2020, the patient received a 0.5 ml dose of suspect INFLUENZA QUADRIVALENT RECOMBINANT VACCINE (lot number and expiry date: not reported) via an intramuscular route in the right arm for prophylactic vaccination. It was a case of actual medication error due to wrong product administered and product administered to patient of inappropriate age (latency on same day). At the time of report no adverse event was reported. This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holder''s compliance with the requirements set out in Directive 2001/83/EC and Module VI of the Good Pharmacovigilance Practices. The classification as a medical error is in no way intended, nor should it be interpreted or construed as an allegation or claim made by the marketing authorization holder that any third party has contributed to or is to be held liable for the occurrence of this medication error. |
|
| VAERS ID: |
911666 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Female |
| Location: |
Georgia |
| Vaccinated: | 2020-12-11 |
| Onset: | 2020-12-11 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-29 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLUR4: INFLUENZA (SEASONAL) (FLUBLOK QUADRIVALENT) / PROTEIN SCIENCES CORPORATION |
UJ489AA / UNK |
RA / OT |
Administered by: Unknown Purchased by: ?
Symptoms: Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USSA2020SA367895
Write-up: 17 year old female patient was inadvertently administered FLUBLOK QUADRIVALENT, no AE; Initial information received on 21-Dec-2020 regarding an unsolicited valid non-serious case received from a other health professional. This case involves a 17 year old female patient who inadvertently vaccinated with INFLUENZA QUADRIVALENT RECOMBINANT VACCINE [FLUBLOK QIV] (product administered to patient of inappropriate age). Medical history, medical treatment, concomitant medication, vaccination and family history were not provided. Patient did not received other vaccines. It was a case of actual medication error due to product administered to patient of inappropriate age (latency on same day). At the time of report no adverse event was reported. This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holder''s compliance with the requirements set out in Directive 2001/83/EC and Module VI of the Good Pharmacovigilance Practices. The classification as a medical error is in no way intended, nor should it be interpreted or construed as an allegation or claim made by the marketing authorization holder that any third party has contributed to or is to be held liable for the occurrence of this medication error. |
|
| VAERS ID: |
911717 (history) |
| Form: |
Version 2.0 |
| Age: |
15.0 |
| Sex: |
Female |
| Location: |
Massachusetts |
| Vaccinated: | 2020-12-27 |
| Onset: | 2020-12-27 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-29 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. |
281835 / N/A |
LA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Feeling hot,
Hyperhidrosis,
Malaise,
Pallor
SMQs:, Neuroleptic malignant syndrome (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: JUNEL FE 1/20
Current Illness: Unknown
Preexisting Conditions: Stated has low blood sugar sometimes Stated low blood pressure sometimes (not being treated for)
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:
Write-up: patient received flu shot stated felt fine got up and left booth to meet her mom we were all talking for approximately 5 minutes all of a sudden she said she didn''t feel well and got pale her mother and I sat her in chair did not lose consciousness felt hot and sweaty no throat closure rash etc did say her vision was off (black and rainbow) called 911 paramedics came and she walked to stretcher and left spoke to mom later that night and said she was fine |
|
| VAERS ID: |
912366 (history) |
| Form: |
Version 2.0 |
| Age: |
12.0 |
| Sex: |
Male |
| Location: |
Texas |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-15 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-29 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR |
UT7108NA / 1 |
- / IM |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
1687290 / 2 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Loss of consciousness,
Tonic clonic movements,
Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: NKDA, NKFA
Diagnostic Lab Data: N/A
CDC Split Type:
Write-up: As the MA was leaving the room after giving the Gardasil and Flu vaccines, sister ran out of the room stating that her brother needed help. MA went straight back in and found him "passed out" / slumping to the floor. Mother and MA report that he had a "tremor" and had a couple of tonic-clonic beats of his arms (but not legs / was standing up though and slumping, so legs might have been missed). Mother got hold of him and put in in supine position on the exam table. He was observed for 30 minutes after the event and vital signs remained stable. He returned to completely normal within a couple of minutes. Tonic-clonic movements lasted on a few seconds (less than 20 seconds). +sibling with known seizure disorder, so referral neurology was ordered |
|
| VAERS ID: |
913531 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Male |
| Location: |
Massachusetts |
| Vaccinated: | 2020-12-28 |
| Onset: | 2020-12-28 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
T007024 / UNK |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Inappropriate schedule of product administration
SMQs:, Medication errors (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: doxycycline FLUOXETINE methylphenidate trazodone
Current Illness: None
Preexisting Conditions: ADHD Allergic Rhinitis Sleep Disorder
Allergies: Amoxicillin-pot Clavulanate Dust Mite Extract Environmental
Diagnostic Lab Data:
CDC Split Type:
Write-up: vaccine was not given according to the recommended schedule it was given to early. Called and discussed with father. Do not expect an adverse effect from an extra dose, but will need a fourth dose. Recommend waiting at least three months or longer for this. |
|
| VAERS ID: |
913574 (history) |
| Form: |
Version 2.0 |
| Age: |
14.0 |
| Sex: |
Female |
| Location: |
Texas |
| Vaccinated: | 2020-12-17 |
| Onset: | 2020-12-17 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLULAVAL QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS |
G2RX7 / 1 |
RA / IM |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
1687290 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Pain in extremity,
Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: BMI 38 amenorrhea
Preexisting Conditions: acanthosis nigricans
Allergies: aspirin
Diagnostic Lab Data: n/a
CDC Split Type:
Write-up: about 12 hours later w/ PAIN ON RT ARM , SWELLING OF left THIGH WITH PAIN |
|
| VAERS ID: |
913782 (history) |
| Form: |
Version 2.0 |
| Age: |
13.0 |
| Sex: |
Female |
| Location: |
South Carolina |
| Vaccinated: | 2020-12-11 |
| Onset: | 2020-12-12 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR |
UT7049MA / 1 |
LA / IM |
Administered by: Public Purchased by: ?
Symptoms: Abdominal pain,
Fatigue,
Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Fluticasone nasal spray
Current Illness:
Preexisting Conditions: none
Allergies: No known allergies
Diagnostic Lab Data: Given: Hydrocortisone cream prednison hydroxyzine dexamethasone injection
CDC Split Type:
Write-up: Rash all over body, reports abdominal pain and some fatigue |
|
| VAERS ID: |
914270 (history) |
| Form: |
Version 2.0 |
| Age: |
15.0 |
| Sex: |
Female |
| Location: |
Iowa |
| Vaccinated: | 2020-12-09 |
| Onset: | 2020-12-09 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEP: HEP B (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
| IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR |
P1F49 / UNK |
- / OT |
| TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS |
- / UNK |
- / - |
Administered by: Unknown Purchased by: ?
Symptoms: Expired product administered
SMQs:, Medication errors (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USSA2020SA362278
Write-up: that the Ipol vaccine had expired with no AE; Initial information received on 16-Dec-2020 regarding an unsolicited valid non-serious case received from a other health professional. This case involves a 15 years old female patient who received an 0.5 ml expired dose of IPV (VERO) [IPOL] (lot number: P1F49, expiry date: 30-Nov-2020) via intramuscular route in unknown administration site on 09-Dec-2020 for prophylactic vaccination (expired product administered). The patient''s medical history, medical treatments, vaccinations and family history were not provided. Concomitant medications included Diphtheria Vaccine Toxoid, Pertussis Vaccine Acellular 3-Component, Tetanus Vaccine Toxoid (Boostrix) And Hepatitis B Vaccine (Hepatitis B Vaccin) It was an actual medication error due to the expired vaccine used (latency same day). At the time of report, no adverse event was reported. This suspected adverse reaction report is submitted and classified as a medication error solely and exclusively to ensure the marketing authorization holder''s compliance with the requirements set out in Directive 2001/83/EC and Module VI of the Good Pharmacovigilance Practices. The classification as a medical error is in no way intended, nor should it be interpreted or construed as an allegation or claim made by the marketing authorization holder that any third party has contributed to or is to be held liable for the occurrence of this medication error. |
|
| VAERS ID: |
914470 (history) |
| Form: |
Version 2.0 |
| Age: |
18.0 |
| Sex: |
Female |
| Location: |
New York |
| Vaccinated: | 2020-12-29 |
| Onset: | 2020-12-30 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC. |
276584 / 1 |
LA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: unknown
CDC Split Type:
Write-up: vomiting |
|
| VAERS ID: |
914656 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Michigan |
| Vaccinated: | 2020-12-30 |
| Onset: | 2020-12-30 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-30 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
CH2639 / 2 |
LA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Cold sweat,
Hyperhidrosis,
Loss of consciousness,
Skin warm
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NO
Current Illness: NO
Preexisting Conditions: NO
Allergies: NO
Diagnostic Lab Data: EMT COMPLETED VITALS ALL WITHIN NORMAL LIMITS. SAID SHE WAS FINE RELEASSED TO SISTER AND PARENT.
CDC Split Type:
Write-up: PATIENT APPEARED NORMAL IMMEDIATELY AFTER INJECTION. AS SHE WAS WALKING OUT OF THE CONSULTATION ROOM WITH HER SISTER SHE BEGIN TO SLUMP OVER, HER SISTER HELD HER AND THE INTERN SECURED HER UNDER THE ARMS FROM BEHIND. PHARMACIST IN CHARGE WAS ALERTED. PATIENT CAME ALERT AS PHARMACIST ARRIVED, SUPPORTED HER, ASKED IF SHE WAS OKAY? PATIENT RESPONDED YES THAN REQUESTED TO LAY DOWN. SENT INTERN FOR COLD CLOTH AS PATIENT WAS WARM, SWEATY AND CLAMY TO THE TOUCH. WE HELPED HER TO THE FLOOR, SUPPORTED HER HEAD AND PATIENT LOSS CONCISENESS, BEGAN TO BREATHE DEEPLY, ABDOMEN CONTRACTING IN, HANDS CLENCHING. CALLED 911, SISTER DENIED H/O SEIZURES, PREVIOUS RXN WITH FRIST DOSE OR ANY OTHER ILLNESSES. PATIENT REGAINED CONCISENESS AND SIAD SHE WAS FINE. SHE DID URINATE, NO VOMITTING. EMT WAS ALERTED CONCERNED SHE HAD A SEIZURE |
|
| VAERS ID: |
915693 (history) |
| Form: |
Version 2.0 |
| Age: |
12.0 |
| Sex: |
Male |
| Location: |
Michigan |
| Vaccinated: | 2020-12-28 |
| Onset: | 2020-12-28 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-31 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
U6787AB / UNK |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Inappropriate schedule of product administration
SMQs:, Medication errors (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:
Write-up: Vaccine given early Before due date. |
|
| VAERS ID: |
916237 (history) |
| Form: |
Version 2.0 |
| Age: |
12.0 |
| Sex: |
Male |
| Location: |
Florida |
| Vaccinated: | 2020-12-30 |
| Onset: | 2020-12-31 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2020-12-31 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS |
AMVA418A / 1 |
RA / IM |
| TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS |
374LB / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Injection site erythema,
Injection site induration,
Injection site pain,
Injection site warmth
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: none
Preexisting Conditions: none
Allergies: None
Diagnostic Lab Data: none
CDC Split Type:
Write-up: 5 x 5.5 inch induration which is erythematous, hot to touch, mildly tender on right deltoid area |
|
| VAERS ID: |
917550 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Arkansas |
| Vaccinated: | 2021-01-02 |
| Onset: | 2021-01-02 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-02 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
U62828AA / 2 |
LA / IM |
Administered by: Pharmacy Purchased by: ?
Symptoms: Pruritus
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None stated originally. However later, during reaction event, I discovered patient had allergic reaction during Biology class during dissection of frog. Believed at the time reaction was to Formaldehyde, and since this discussion learned her brother and father both have this reaction to Formaldehyde as well.
Diagnostic Lab Data: None
CDC Split Type:
Write-up: Vaccination given at 3:28pm, at 3:40 patient reported sensation of itch in her arm and left hand. Also reported sensation of swelling in left hand. Visual comparison of left vs right hands did not reveal any obvious differences, however I proceeded to treatment at 3:42 with oral diphenhydramine liquid at 25mg dose. At 3:55, patient reports symptoms improving (i.e. no sensation of swelling or any visual disparity left vs right hand). At 4:22 no symptoms present and parent of patient and patient left treatment area. Telephone contact with parent at 5:20pm, patient has no itching or swelling sensation at all. |
|
| VAERS ID: |
918965 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Michigan |
| Vaccinated: | 2020-12-31 |
| Onset: | 2020-12-31 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-04 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS |
ABXA95AA / 2 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Vomiting
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Penicillin, IV contrast, Amoxicillin
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient received 2nd dose of Bexsero and after she left the building and was at home she began to vomit. |
|
| VAERS ID: |
921417 (history) |
| Form: |
Version 2.0 |
| Age: |
18.0 |
| Sex: |
Female |
| Location: |
Washington |
| Vaccinated: | 2021-01-05 |
| Onset: | 2021-01-05 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-05 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
S026371 / 1 |
RA / IM |
| MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS |
ABXB05BA / 1 |
LA / IM |
| MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR |
U6787AA / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Contusion,
Head injury,
Presyncope
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: syncope asthma
Allergies: peanuts
Diagnostic Lab Data: N/A
CDC Split Type:
Write-up: Patient vasovagaled in waiting room while scheduling second doses of vaccines. Patient did hit right side of head on countertop, next to eye. Patient had a slight bruise next to eye before leaving. Patient was checked over by MD in the waiting room while remaining on the floor with a cool compress on her neck. Vitals were rechecked two times in the waiting room to verify that they were getting better. Patient also given a bottle of water. Patient''s mother was brought in to the office to accompany patient down to the car who was brought down to the car in a wheelchair by a nurse. |
|
| VAERS ID: |
921494 (history) |
| Form: |
Version 1.0 |
| Age: |
12.0 |
| Sex: |
Female |
| Location: |
New York |
| Vaccinated: | 2020-12-31 |
| Onset: | 2021-01-04 |
| Days after vaccination: | 4 |
| Submitted: |
2021-01-05 |
| Days after onset: | 1 |
| Entered: |
2021-01-05 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS |
G2RX7 / 6 |
LA / IM |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
1637648 / 2 |
RA / IM |
Administered by: Private Purchased by: Private
Symptoms: Induration
SMQs:, Extravasation events (injections, infusions and implants) (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: none
Allergies:
Diagnostic Lab Data: none
CDC Split Type:
Write-up: Local induration 2.5cm x 1.5cm oval |
|
| VAERS ID: |
921849 (history) |
| Form: |
Version 2.0 |
| Age: |
19.0 |
| Sex: |
Female |
| Location: |
Colorado |
| Vaccinated: | 2021-01-05 |
| Onset: | 2021-01-05 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-05 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEP: HEP B (HEPLISAV-B) / DYNAVAX TECHNOLOGIES CORPORATION |
933622 / 2 |
LA / IM |
Administered by: Other Purchased by: ?
Symptoms: Hypoaesthesia,
Pain,
Pain in extremity,
Pruritus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: Employee had a complaint of a shooting pain 6/10 between her left elbow and her left wrist, with itching between her left elbow and her left wrist. Employee also had a complaint of a numb feeling at the base of her middle and ring fingers on her left hand, 5 1/2 hours after receiving her Hepatitis B vaccine. Vital signs obtained and ice pack applied to left arm at the injection site. Employee states, "I don''t need the ice pack after 10 minutes and return to work. Staff notified. |
|
| VAERS ID: |
921856 (history) |
| Form: |
Version 2.0 |
| Age: |
14.0 |
| Sex: |
Female |
| Location: |
Oregon |
| Vaccinated: | 2021-01-05 |
| Onset: | 2021-01-05 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-05 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
1621934 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None.
CDC Split Type:
Write-up: Syncopal episode that last about 5 seconds |
|
| VAERS ID: |
922369 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Unknown |
| Location: |
New Jersey |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-15 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-06 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HEPA: HEP A (VAQTA) / MERCK & CO. INC. |
T013204 / UNK |
- / - |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
1637641 / UNK |
- / - |
| UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
| UNK: VACCINE NOT SPECIFIED (NO BRAND NAME) / UNKNOWN MANUFACTURER |
- / UNK |
- / - |
Administered by: Unknown Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075132012USA013056
Write-up: Nurse reported temperature excursion with GARDASIL 9 and VAQTA.; This spontaneous report as received from a Registered Nurse referring to a 17 year old patient of unknown gender. The patient''s medical history, concurrent conditions, concomitant medications, and historical drugs were not reported. On 15-DEC-2020, the patient was vaccinated with an improperly stored dose of hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast)(GARDASIL 9) 0.5 milliliter (strength, route, frequency, and anatomical location were unknown) with lot # 1637641 and expiration date on 16-FEB-2022; and finally with an improperly stored dose of Hepatitis A Vaccine, Inactivated(VAQTA) 0.5 milliliter (strength, route, frequency, and anatomical location were unknown) with lot # T013204 and expiration date on 03-DEC-2021 for prophylaxis. The administered doses of vaccines experienced temperature excursion (0.38 degrees Celsius) for 4 hours and 45 minutes and (11.09 degrees Celsius) for 1 hour and 30 minutes. There was a digital data logger invloved, but no previous temperature excursion for Hepatitis A Vaccine, Inactivated(VAQTA) but there was a previous temperature excursion with hpv rl1 6 11 16 18 31 33 45 52 58 vlp vaccine (yeast)(GARDASIL 9) (17.52 degrees Celsius) for 2 hours and 42 minutes. |
|
| VAERS ID: |
923502 (history) |
| Form: |
Version 2.0 |
| Age: |
18.0 |
| Sex: |
Female |
| Location: |
Massachusetts |
| Vaccinated: | 2021-01-05 |
| Onset: | 2021-01-05 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-06 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
CW3116 / 1 |
RA / IM |
Administered by: Private Purchased by: ?
Symptoms: Skin laceration,
Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Hostility/aggression (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Junel Fe 1.5/30 oral tablet. 1 tab, oral, daily
Current Illness: Right sided otalgia
Preexisting Conditions: N/A
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:
Write-up: Patient received 1st dose of Trumenba vaccine and fainted shortly after. Struck right eyebrow on chair. Doctor evaluated laceration on right eyebrow. Parent came to office and took patient to urgent care where they placed 8 sutures and then discharged home. |
|
| VAERS ID: |
923990 (history) |
| Form: |
Version 2.0 |
| Age: |
17.0 |
| Sex: |
Male |
| Location: |
Unknown |
| Vaccinated: | 2020-12-30 |
| Onset: | 2020-12-30 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-06 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH |
CW3116 / 1 |
LA / IM |
Administered by: Unknown Purchased by: ?
Symptoms: Asthenia,
Headache,
Injection site erythema,
Malaise,
Paraesthesia
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:
Write-up: A nurse administered the vaccine. 5-10 minutes later, during the blood draw, patient felt pins and needles sensation throughout the body, traveling to the head. Patient also felt tired and face was pale at that time. 30 minutes after the vaccine was administered, patient felt generally weak but no fever or other symptoms. One day after vaccine administered, felt unwell and weak. Area around injection site was slightly red. Had malaise and headache. Three days after vaccine, back to baseline. |
|
| VAERS ID: |
924268 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Washington |
| Vaccinated: | 2021-01-06 |
| Onset: | 2021-01-06 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-06 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS |
ABXA94AA / 1 |
RA / IM |
| MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS |
AMVA397A / 2 |
LA / IM |
Administered by: Military Purchased by: ?
Symptoms: Immediate post-injection reaction,
Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:
Write-up: Patient fainted immediately after receiving vaccinations. Lasted no more than 5 seconds. |
|
| VAERS ID: |
927939 (history) |
| Form: |
Version 1.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Georgia |
| Vaccinated: | 2021-01-05 |
| Onset: | 2021-01-05 |
| Days after vaccination: | 0 |
| Submitted: |
2021-01-05 |
| Days after onset: | 0 |
| Entered: |
2021-01-06 |
| Days after submission: | 1 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS |
ABXA93AA / 1 |
RA / IM |
Administered by: Private Purchased by: Public
Symptoms: Erythema,
Induration,
Pain
SMQs:, Anaphylactic reaction (broad), Extravasation events (injections, infusions and implants) (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: 0
Preexisting Conditions: asthma, heart murmur, IBS
Allergies:
Diagnostic Lab Data: None
CDC Split Type:
Write-up: 2.5 x 3cm red, painful induration |
|
| VAERS ID: |
924833 (history) |
| Form: |
Version 2.0 |
| Age: |
15.0 |
| Sex: |
Female |
| Location: |
New York |
| Vaccinated: | 2021-01-06 |
| Onset: | 2021-01-06 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-07 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. |
1687291 / 1 |
LA / IM |
Administered by: Private Purchased by: ?
Symptoms: Syncope,
Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Not applicable
CDC Split Type:
Write-up: 5 minutes after receiving the vaccine, she was having a venipuncture performed and she had a syncopal episode < 5seconds and vomited 4 times |
|
| VAERS ID: |
925233 (history) |
| Form: |
Version 2.0 |
| Age: |
15.0 |
| Sex: |
Unknown |
| Location: |
New Jersey |
| Vaccinated: | 2020-12-15 |
| Onset: | 2020-12-15 |
| Days after vaccination: | 0 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-07 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. |
S037503 / UNK |
- / - |
Administered by: Unknown Purchased by: ?
Symptoms: Product storage error
SMQs:, Medication errors (narrow)
Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: US0095075132012USA013013
Write-up: No further details available; Caller reporting temperature excursion. Caller reports AE as product was administered; This spontaneous report was received from a registered nurse and refers to a 15-year-old patient of unknown gender. There was no information about patient''s concomitant medications, concurrent conditions or pertinent medical history. On 15-DEC-2020, the patient was vaccinated with measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (rHA) (M-M-R II) (lot # S037503 and expiration date since it makes match with the autopopulated expiration date 20-NOV-2020), 0.5 milliliter (route of administration and anatomical location were not reported ) for prophylaxis. It was reported, the measles, mumps, and rubella (wistar ra 27-3) virus vaccine, live (M-M-R II) vaccine was stored at temperature excursion. The temperature excursion was 0.38 degrees Celsius for a time frame of four hours and 45 minutes, and 11.09 degrees Celsius for 1 hour and 30 minutes, as recorded by a data logger. There was no previous temperature excursion. No further details available. This is one of several reports from the same source.; Sender''s Comments: US-009507513-2012USA012971: US-009507513-2012USA012900: |
|
