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From the 10/15/2021 release of VAERS data:

Found 9,125 cases where Age is 12-or-more-and-under-17 and Vaccination Date from '2016-01-01' to '2020-11-30'

Table

   
AgeEvent OutcomeCountPercent
12-17 YearsDeath140.15%
Permanent Disability2002.19%
Office Visit1,65818.17%
Emergency Room8899.74%
Emergency Doctor/Room7538.25%
Hospitalized5726.27%
Hospitalized, Prolonged30.03%
Recovered4,19445.96%
Birth Defect20.02%
Life Threatening870.95%
Not Serious3,02733.17%
total11,399124.92%
TOTAL† 11,399† 124.92%
† Because some cases have multiple vaccinations and symptoms, a single case can account for multiple entries in this table. This is the reason why the Total Count is greater than 9125 (the number of cases found), and the Total Percentage is greater than 100.



Case Details

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VAERS ID: 617589 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2016-01-05
Onset:2016-01-05
   Days after vaccination:0
Submitted: 2016-01-05
   Days after onset:0
Entered: 2016-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS 475PE / 2 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 294X9 / 1 RA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L016428 / 1 RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR L10011 / 1 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. K022284 / 2 RA / SC
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U4852AA / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Hyperventilation, Hypoaesthesia, Muscle spasms, Rash
SMQs:, Anaphylactic reaction (narrow), Asthma/bronchospasm (broad), Peripheral neuropathy (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No.
Preexisting Conditions: No.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After vaccines were administered to patient at 11:50 AM, patient was advised to wait 30 minutes for monitoring. Patient was speaking to the nurse for about 5 minutes and the patient started hyperventilating and complaining of numbness to both arms and cramping on both hands. Patient remained alert and oriented x3. Nurse remained with patient and measures were done to attempt to calm patient down. Patient calmed down and was breathing normally, and minutes later started hyperventilating again and rashes were observed on patient''s upper chest. Telephone call made to 911 for emergency intervention.


VAERS ID: 617591 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2016-01-04
Onset:2016-01-04
   Days after vaccination:0
Submitted: 2016-01-05
   Days after onset:1
Entered: 2016-01-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L017407 / 2 RA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Presyncope, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient developed a fever. This am he vomited x1 and had a near syncopal event.


VAERS ID: 617802 (history)  
Form: Version 1.0  
Age: 13.0  
Sex: Female  
Location: Kansas  
Vaccinated:2016-01-06
Onset:2016-01-06
   Days after vaccination:0
Submitted: 2016-01-06
   Days after onset:0
Entered: 2016-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L023230 / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS M15032 / 1 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 2224P / 2 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Extra dose administered, Wrong drug 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: No
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: RN gave Tdap instead of Flu vaccine, two Tdaps were given to patient in the same arm (Left deltoid.)


VAERS ID: 617803 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: Arizona  
Vaccinated:2016-01-05
Onset:2016-01-06
   Days after vaccination:1
Submitted: 2016-01-06
   Days after onset:0
Entered: 2016-01-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR K13301 / 5 LA / SC
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS M14135 / 2 RA / IM
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR C4736CA / 2 LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. L011082 / 3 RA / SC

Administered by: Public       Purchased by: Public
Symptoms: Asthenia, Headache, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Guillain-Barre syndrome (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: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Mother called to complain of sore swollen left arm. Complains of Weakness, and headache. Denies Fever. She was told to seek medical attention if she feels her son needs to be seen. She said he is sleeping now but would update me in the morning or take him to the hospital if need be.


VAERS ID: 617920 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Male  
Location: Virginia  
Vaccinated:2016-01-04
Onset:2016-01-04
   Days after vaccination:0
Submitted: 2016-01-07
   Days after onset:3
Entered: 2016-01-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS LL43A / 2 LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L016428 / 2 RA / IM
IPV: POLIO VIRUS, INACT. (POLIOVAX) / SANOFI PASTEUR L11301 / 2 LA / SC
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. K024038 / 2 RA / SC
TD: TD ADSORBED (NO BRAND NAME) / SANOFI PASTEUR U4852AA / 2 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. L031068 / 2 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Flushing, Pruritus, Rash, Rash erythematous
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: n/a
CDC Split Type: VA16001

Write-up: Patient began to have red flat rashes on chest and abdomen with itching. This progressed to face and bilateral inner arm. Patient also had facial flushing. The ems were called but patient and his parents declined help. The patient stated that he felt better right before he left the health department.


VAERS ID: 618255 (history)  
Form: Version 1.0  
Age: 13.0  
Sex: Female  
Location: Colorado  
Vaccinated:2016-01-06
Onset:2016-01-07
   Days after vaccination:1
Submitted: 2016-01-08
   Days after onset:1
Entered: 2016-01-11
   Days after submission:3
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UI440AC / 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. L018357 / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Abdominal discomfort, Chills, Dyspnoea, Headache, Injection site erythema, Injection site pain, Injection site swelling, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (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:
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient received MENACTRA, HPV and FLUZONE on 1/6/16. Approx. 13 hrs later awoke at 4:30 am to vomit x 5, felt abdominal discomfort, chills and headache. Felt short of breath at time of vomiting. On exam had 3mm injection site redness/tenderness/swelling at site of MENACTRA.


VAERS ID: 618550 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: Georgia  
Vaccinated:2016-01-12
Onset:2016-01-12
   Days after vaccination:0
Submitted: 2016-01-12
   Days after onset:0
Entered: 2016-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2115 / 1 NS / IN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. K010215 / 3 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Dysgeusia, Headache, Pharyngeal paraesthesia, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Taste and smell disorders (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (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: None
Current Illness: None
Preexisting Conditions: GERD
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Throat tingling and tight, H/A, Funny taste in mouth. Gave water to drink. Benadryl 25mg liquid po and Tylenol ES 2 po. V/S stable and observation.


VAERS ID: 618577 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Washington  
Vaccinated:2016-01-12
Onset:2016-01-12
   Days after vaccination:0
Submitted: 2016-01-12
   Days after onset:0
Entered: 2016-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U5263AA / 1 LA / IM

Administered by: Other       Purchased by: Unknown
Symptoms: Dizziness, Nausea
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient became light-headed and nauseous. She tried to sit down and then had to take a seat and put her feet up in order to not throw-up. The symptoms lasted about 15 minutes in the pharmacy. She said she was feeling a little better about 10 minutes after vaccination. The patient left after about 20 minutes and I am not sure when she fully recovered.


VAERS ID: 618837 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2016-01-04
Onset:2016-01-04
   Days after vaccination:0
Submitted: 2016-01-13
   Days after onset:9
Entered: 2016-01-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 32BH5 / UNK RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. L033347 / 2 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Fatigue, Headache, Nausea
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: None
Current Illness: Hemorrhage of anus and rectum
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache, nausea and fatigue post vaccines.


VAERS ID: 618932 (history)  
Form: Version 1.0  
Age: 13.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2016-01-13
Onset:2016-01-14
   Days after vaccination:1
Submitted: 2016-01-14
   Days after onset:0
Entered: 2016-01-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L017407 / 2 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: 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? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: MVI
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Mom phoned to clinic stating pt woke up with a fever (100.1), nausea, and a horrible HA. Second HPV received yesterday (1/13/16). First injection 11/8/15, mom states pt c/o HA day after injection.


VAERS ID: 619271 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: Idaho  
Vaccinated:2016-01-04
Onset:2016-01-04
   Days after vaccination:0
Submitted: 2016-01-11
   Days after onset:7
Entered: 2016-01-15
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR L1001 / UNK LL / SC
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5179AA / 2 RL / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U5247BA / 2 RL / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Abasia, Eye swelling, Fatigue, Headache, Malaise, Pain, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Ventolin HFA; Loratadine
Current Illness:
Preexisting Conditions: Migraines
Allergies:
Diagnostic Lab Data:
CDC Split Type: ID16003

Write-up: Pt was given tetanus booster and meningococcal vaccine in the right thigh and polio vaccine in the left thigh. Mom reports pt had severe pain in the right thigh shortly afterwards. Pt had severe malaise and fatigue for 2-3 days. Pt was unable to walk and stayed in bed for several days missing school. Leg pain developed into full body aches. Over the weekend pt developed severe headache and swelling in left eye. Pt started on prednisone 20 mg for 3 days and BENADRYL as well.


VAERS ID: 619303 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2016-01-14
Onset:2016-01-14
   Days after vaccination:0
Submitted: 2016-01-15
   Days after onset:1
Entered: 2016-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FM2220 / 1 NS / IN
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L025737 / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Muscle spasms, Muscle twitching
SMQs:, Dyskinesia (broad), Dystonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concerta, Ortho-Cyclen
Current Illness: No
Preexisting Conditions: ADHD, dysfunctional uterine bleeding
Allergies:
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Upper right arm twitching and muscle cramping into elbow -- episodic.


VAERS ID: 619430 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Texas  
Vaccinated:2016-01-13
Onset:2016-01-13
   Days after vaccination:0
Submitted: 2016-01-16
   Days after onset:3
Entered: 2016-01-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV2: HPV (CERVARIX) / GLAXOSMITHKLINE BIOLOGICALS 4534D / 1 LL / IM

Administered by: Private       Purchased by: Private
Symptoms: Lip swelling, Peripheral swelling
SMQs:, Cardiac failure (broad), 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? 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:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Swelling in lips and hands. 1/14/16 at 8am BENADRYL given, prednisone 20mg x 3 days.


VAERS ID: 619668 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: D.C.  
Vaccinated:2016-01-14
Onset:2016-01-14
   Days after vaccination:0
Submitted: 2016-01-19
   Days after onset:5
Entered: 2016-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U5304AA / 3 RA / IM

Administered by: Private       Purchased by: Public
Symptoms: Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Cold
Preexisting Conditions: Diabetic; Learning disorder
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Seizure, seen in ER.


VAERS ID: 619791 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2016-01-18
Onset:2016-01-19
   Days after vaccination:1
Submitted: 2016-01-19
   Days after onset:0
Entered: 2016-01-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M13066 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Chills, Fatigue, Headache
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: C/o nausea, anxiety, Migraine
Preexisting Conditions: Amoxicillin
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Chills, fatigue, headache.


VAERS ID: 619803 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Male  
Location: Texas  
Vaccinated:2016-01-18
Onset:2016-01-19
   Days after vaccination:1
Submitted: 2016-01-20
   Days after onset:1
Entered: 2016-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. L027282 / UNK - / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Chest X-ray normal, Chest pain, Costochondritis
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (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: Dulera Inhaler, Claritin tablets
Current Illness: No
Preexisting Conditions: Asthma. He is a bilateral below the Knee Amputee due to congenital sacral agenesis. Allergic rhinitis. Hx of Imperforate anus s/p repair at birth
Allergies:
Diagnostic Lab Data: Chest XRay clear
CDC Split Type:

Write-up: Patient developed sharp midsternal pain in the center of chest. He was diagnosed with Costochondritis. Clear Chest Xray. No hx of fever.


VAERS ID: 619853 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2016-01-11
Onset:2016-01-11
   Days after vaccination:0
Submitted: 2016-01-13
   Days after onset:2
Entered: 2016-01-20
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR L1001 / 4 LA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. L012481 / 2 RA / SC
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / 1 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. L027287 / 2 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Erythema, Injection site erythema, Injection site swelling, Injection site warmth, Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: NKDA;NKA
Allergies:
Diagnostic Lab Data: None
CDC Split Type: AR163

Write-up: Pt. c/o pain, swelling and redness in left arm within 1 1/2 hours of injection on 1/11/16, took TYLENOL, BENADRYL and applied ice. Repeated treatment 1/12/16 but says left arm continues to swell, have erythema and pain. Measured left deltoid at 15.75", compared to unaffected arm at 14.5". Hot to touch, but very little erythema today. Will continue BENADRYL, ibuprofen and elevation of left arm, talked to PCP today with those recommendations.


VAERS ID: 620011 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2016-01-20
Onset:2016-01-20
   Days after vaccination:0
Submitted: 2016-01-20
   Days after onset:0
Entered: 2016-01-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. - / 2 LA / UN

Administered by: Private       Purchased by: Other
Symptoms: Eyelid rash, Rash, Swelling, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Periorbital and eyelid disorders (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: None
Current Illness: NO
Preexisting Conditions: Mild grass, tree pollen and mold allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: At 3:30 I noticed a small rash on my daughter''s chin and a small rash with hives on her forehead. I spoke with the nurse at our PCP''s office to report the symptoms and requested the doctor be notified and a non-urgent call back to discuss. I gave my daughter 25 mg Benadryl around 4:00. Between 3:30 and 4:30, the rash and hives were more spotty on other areas of the face so I administered another dose of 25 mg Benadryl (the highest recommended dosage for her age). I then phoned my PCP again because the rash had spread to the eye area and looked swollen. I spoke with my PCP who recommended we go to the ER for further assessment. However, as I prepared the family to leave for the ER, around 4:45, the rash appeared to be diminishing. I did not feel an ER visit was indicated. My daughter had no difficulty breathing nor any other symptoms during the event. By 5:30, the rash had decreased at least 90% and was 100% cleared by 6:30.


VAERS ID: 620036 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Male  
Location: Maryland  
Vaccinated:2016-01-20
Onset:2016-01-20
   Days after vaccination:0
Submitted: 2016-01-20
   Days after onset:0
Entered: 2016-01-21
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. L019297 / 1 LA / IM

Administered by: Other       Purchased by: Other
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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: None stated.


VAERS ID: 620063 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Arizona  
Vaccinated:2016-01-18
Onset:0000-00-00
Submitted: 2016-01-21
Entered: 2016-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. K016966 / 3 RA / UN

Administered by: Other       Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, 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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1601USA007093

Write-up: Information has bee received from a physician referring to a patient of unknown age and gender. On an unknown date the patient was vaccinated with the second dose of GARDASIL (dose, lot # and route were not reported) 2 months after the first dose and then was vaccinated with the third dose of GARDASIL 2 months after the second dose (inappropriate schedule of vaccine administered). No adverse effect was reported. Additional information has been requested.


VAERS ID: 620199 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: Ohio  
Vaccinated:2016-01-19
Onset:0000-00-00
Submitted: 2016-01-20
Entered: 2016-01-21
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / UNK UN / IM

Administered by: Private       Purchased by: Private
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZYRTEC; Multivitamin
Current Illness: Had gastro 1 week prior
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Finger swelling 1 day after MENACTRA and ball of foot hurts. No other symptoms.


VAERS ID: 620211 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2016-01-04
Onset:2016-01-04
   Days after vaccination:0
Submitted: 2016-01-21
   Days after onset:17
Entered: 2016-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / UNK - / -

Administered by: Public       Purchased by: Other
Symptoms: Extra dose administered, No adverse event
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: none~Meningococcal Conjugate (Menactra)~1~16.33~Patient
Other Medications: Prescribed amoxil for suspected UTI
Current Illness: Abdominal pain
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Only discussed with DH Vaccine consultant, who discussed this scenario with CDC. I was advised to report to VAERS even though there was no adverse effect. Despite the vaccines being so close together.
CDC Split Type:

Write-up: Child received an additional dose of Meningococcal Vaccine in error not knowing she had already received a dose in November 2015 at a Health Department.


VAERS ID: 620212 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2016-01-20
Onset:2016-01-20
   Days after vaccination:0
Submitted: 2016-01-21
   Days after onset:1
Entered: 2016-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L016429 / 2 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U5214AA / 1 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Fall, Gingival bleeding, Head injury
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Gingival disorders (narrow), Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No.
Preexisting Conditions: After event, mother notified us that the patient gets pale when she receives vaccines, and has fainted at school when she was learning about blood.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 01/20/16, medical assisitant (MA) administered TDAP (Adacel) Lot#: U5214AA Exp: 12/04/17, Manuf: SP; and HPV9 (Gardasil) Lot#: L016429 Exp: 08/09/17 Manuf: Merck & Co vaccines. Per MA pt tolerated well immediately after administration. Pt''s mother was present and stated the same. As stated by MA, she left the room door slightly open to be able to observe the pt, and mother was present with pt. Less than 4 minutes later we heard a loud scream, which was the pt''s mother asking for help. MA was the first to respond, since she was near the room, and per MA she noted the pt was on the floor faced up, and called code blue. All medical and nursing staff responded to code blue. Front desk called 911. Pt was conscious, A&O x 4, vitals WNL, and pt denied any pain. A bump on her forehead was noted and slight blood on her gums. Pt''s mother stated she was looking at her phone, and from her peripheral vision she saw the pt falling down from exam table/bed. Pt''s mother stated the pt fell face forward, and she turned her over. Pt''s mother stated the pt gets nervous around blood and needles. She stated the pt has" fainted at school when learning about blood cells, and gets pale after receiving vaccines." Notified pt''s mom to always alert anyone giving her vaccines or drawing her blood of this. About 8 min later the paramedics arrived and assessed pt. Per pt''s mother, she was given the option to have the ambulance take pt to hospital, or stay and take pt to the ER within the pt''s insurance network. Pt''s mother stated she would stay and take the pt to ER herself. Paramedics left and pt was continuously assessed by Dr., and myself for about 45 min. Vitals were WNL, pt was A&O x 4, and still denied any pain 0/10. Pt was provided with water and cold compresses. At 4:06 pm Dr. okayed pt to go. Discharge instructions provided to pt''s mother, by Dr. Pt''s mother verbalized understanding.


VAERS ID: 620243 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Female  
Location: California  
Vaccinated:2016-01-20
Onset:2016-01-20
   Days after vaccination:0
Submitted: 2016-01-21
   Days after onset:1
Entered: 2016-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUVIRIN) / NOVARTIS VACCINES AND DIAGNOSTICS 158003 / 2 LA / IM
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 49LH2 / 2 LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L018351 / 2 RA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. L034369 / 2 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Chills, Dyspnoea, Speech disorder, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Psychosis and psychotic disorders (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Hypersensitivity (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: PPD
Current Illness: None Reported or stated
Preexisting Conditions: None Reported or stated
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 14 y/o female was in Clinic for immunizations Wednesday evening at 8PM on 1/20/2016. She denied reactions to previous vaccine, heart and lungs sounds were normal, and she was afraid. Approximately 15 minutes after giving last of four vaccines (HPV, Varicella, Hepatitis A, Influenza and PPD). Patient started shivering, she was covered, provider asked mother to stay at her side, and provider checked on her approximately 4 times in the 15 minutes. Patient started complaining of shortness of breath and difficulty speaking. Provider then administered oxygen via nasal cannula at 4LPM. Symptoms improved somewhat but patient was still shivering and complaining of constriction in her throat. Provider asked medical assistant to call 911 at approximately 8:55 Pm. Fire paramedics arrived approximately 9:05pm, assessed patient, and they gave her Benadryl 50 mg, loaded patient on Gurney, transported to hospital.


VAERS ID: 620244 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: Indiana  
Vaccinated:2016-01-12
Onset:2016-01-13
   Days after vaccination:1
Submitted: 2016-01-21
   Days after onset:8
Entered: 2016-01-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 LA / -

Administered by: Unknown       Purchased by: Other
Symptoms: Fatigue, Injection site erythema, Injection site pruritus, Injection site swelling, Pain, Peripheral swelling, Pyrexia, Tenderness
SMQs:, Cardiac failure (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (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: swelling at injection site~HPV (Gardasil)~1~16.25~Patient
Other Medications: Ibuprofen 1 hr before vaccination
Current Illness: None.
Preexisting Conditions: None.
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Upper arm swollen and tender from elbow to shoulder. Red swollen area around shot site, size of 50 cent piece. Itching at injection site, body ache, fatique, fever for a day. Symptoms lasting for 1 week. Used Benadryl for itching and ibuprofen for pain and aches. Called Dr. office and told to administer above products.


VAERS ID: 620329 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Male  
Location: Ohio  
Vaccinated:2016-01-18
Onset:2016-01-19
   Days after vaccination:1
Submitted: 2016-01-22
   Days after onset:3
Entered: 2016-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2115 / UNK NS / IN
MENB: MENINGOCOCCAL B (BEXSERO) / NOVARTIS VACCINES AND DIAGNOSTICS 148901A / UNK LA / IM

Administered by: Unknown       Purchased by: Public
Symptoms: Headache, Hypoaesthesia, Intervertebral disc disorder, Nuclear magnetic resonance imaging brain normal, Nuclear magnetic resonance imaging spinal abnormal, Paraesthesia, Spinal osteoarthritis
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Arthritis (narrow), 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, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Claritin, Ibuprofen, MiraLax
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: MRI w/o contract of Cervical spine - negative; MRI Lumbar spine w/o contrast -mild degenerative changes at L4-5 and L5-S1; MRI Thoracic spine- mild prominence of central canal mid thoracic spine on the cord of doubtful significance. Few Schmorl''s nodes of the mid thoracic spine noted otherwise unremarkable MRI of the thoracic spine. MRI Brain w/o contrast-no evidence of an acute intracranial process or mass or abn signal in the brain
CDC Split Type:

Write-up: Patient awoke with headache, numbness and tingling of lower extremities and fingers both hands. Seen in PCP office that morning and admitted to hospital for evaluation.


VAERS ID: 620401 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: New York  
Vaccinated:2016-01-19
Onset:2016-01-19
   Days after vaccination:0
Submitted: 2016-01-20
   Days after onset:1
Entered: 2016-01-22
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. L016428 / 2 RA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M13065 / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Feeling hot, Hyperhidrosis, Nausea, Pharyngitis, Pyrexia, Sinusitis, Streptococcus test negative
SMQs:, Acute pancreatitis (broad), Agranulocytosis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal infections (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine sodium
Current Illness: Pt seen in office 1/21/16 dx with sinusitis and pharyngitis and placed on abx.
Preexisting Conditions: 3/10 autoimmune hypothyroid
Allergies:
Diagnostic Lab Data: Strep test (-)
CDC Split Type:

Write-up: 5 min after the injection pt began to feel very warm, became diaphoretic, and nauseous. Pt advised to lay down and a cool compress was applied to her forehead. Pt was given a freezie pop and she began to feel better within minutes. Pt stayed in office for another 15 min. Pushed fluids when pt got home. That night pt dev a fever. Pt was seen in office 1/21/16 dx with sinusitis and pharyngitis and placed on abx.


VAERS ID: 620406 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: Kansas  
Vaccinated:2016-01-22
Onset:2016-01-22
   Days after vaccination:0
Submitted: 2016-01-22
   Days after onset:0
Entered: 2016-01-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. L016429 / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5082BA / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Seizure, Tonic clonic movements, Urinary incontinence
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Referral to neurology
CDC Split Type:

Write-up: Seizure with loss of bladder function as well as Rt sided tonic clonic behaviors lasting 90-120 seconds in duration. Approximately 30 sec following GARDASIL inj.


VAERS ID: 620487 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2016-01-18
Onset:2016-01-20
   Days after vaccination:2
Submitted: 2016-01-20
   Days after onset:0
Entered: 2016-01-22
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M37314 / 1 AR / IM

Administered by: Private       Purchased by: Public
Symptoms: Injection site erythema, Injection site macule
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:
Preexisting Conditions: No known allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 8x7 cm very faint pinkish macule distal and lateral to actual injection site. Area was more near mid upper inner extremity rather than deltoid area.


VAERS ID: 620464 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Louisiana  
Vaccinated:2016-01-23
Onset:2016-01-23
   Days after vaccination:0
Submitted: 2016-01-23
   Days after onset:0
Entered: 2016-01-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (AFLURIA) / CSL LIMITED U55406 / 1 RA / IM

Administered by: Other       Purchased by: Public
Symptoms: Flushing
SMQs:, Anaphylactic reaction (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: None
Current Illness: Flushing of face, hands and arms bilat.
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data: None. Benadryl po given.
CDC Split Type:

Write-up: Flushing to face, hands and lower arms bilat.


VAERS ID: 620516 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Female  
Location: Virginia  
Vaccinated:2016-01-18
Onset:2016-01-20
   Days after vaccination:2
Submitted: 2016-01-21
   Days after onset:1
Entered: 2016-01-25
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UI446AA / 1 RA / IM
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. L033707 / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Fatigue, Generalised oedema, Headache, Influenza virus test negative, Injection site erythema, Injection site rash, Injection site swelling, Myalgia, Nausea, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Mild persistent asthma, well-controlled
Preexisting Conditions: Asthma, well-controlled
Allergies:
Diagnostic Lab Data: Flu test - negative
CDC Split Type:

Write-up: Rash, red, generalized, raised and swollen at injection site with generalized edema. Symptoms began 2 days after injection. Fever, muscle pain, nausea, headache and fatigue.


VAERS ID: 620690 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Michigan  
Vaccinated:2016-01-25
Onset:2016-01-25
   Days after vaccination:0
Submitted: 2016-01-25
   Days after onset:0
Entered: 2016-01-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2013 / 1 NS / IN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 32DZ5 / 1 LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L020015 / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5172BA / 1 RA / IM
TDAP: TDAP (ADACEL) / SANOFI PASTEUR U5264AA / 1 LA / IM

Administered by: Public       Purchased by: Public
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: BP 110/76
CDC Split Type:

Write-up: Patient had momentary loss of consciousness following HPV-9 which was final immunization. Recovered spontaneously.


VAERS ID: 620784 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Michigan  
Vaccinated:2016-01-19
Onset:2016-01-19
   Days after vaccination:0
Submitted: 2016-01-26
   Days after onset:7
Entered: 2016-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. L013380 / 1 RA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. L014415 / 1 LA / IM

Administered by: Private       Purchased by: Public
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Eczema
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Witnessed pt. pass out. (1/19) mom called 1/25 with c/o dizziness since receiving vaccine.


VAERS ID: 620910 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2016-01-26
Onset:2016-01-26
   Days after vaccination:0
Submitted: 2016-01-26
   Days after onset:0
Entered: 2016-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L028083 / 1 RA / IM

Administered by: Private       Purchased by: Private
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: Amoxicillin
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received HPV 9 in R deltoid. Remained on the exam table in a laying position for 5 minutes and in room for 10 minutes post vaccination. Patient felt faint and mother assisted patient to table. Patient loss of consciousness for 1 second approximatly. BP taken, juice, and crackers given. Patient remained for observation and provider examined prior to release. Chart alert placed.


VAERS ID: 620916 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Maine  
Vaccinated:2016-01-25
Onset:2016-01-25
   Days after vaccination:0
Submitted: 2016-01-26
   Days after onset:1
Entered: 2016-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5186AA / 1 LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Diarrhoea, Dizziness, Headache, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), 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: Sertraline
Current Illness: None
Preexisting Conditions: Allergic to amoxicillin
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 4 hrs after vaccine -had diarrhea, then vomiting; headache and some dizziness. No fever. No localized reaction.


VAERS ID: 620959 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Male  
Location: Texas  
Vaccinated:2016-01-22
Onset:2016-01-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2016-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UI515AA / 2 LA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. K010215 / 2 LA / SYR

Administered by: Private       Purchased by: Public
Symptoms: Pruritus, Rash, Scrotal swelling, Swelling face
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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None in office. Seen in ER
CDC Split Type:

Write-up: Patient had out break of rash on face, with swelling, itching. Swelling and rash on scrotal area, Prednisone p.o. BENADRYL p.o. initial injection.


VAERS ID: 620986 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Female  
Location: Unknown  
Vaccinated:2016-01-05
Onset:2016-01-05
   Days after vaccination:0
Submitted: 2016-01-27
   Days after onset:22
Entered: 2016-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. L037003 / 3 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, 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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1601USA007636

Write-up: This spontaneous report as received from a Licensed Vocational Nurse and refers to a 14 years old female patient. Concurrent conditions, medical history and concomitant medications were not provided. On 09-SEP-2015, the patient was vaccinated with first dose of GARDASIL (dose, administration route, lot #, expiration date and anatomical site were not reported). On 04-NOV-2015 the patient was vaccinated with the second dose of GARDASIL (dose, administration route, lot #, expiration date and anatomical site were not reported). On 05-JAN-2016, the patient was vaccinated with the third dose of GARDASIL lot # L037003, expiry date 25-MAY-2017 (dose, administration route and anatomical site were not reported). No adverse effects were reported. It was unknown if the patient sought medical attention. No product quality complaint (PQC) was involved. This is one of two reports received from the same source. Additional information has been requested.


VAERS ID: 621130 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Indiana  
Vaccinated:2016-01-12
Onset:2016-01-13
   Days after vaccination:1
Submitted: 2016-01-14
   Days after onset:1
Entered: 2016-01-27
   Days after submission:13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS MI15065 / 1 LA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 943L5 / 1 LA / IM

Administered by: Public       Purchased by: Public
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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Redness, swelling about 6 inches x 3 inches (L) upper arm at injection site.


VAERS ID: 621137 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: California  
Vaccinated:2016-01-07
Onset:2016-01-08
   Days after vaccination:1
Submitted: 2016-01-15
   Days after onset:7
Entered: 2016-01-27
   Days after submission:12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. K005881 / 2 LA / UN

Administered by: Private       Purchased by: Other
Symptoms: Anxiety, Asthenia, Delusion, Diarrhoea, Dizziness, Electrocardiogram, Headache, Heart rate increased, Malaise, Nervousness, Palpitations
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Pseudomembranous colitis (broad), Psychosis and psychotic disorders (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad), Dehydration (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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: EKG, Blood pressure, oxygen intake, took temperature.
CDC Split Type:

Write-up: On Friday, 1/8/16 he was delusional, weak, some diarrhea, heart palpitation and did not feel well. Was sent home from school. Slept a few hours then felt better. On Saturday 1/9/16 he had rapid heartbeats at about 6:15 pm was dizzy, had headache, anxious, nervous felt weak, had to walk to get heart rate back to normal. Took him to the Emergency room at hospital. They monitored him there. On Friday, 1/8/6 8:10 AM he was delusional, weak, some diarrhea, heart palpitation, and did not feel well. Was sent home from school. Slept a few hours then felt better. On Saturday, 1/9/16 he had rapid heart beats at about 6:15 pm was dizzy, had headache, anxious, nervous felt weak, had to walk to get heart rate back to normal. (Took him to the Emergency Room at hospital, monitored him there.


VAERS ID: 621250 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2016-01-25
Onset:2016-01-26
   Days after vaccination:1
Submitted: 2016-01-27
   Days after onset:1
Entered: 2016-01-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. L019297 / 1 RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR M15029 / 1 RA / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 7XR47 / 1 LA / UN

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Tenderness
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness, tenderness.


VAERS ID: 621281 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Washington  
Vaccinated:2016-01-21
Onset:2016-01-22
   Days after vaccination:1
Submitted: 2016-01-28
   Days after onset:6
Entered: 2016-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. - / 1 RA / IM

Administered by: Public       Purchased by: Other
Symptoms: Injection site erythema, Injection site pain, Injection site pruritus, 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: Amitriptyline 50 mg, Desowen 0.05% cream, Ibuprofen 200 mg
Current Illness: No
Preexisting Conditions: NKA, Hypertriglyceridemia, Eczema, Myopia
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Quarter size swelling, hot, itchy, soreness and redness at injection site. Treating with ice and Ibuprofen. Symptoms greater than a week after injection.


VAERS ID: 621511 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2016-01-27
Onset:2016-01-28
   Days after vaccination:1
Submitted: 2016-01-28
   Days after onset:0
Entered: 2016-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5272AA / UNK RA / UN

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Face oedema, Full blood count normal, Metabolic function test normal
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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: CBC, CMP - WNL
CDC Split Type:

Write-up: Facial erythema, edema within 24 hours of MENACTRA.


VAERS ID: 621294 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Florida  
Vaccinated:2016-01-25
Onset:2016-01-27
   Days after vaccination:2
Submitted: 2016-01-29
   Days after onset:2
Entered: 2016-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS A15031 / 1 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Injection site erythema, Injection site oedema, Injection site pain
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: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Injection site with severe erythema and severe edema and pain. Rx: Ibuprofen 400 MG PO Q6hrs. RX: Benedryl 25 MG PO Q 6hrs. RX: Prelone 15/5 susp. 45mg po day #1 30mg po day #2 22.5mg po day #3 15mg po day #4.


VAERS ID: 621537 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Idaho  
Vaccinated:2016-01-01
Onset:2016-01-01
   Days after vaccination:0
Submitted: 2016-01-29
   Days after onset:28
Entered: 2016-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. - / 3 UN / SYR

Administered by: Other       Purchased by: Other
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1601USA011118

Write-up: Information has been received from a physician via company representative referring to a 12 year old female patient. On unspecified dates, the patients was vaccinated with GARDASIL 9 (dose 1 and 2 timely, lot number and route not provided). The patient did not experienced adverse reactions with the first two doses. In January 2016 ("sometime last week"), the patient was vaccinated with the third dose of GARDASIL 9 (lot number and route not provided). The patient fainted after administration of GARDASIL 9. The patient was not injured and "kept down" as well as monitored for an unspecified amount of time by the physician. The patient recovered not long after being monitored. There was no product quality issue (PQC) involved. Additional information is not expected as we could not contact the physician.


VAERS ID: 621472 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: Ohio  
Vaccinated:2016-02-01
Onset:2016-02-01
   Days after vaccination:0
Submitted: 2016-02-01
   Days after onset:0
Entered: 2016-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 3 RA / IM

Administered by: Private       Purchased by: Other
Symptoms: Dyskinesia, Grunting, Loss of consciousness, Seizure like phenomena, 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), Convulsions (narrow), Dyskinesia (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (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: Oral contraceptive Lolestrin FE
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: She fainted and while she was passed out it looked as if she was having a seizure, her body was jerking around and she made a weird sound like a grunting. I''d say the whole episode from fainting to awake and calmed down lasted at least 3-4 minutes.


VAERS ID: 621516 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: Kansas  
Vaccinated:2016-02-01
Onset:2016-02-01
   Days after vaccination:0
Submitted: 2016-02-01
   Days after onset:0
Entered: 2016-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UI505AA / 7+ RA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L023230 / 2 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS M14136 / 2 LA / IM

Administered by: Public       Purchased by: Private
Symptoms: Dizziness
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: TB skin test
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: After HPV9 and MCV4 vaccine was given pt started feeling lightheaded and dizzy. Had pt lay on floor with legs up and ice applied to neck. She laid there for about 5 minutes then sat in chair. TP skin test was given, patient felt the same symptoms again. Had her lay on floor again for 5 minutes then she felt better.


VAERS ID: 621520 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: Virginia  
Vaccinated:2016-01-29
Onset:2016-01-29
   Days after vaccination:0
Submitted: 2016-02-01
   Days after onset:3
Entered: 2016-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2112 / 4 NS / IN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5180AA / 2 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Rash macular, Respiratory tract congestion
SMQs:, Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Congestion and splotchy rash.


VAERS ID: 623341 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: Unknown  
Vaccinated:2016-01-22
Onset:2016-01-25
   Days after vaccination:3
Submitted: 2016-02-01
   Days after onset:7
Entered: 2016-02-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L027282 / UNK UN / IM

Administered by: Other       Purchased by: Other
Symptoms: Headache
SMQs:

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1602USA000248

Write-up: This spontaneous report was received from a nurse practitioner and refers to a 16 year old female patient. The patient''s current conditions, medical history and concomitant medications were not reported. On 22-JAN-2016, the patient was vaccinated with GARDASIL 9 injection 0.5 ml, lot # L027282 (expiry date 21-SEP-2017) intramuscularly. On 25-JAN-2016, the patient developed a headache. Treatment was not given for the event. Lab diagnostic studies were not performed. The patient sought medical attention. On 28-JAN-2016, the patient saw nurse practitioner for the ongoing headache. Product quality complaint (PQC) was not involved. No further information was provided. The event was not resolved. The reporter did not provide causal relationship between the event and suspect therapy. Additional information has been requested.


VAERS ID: 621592 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2016-01-27
Onset:2016-01-27
   Days after vaccination:0
Submitted: 2016-01-27
   Days after onset:0
Entered: 2016-02-02
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. - / 1 NS / IN
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L019297 / 1 LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR - / 1 RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS - / 1 RA / IM

Administered by: Private       Purchased by: Public
Symptoms: Dizziness
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: Albuterol HFA inhaler
Current Illness:
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Pt complained of feeling dizzy approximately 1 minute after receiving injections. Had her lay down on exam table and propped up lower legs with blankets. Got her cup of water and crackers (she hadn''t eaten breakfast). Felt better in approximately 5 minutes.


VAERS ID: 621623 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2016-01-26
Onset:2016-01-26
   Days after vaccination:0
Submitted: 2016-02-02
   Days after onset:7
Entered: 2016-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L019297 / UNK - / IM

Administered by: Unknown       Purchased by: Public
Symptoms: Dizziness, Headache, Irritability, Oropharyngeal pain
SMQs:, Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hostility/aggression (broad), Vestibular disorders (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: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Light headedness, headache, sore throat, irritability.


VAERS ID: 621641 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: New York  
Vaccinated:2016-01-26
Onset:2016-01-26
   Days after vaccination:0
Submitted: 2016-02-02
   Days after onset:7
Entered: 2016-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L017407 / 2 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Computerised tomogram head, Fall, Head injury, Spinal X-ray, 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? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Head CT; Neck/cervical X-Ray
CDC Split Type:

Write-up: On 1/26/16 pt was given HPV #2. She waited in pt room approximately 10 min with her dad, stated felt ok and left to go to scheduling window to schedule HPV #3. Was standing behind dad and fainted - fell back and hit head.


VAERS ID: 621674 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2016-02-01
Onset:2016-02-01
   Days after vaccination:0
Submitted: 2016-02-02
   Days after onset:1
Entered: 2016-02-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUARIX QUADRIVALENT) / GLAXOSMITHKLINE BIOLOGICALS 2SN22 / UNK RA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L024993 / UNK LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5186AA / UNK RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Dizziness
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: Ibuprofen [MOTRIN] 200 mg tablet 1-2 tablets by mouth every 6 hours as needed for pain.
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient was vaccinated with Human Papillomavirus 9-valent Vaccine, Meningococcal Conjugate vaccine and the Inactivated Influenza vaccine. The patient sat and was monitored for the recommended 15 minutes after the immunizations and did not show any symptoms of adverse reactions. As the patient was getting ready to leave, she began to feel lightheaded and was assisted to lie in Trendelenburg position, the patient''s symptoms began to resolve after about 5 minutes. The patient drank 6 ounces of apple juice and was then able to sit up, without return of lightheadedness or any other symptoms. Vital signs were stable (blood pressure 136/82, pulse 73), and patient''s condition returned to the same as it was prior to vaccination. Patient was then discharged to home. Patient was advised to get plenty of rest, drink adequate oral fluids and refrain from over-exertion and strenuous activities for the next several hours. Patient was advised for future vaccination, she should lie down prior to and for 15 minutes after the vaccinations.


VAERS ID: 623380 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Female  
Location: Ohio  
Vaccinated:2016-01-28
Onset:2016-01-29
   Days after vaccination:1
Submitted: 2016-01-29
   Days after onset:0
Entered: 2016-02-02
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / UNK UN / IM

Administered by: Unknown       Purchased by: Unknown
Symptoms: Dizziness, Pyrexia, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: My daughter got her last GARDASIL vaccine yesterday. Woke up with shakes through the night and it very dizzy today. Feels feverish.


VAERS ID: 623428 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: Arkansas  
Vaccinated:2016-01-12
Onset:2016-01-13
   Days after vaccination:1
Submitted: 2016-01-14
   Days after onset:1
Entered: 2016-02-02
   Days after submission:19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS M15067 / 2 RA / UN

Administered by: Public       Purchased by: Public
Symptoms: Injection site erythema, Peripheral swelling, Skin warm
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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: 8/27/10~Meningococcal Conjugate (Menactra)~1~11.00~Patient
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: AR164

Write-up: Right arm is red, swollen, and hot to touch. The redness starts from the deltoid muscle to the elbow and the width of the arm.


VAERS ID: 623923 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Male  
Location: Montana  
Vaccinated:2016-01-26
Onset:2016-01-26
   Days after vaccination:0
Submitted: 2016-02-02
   Days after onset:7
Entered: 2016-02-04
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L016428 / 1 LA / IM
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. L033697 / 1 LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Drug administered to patient of inappropriate age, No adverse event
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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Vaccine licensed through age 12 was administered to a 16 year old child. No adverse side effects experienced.


VAERS ID: 624147 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2016-01-28
Onset:0000-00-00
Submitted: 2016-02-04
Entered: 2016-02-05
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M13064 / 1 RA / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5178AA / 1 LA / UN

Administered by: Public       Purchased by: Public
Symptoms: Diarrhoea, Erythema, Feeling cold, Pyrexia
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Phone call from mother stated she took child to hospital while being out of town due to fever, chills, and redness on both arms, diarrhea.


VAERS ID: 624152 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: Alabama  
Vaccinated:2016-02-01
Onset:2016-02-01
   Days after vaccination:0
Submitted: 2016-02-03
   Days after onset:2
Entered: 2016-02-05
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L011846 / 2 RA / IM

Administered by: Private       Purchased by: Public
Symptoms: Chest pain
SMQs:, Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: No chronic medical concerns, no allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: HPV vaccine (2 of 3 in series) given IM, right deltoid. Child return to clinic approx. 40 minutes later c/o (R) sided chest pain. MD evaluated, patient stable, EMS transported patient to ED for further evaluation.


VAERS ID: 622047 (history)  
Form: Version 1.0  
Age: 13.0  
Sex: Female  
Location: Florida  
Vaccinated:2016-01-18
Onset:2016-01-19
   Days after vaccination:1
Submitted: 2016-02-08
   Days after onset:20
Entered: 2016-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 2 RA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Chest X-ray, Dyspnoea, Electrocardiogram, Pharyngoscopy, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (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? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data: Chest X Ray, EKG, Throat Scope, Inhaled Epinephrine
CDC Split Type:

Write-up: Had trouble breathing. Wheezing hard.


VAERS ID: 622099 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: Washington  
Vaccinated:2016-01-27
Onset:2016-01-28
   Days after vaccination:1
Submitted: 2016-01-29
   Days after onset:1
Entered: 2016-02-08
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FK2037 / 2 NS / IN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5021AB / 2 RA / IM

Administered by: Public       Purchased by: Public
Symptoms: Induration, Inflammation, Skin warm
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: None
Current Illness: Local reaction
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Deltoid warm, inflamed, indurated.


VAERS ID: 622150 (history)  
Form: Version 1.0  
Age: 13.0  
Sex: Female  
Location: Texas  
Vaccinated:2016-02-04
Onset:2016-02-04
   Days after vaccination:0
Submitted: 2016-02-08
   Days after onset:4
Entered: 2016-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L020015 / 1 RA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Lethargy, Unresponsive to stimuli, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: ZOLOFT; SEROQUEL; DEPAKOTE; COGENTIN
Current Illness: None
Preexisting Conditions: NKDA; Diagnosis of depression and mood d/o
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. received HPV9 on 2-4-16 at approx 10:15AM, at 12:11 PM, foster home staff called and reported pt. was lethargic, non responsive to staff questions, vomited x2. Advised to call 911.


VAERS ID: 624342 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: Virginia  
Vaccinated:2016-02-02
Onset:2016-02-02
   Days after vaccination:0
Submitted: 2016-02-02
   Days after onset:0
Entered: 2016-02-08
   Days after submission:6
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5244AA / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Chest pain, Feeling abnormal, Limb discomfort, Oral pruritus, Swollen tongue
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dementia (broad), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: No
Preexisting Conditions: Allergy to soy
Allergies:
Diagnostic Lab Data: Sending to allergist for further work up and testing. (2nd episode during the night.)
CDC Split Type:

Write-up: ? Reaction to MENACTRA - started with symptoms per mom ''10 minutes after leaving office. Symptoms included "weird feeling", arm felt heavy, tongue swelling. mouth itching, chest pains. Instructed mom to given BENADRYL and call 911 for transport to nearest ER. I was already home when she called off back. ER gave prednisone, famotidine, and cetirizine. Epipen prescribed.


VAERS ID: 624414 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: Unknown  
Vaccinated:2016-01-22
Onset:2016-01-22
   Days after vaccination:0
Submitted: 2016-02-08
   Days after onset:17
Entered: 2016-02-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. - / 2 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Inappropriate schedule of drug administration, 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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1601USA009915

Write-up: This spontaneous report was received from a registered nurse referring to a 12 year old male patient. The patient''s concurrent conditions and medical history were not provided. On 22-JAN-2016, the patient was vaccinated with a first dose of GARDASIL 9, lot # L014415, expiration date on 25-JUL-2017 (route was not provided. Then; at the same day, the patient went to another clinic and was vaccinated with a second dose of GARDASIL 9 (route, lot number and expiration date were unspecified). Concomitant therapies were not provided. No adverse events were reported. No product quality complaint was involved. Additional information has been requested.


VAERS ID: 622149 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Female  
Location: Michigan  
Vaccinated:2016-01-06
Onset:2016-02-02
   Days after vaccination:27
Submitted: 2016-02-04
   Days after onset:2
Entered: 2016-02-09
   Days after submission:5
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FL2117 / 2 NS / IN
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L045711 / 3 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Chest pain, Injection site pain, Mobility decreased, Musculoskeletal stiffness, Pain in extremity
SMQs:, Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Arthritis (broad), 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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pain at injection site started around 2/2/16. Stiffness, pain is worse now. Pain going down arm and into shoulder/chest. Unable to lift arm above shoulder.


VAERS ID: 622153 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2016-01-08
Onset:2016-01-12
   Days after vaccination:4
Submitted: 2016-02-09
   Days after onset:28
Entered: 2016-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS A15021 / 2 RA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Abasia, Acute disseminated encephalomyelitis, Asthenia, Dyskinesia, Lumbar puncture, Nervous system disorder, Nuclear magnetic resonance imaging, Pyrexia, Vaccination complication
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dyskinesia (narrow), Dystonia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (narrow), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: SINUSITIS, GERD
Allergies:
Diagnostic Lab Data: MRI; SPINAL TAP; PATIENT DIAGNOSED WITH POSTIMMUNIZATION ACUTE DISSEMINATED ENCEPHALOMYELITIS
CDC Split Type:

Write-up: 01/12/2016-01/14/2016-FEVER. 01/15/2015-NEUROLOGICAL DEFICIT, INVOLUNTARY MOVEMENTS, WEAKNESS, INABILITY TO WALK.


VAERS ID: 622176 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2016-02-08
Onset:2016-02-08
   Days after vaccination:0
Submitted: 2016-02-09
   Days after onset:1
Entered: 2016-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS 3L9LD / 2 LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L018351 / 2 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Injection site reaction
SMQs:

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: Birth control
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt given 2 shots on 2-8-16, called and then presented to office with rxn on (L) deltoid. PNP notified, pt assessed - determined to be local rxn given BENADRYL in office and told to do cold compresses at home to call if any ?''s or concerns.


VAERS ID: 624623 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2016-02-01
Onset:2016-02-04
   Days after vaccination:3
Submitted: 2016-02-09
   Days after onset:5
Entered: 2016-02-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENVEO) / NOVARTIS VACCINES AND DIAGNOSTICS A15065 / UNK LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. L031066 / UNK LA / SC

Administered by: Private       Purchased by: Public
Symptoms: Erythema, Local reaction
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: PROAIR
Current Illness: No
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Rcv''d 2 vaccines in (L) arm (one IM/one subq) started having redness- local rxn on 2-3-16 mom had started cold compresses and BENADRYL before visit so site has reduced in size. Continue home tx as directed by PAC on 2-4-16.


VAERS ID: 622248 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Female  
Location: Illinois  
Vaccinated:2016-02-09
Onset:2016-02-09
   Days after vaccination:0
Submitted: 2016-02-10
   Days after onset:1
Entered: 2016-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS F4KR5 / 1 LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L017407 / 1 RA / IM

Administered by: Public       Purchased by: Private
Symptoms: Rash generalised
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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None known
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Systemic rash treated with Benadryl.


VAERS ID: 622264 (history)  
Form: Version 1.0  
Age: 13.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2016-01-29
Onset:2016-02-06
   Days after vaccination:8
Submitted: 2016-02-10
   Days after onset:4
Entered: 2016-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L020015 / 1 LA / UN

Administered by: Unknown       Purchased by: Public
Symptoms: Anxiety, Muscle twitching, Self-injurious ideation, Tremor
SMQs:, Suicide/self-injury (narrow), Neuroleptic malignant syndrome (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zoloft
Current Illness: No
Preexisting Conditions: Depression treated with Zoloft
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Shaky arm twitching, anxious feeling, she was picked up from school Tuesday Feb the 9th for shaking and thoughts of hurting herself was taken to ER and then admitted to psychiatric ward.


VAERS ID: 622325 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2016-02-08
Onset:2016-02-08
   Days after vaccination:0
Submitted: 2016-02-10
   Days after onset:2
Entered: 2016-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. - / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Dizziness, Dyspnoea, Gait disturbance, Nausea
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), 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: The vaccine was Gardasil 9 and I didn''t see it on the list.
Current Illness: No.
Preexisting Conditions: Amoxicillin allergy
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Difficulty breathing, difficulty walking, dizzy, nausea. Called clinic to report and the nurse said it was "normal".


VAERS ID: 624774 (history)  
Form: Version 1.0  
Age: 13.0  
Sex: Male  
Location: Washington  
Vaccinated:2016-02-02
Onset:2016-02-02
   Days after vaccination:0
Submitted: 2016-02-10
   Days after onset:8
Entered: 2016-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / SANOFI PASTEUR UI450AB / 1 LA / UN
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS 3RB2G / 1 LA / UN
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L016428 / UNK UN / UN
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5020AA / 1 LA / UN

Administered by: Other       Purchased by: Other
Symptoms: Incorrect product storage, 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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1602USA004218

Write-up: This spontaneous report was received from a certified medical assistant referring to a patient of unknown age and gender. Concurrent conditions or pertinent medical history were not reported. On 02-FEB-2016, the patient was vaccinated with an improperly stored dose of GARDASIL 9 (confirmed no GARDASIL) (lot # L016428, expiration date: 09-AUG-2017) (dose, route of administration and frequency were not reported). It was stated that the temperature and time frame were 27 deg F for 168 hours. Concomitant medications were not reported. No adverse effects were reported. No product quality complaint was involved. Additional information has been requested.


VAERS ID: 624867 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2016-02-03
Onset:2016-02-03
   Days after vaccination:0
Submitted: 2016-02-10
   Days after onset:7
Entered: 2016-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HIBV: HIB (PEDVAXHIB) / MERCK & CO. INC. L033690 / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: No adverse event, Wrong drug 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 other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1602USA003009

Write-up: Information has been received from a healthcare worker referring to a 12 year old patient of unknown age and gender. Concurrent condition and medical history were not reported. On 03-FEB-2016 the patient was inadvertently vaccinated with a dose of PEDVAXHIB (lot # L033690, expiration date 14-JUN-2018, dose and route were unknown), instead of the intended vaccine MENACTRA (Sanofi-Pasteur) (Wrong drug administered). No adverse effects were reported. Additional information has been requested.


VAERS ID: 622373 (history)  
Form: Version 1.0  
Age: 13.0  
Sex: Male  
Location: California  
Vaccinated:2016-02-10
Onset:2016-02-10
   Days after vaccination:0
Submitted: 2016-02-11
   Days after onset:1
Entered: 2016-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. - / UNK - / IM
MMR: MEASLES + MUMPS + RUBELLA (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK - / IM

Administered by: Unknown       Purchased by: Public
Symptoms: Asthenia, Dizziness, Feeling abnormal, Feeling hot, Headache, Pyrexia, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Minor congestion
Preexisting Conditions: Sickle Cell Anemia Disease Hbss
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe headache, blurred vision, fever, feeling hot, dizziness, weakness, feeling disconnected. Administered Tylenol.


VAERS ID: 622408 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Florida  
Vaccinated:2016-02-09
Onset:2016-02-09
   Days after vaccination:0
Submitted: 2016-02-11
   Days after onset:2
Entered: 2016-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK RA / IM

Administered by: Unknown       Purchased by: Other
Symptoms: Anticonvulsant drug level, Generalised tonic-clonic seizure, Urine analysis normal
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lamotrigine; Abilify; Enbrel; Trazadone; Ibuprofen; Melatonin; Low Dose ASA; Multivitamin
Current Illness: No
Preexisting Conditions: Yes
Allergies:
Diagnostic Lab Data: Lamotrigine level drawn in ER. Urinalysis for UTI negative. Follow up for EEG with MD on 02/19/2016.
CDC Split Type:

Write-up: Grand Mal seizure. 911 called and transported to Pediatric ER.


VAERS ID: 622510 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2016-02-06
Onset:2016-02-06
   Days after vaccination:0
Submitted: 2016-02-11
   Days after onset:5
Entered: 2016-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UI431AD / UNK RA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L036245 / UNK LA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5260AA / UNK RA / IM
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS KJ4MS / UNK LA / IM

Administered by: Public       Purchased by: Public
Symptoms: Eye movement disorder, Fall, Posture abnormal, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), Ocular motility disorders (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: Concerta 18mg one a day
Current Illness: Patient came in for right eye discomfort
Preexisting Conditions: Allergic to peanuts; Patient has ADHD and acne
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stood up, fell back in exam chair, eyes rolled back, had some tremors and leaned to side. Event lasted less then 30 seconds. Patients VS taken immediately after and were within normal ranges, patient given water and a candy sucker, patient sat and waited approx 30 minutes after even and VS taken again and were normal. Patient was escorted to parking lot, walked and felt fine. Had no complaints when left facility.


VAERS ID: 622513 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2016-02-09
Onset:2016-02-09
   Days after vaccination:0
Submitted: 2016-02-11
   Days after onset:2
Entered: 2016-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS 9423K / UNK LA / IM
MEN: MENINGOCOCCAL (MENOMUNE) / SANOFI PASTEUR - / UNK - / -
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. - / UNK - / -
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS - / UNK - / -

Administered by: Public       Purchased by: Public
Symptoms: Expired 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: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: n/a
CDC Split Type:

Write-up: Administered expired dose.


VAERS ID: 624807 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: Virginia  
Vaccinated:2016-02-11
Onset:2016-02-11
   Days after vaccination:0
Submitted: 2016-02-11
   Days after onset:0
Entered: 2016-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (HAVRIX) / GLAXOSMITHKLINE BIOLOGICALS X22P4 / 2 LA / IM
HPV4: HPV (GARDASIL) / MERCK & CO. INC. K011562 / 2 RA / IM

Administered by: Private       Purchased by: Unknown
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: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: While patient was waiting in the office room after receiving GARDASIL and Hep A, patient loss consciousness for a few seconds. Patient woke up saying that it felt like a dream. Per mom''s report. Pt was given juice and peanut butter with pretzels. Pt feeling back to normal.


VAERS ID: 624913 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Unknown  
Location: Unknown  
Vaccinated:2016-02-04
Onset:2016-02-04
   Days after vaccination:0
Submitted: 2016-02-11
   Days after onset:7
Entered: 2016-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HEPA: HEP A (VAQTA) / MERCK & CO. INC. K005415 / UNK UN / IM

Administered by: Other       Purchased by: Other
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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1602USA004219

Write-up: This spontaneous report was received from a nurse and refers to a 15-year-old patient of unknown gender. No concurrent conditions or medical history were provided. On 04-FEB-2016, the patient was vaccinated with an adult dose of VAQTA 50/1.0 U/ml injection, lot # K005415, 1 ml, intramuscularly (site of administration was unspecified), that had expired on 15-JAN-2016. No concomitant medications were reported. No adverse effects were reported. Additional information is not expected as there was no consent for further follow-up.


VAERS ID: 624928 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Unknown  
Location: Colorado  
Vaccinated:2016-01-21
Onset:2016-01-21
   Days after vaccination:0
Submitted: 2016-02-11
   Days after onset:21
Entered: 2016-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MMRV: MEASLES + MUMPS + RUBELLA + VARICELLA (PROQUAD) / MERCK & CO. INC. - / UNK UN / UN

Administered by: Other       Purchased by: Other
Symptoms: No adverse event, Wrong drug 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 other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1602USA005834

Write-up: This spontaneous report was received from a certified medical assistant and refers to a 16 year-old patient of unknown gender. No information about the patient''s medical history, concurrent conditions and concomitant medications was reported. On 21-JAN-2016, the patient was inadvertently vaccinated with a dose of PROQUAD (Merck) (dose, lot #, expiry date, route of administration and anatomical location were not reported) instead of VARIVAX (Merck). No symptoms were reported. Product quality complaint (PQC) was not involved. Additional information has been requested.


VAERS ID: 622557 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: Texas  
Vaccinated:2016-02-09
Onset:2016-02-09
   Days after vaccination:0
Submitted: 2016-02-12
   Days after onset:3
Entered: 2016-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS BS79K / UNK LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH L13514 / 1 RA / IM
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5187AA / 2 LA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Chills, Decreased appetite, Fatigue, Headache, Myalgia, Nausea
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fatigue, headache, myalgia, nausea, chills, decreased appetite within 24 hours of vaccine administration.


VAERS ID: 622561 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2016-02-11
Onset:2016-02-12
   Days after vaccination:1
Submitted: 2016-02-12
   Days after onset:0
Entered: 2016-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
JEV1: JAPANESE ENCEPHALITIS (IXIARO) / INTERCELL AG JEV15B84E / 2 LA / IM
RAB: RABIES (IMOVAX) / SANOFI PASTEUR L14271 / 3 RA / IM

Administered by: Other       Purchased by: Private
Symptoms: Body temperature increased, Hyperaesthesia, Pain
SMQs:, Neuroleptic malignant syndrome (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: ~Typhoid Vi Polysaccharide (Typhim Vi)~1~0.00~Patient|mild body aches, mild increased sensitivity to hot/cold~Rabies (Imovax)~2~
Other Medications: No known
Current Illness: Patient denied. Patient close to her menstrual cycle and states she gets increased sensitivity to hot/cold during that time as well.
Preexisting Conditions: Raw fruit allergy (apples, cherries, peaches)
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient has increased temp (99.9), increased sensitivity in skin, mild body aches. Patient rested in health center and encouraged increased PO fluids.


VAERS ID: 622598 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Female  
Location: New York  
Vaccinated:2016-02-08
Onset:2016-02-08
   Days after vaccination:0
Submitted: 2016-02-11
   Days after onset:3
Entered: 2016-02-12
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUARIX) / GLAXOSMITHKLINE BIOLOGICALS BS79K / 4 UN / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Dizziness, Gait disturbance, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None
Preexisting Conditions: No known allergies
Allergies:
Diagnostic Lab Data: R/O Guillain Barre Syndrome
CDC Split Type:

Write-up: Flu vaccine given 2/8/16 about 10 AM, about 6 PM - she developed dizziness, difficulty of walking, weakness of both lower extremities. Refer to ER.


VAERS ID: 622687 (history)  
Form: Version 1.0  
Age: 13.0  
Sex: Male  
Location: Michigan  
Vaccinated:2016-02-10
Onset:2016-02-10
   Days after vaccination:0
Submitted: 2016-02-12
   Days after onset:2
Entered: 2016-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR - / 1 AR / SYR

Administered by: Unknown       Purchased by: Public
Symptoms: Activities of daily living impaired, Decreased appetite, Fatigue, Headache, Hyperacusis, Photophobia, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Corneal disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None known, not sure
Preexisting Conditions: None known
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Severe headache, sensitivity to light and noise, extreme fatigue, loss of appetite, high fever, up to 102.7. We missed two days of school as of February 12, 2016.


VAERS ID: 622691 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Male  
Location: Arizona  
Vaccinated:2016-01-15
Onset:2016-01-15
   Days after vaccination:0
Submitted: 2016-02-12
   Days after onset:28
Entered: 2016-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5216AA / 1 LA / IM
TYP: TYPHOID VI POLYSACCHARIDE (TYPHIM VI) / SANOFI PASTEUR L10721 / 1 LA / IM
YF: YELLOW FEVER (YF-VAX) / SANOFI PASTEUR UI084AA / 1 LA / SC

Administered by: Public       Purchased by: Private
Symptoms: Abdominal pain upper, Abnormal behaviour, Headache, Malaise, Pyrexia, Urticaria
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Psychosis and psychotic disorders (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hostility/aggression (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None noted
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient returned to school after appointment and went to school health, did not feel well. Nurse/caregiver at school called mother and reported that he seemed "loopy". Pt symptoms progressed to fever, headache, stomach ache and general malaise. Lasted for days and headaches for a week. At the end of symptoms, patient developed hives the last few days, being sick over one week total.


VAERS ID: 624980 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Unknown  
Location: Texas  
Vaccinated:2016-01-25
Onset:0000-00-00
Submitted: 2016-02-12
Entered: 2016-02-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR UI515AA / UNK LA / UN
HPV4: HPV (GARDASIL) / MERCK & CO. INC. K008931 / UNK RA / UN
TDAP: TDAP (BOOSTRIX) / GLAXOSMITHKLINE BIOLOGICALS 2224P / UNK LA / UN

Administered by: Other       Purchased by: Other
Symptoms: Incorrect product storage, 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: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1602USA006369

Write-up: This spontaneous report as received from a medical assistant refers to unspecified patients of unknown age and gender. No information about the patient''s medical history, concurrent conditions and concomitant medication was reported. On an unspecified dates in 2016 (reported as "since 05-JAN-2016"), the patients were vaccinated with an improperly stored doses of GARDASIL lot # K008931, expiry date 04-MAR-2017 (dose, route of administration and anatomical location were not reported). Administered doses were exposed to the following conditions: temperature of 33 Fahrenheit degrees for 15 hours and 15 minutes. There was no previous temperature excursion. No adverse effects were reported. Product quality complaint (PQC) was not involved. This is one of several reports received from the same reporter. Additional information has been requested.


VAERS ID: 625061 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Male  
Location: Iowa  
Vaccinated:2016-02-08
Onset:2016-02-09
   Days after vaccination:1
Submitted: 2016-02-10
   Days after onset:1
Entered: 2016-02-12
   Days after submission:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L045711 / 1 LA / IM
MENB: MENINGOCOCCAL B (TRUMENBA) / PFIZER/WYETH M13065 / 1 LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Injection site erythema, Injection site warmth, Mobility decreased, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Parkinson-like events (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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Left deltoid/upper arm with redness and tenderness about the size of a softball. No fever and no other treatment ordered. Dad calling and stating child got HPV and Hep A vaccines on Monday and his arm is swollen now. Dad wondering if they should be worried. Dad calls to report pt got vaccines 2 days ago. The area he got the shots is now red and warm to touch. The red area is about the size of a softball per father. Child is not able to raise arm normally. Appt recommended and dad agrees. Child is at school and father is hoping for something after school. Appt made for 4pm today with Dr. Father will call back before apt time if area worsens at all.


VAERS ID: 622792 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: North Dakota  
Vaccinated:2016-02-03
Onset:2016-02-03
   Days after vaccination:0
Submitted: 2016-02-15
   Days after onset:12
Entered: 2016-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. L007720 / 1 LA / IM

Administered by: Unknown       Purchased by: Other
Symptoms: Erythema, Peripheral swelling, Skin warm
SMQs:, Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (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? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: None reported
Preexisting Conditions: Pollen, STD, cat allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Arm swelled significantly and was very warm to touch and red from shoulder to elbow.


VAERS ID: 622793 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Female  
Location: Michigan  
Vaccinated:2016-02-15
Onset:2016-02-15
   Days after vaccination:0
Submitted: 2016-02-15
   Days after onset:0
Entered: 2016-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. - / 3 RA / -

Administered by: Unknown       Purchased by: Private
Symptoms: Dizziness, Loss of consciousness, 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), Parkinson-like events (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: No
Allergies:
Diagnostic Lab Data: Passed out after receiving Gardasil
CDC Split Type:

Write-up: Light headiness, dizziness, passed out, shaking, quivering.


VAERS ID: 622862 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Male  
Location: North Carolina  
Vaccinated:2016-02-09
Onset:2016-02-09
   Days after vaccination:0
Submitted: 2016-02-15
   Days after onset:6
Entered: 2016-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LG / -
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 2 LG / -
PPV: PNEUMO (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK LG / -

Administered by: Unknown       Purchased by: Private
Symptoms: Injection site pruritus, Injection site urticaria
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hives and itching at injection site and elsewhere on body. Diphenhydramine oral administered for 1 week since. Symptoms persist, mildly, 1 week later.


VAERS ID: 625117 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Male  
Location: Unknown  
Vaccinated:2016-01-30
Onset:2016-01-30
   Days after vaccination:0
Submitted: 2016-02-15
   Days after onset:16
Entered: 2016-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. - / 3 UN / SYR

Administered by: Other       Purchased by: Other
Symptoms: Interchange of vaccine products, No adverse event
SMQs:, Medication errors (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: No other medications
Current Illness: Immunisation
Preexisting Conditions: 10/15/2016, GARDASIL; 07/30/2015, GARDASIL
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1602USA004341

Write-up: This spontaneous report as received from a pharmacist refers to a 14 year old male patient. Information regarding the patient''s concurrent conditions were not provided. On 30-JUL-2015 and 15-OCT-2015 the patient was vaccinated with GARDASIL (reported as GARDASIL 4), dose 1 and dose 2 respectively. On 30-JAN-2016 the patient was then vaccinated with GARDASIL 9, final dose (interchange of vaccine products). No adverse events were reported. No product quality complaint was involved. No further information was provided. Additional information has been requested.


VAERS ID: 625031 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2016-02-04
Onset:2016-02-05
   Days after vaccination:1
Submitted: 2016-02-05
   Days after onset:0
Entered: 2016-02-16
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
MNQ: MENINGOCOCCAL CONJUGATE (MENACTRA) / SANOFI PASTEUR U5068AA / UNK RA / IM

Administered by: Private       Purchased by: Unknown
Symptoms: Injection site erythema, Injection site swelling, Rash generalised, Urticaria
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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Upper respiratory infection
Preexisting Conditions: Penicillin; Latex
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Redness and swelling at injection site, hive-like rash all over body; resolving with oral BENADRYL administration.


VAERS ID: 625038 (history)  
Form: Version 1.0  
Age: 13.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2016-01-27
Onset:2016-01-29
   Days after vaccination:2
Submitted: 2016-02-05
   Days after onset:7
Entered: 2016-02-16
   Days after submission:11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L002560 / 2 LA / IM

Administered by: Public       Purchased by: Unknown
Symptoms: Pruritus, Rash macular
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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Two days following vaccination pt. developed "pink, itchy blotches", smaller than a dime on both arms and both legs. Approx. "20 blotches". No other symptoms. Reported by patient''s grandmother 2/5/16.


VAERS ID: 625230 (history)  
Form: Version 1.0  
Age: 13.0  
Sex: Female  
Location: New York  
Vaccinated:2016-01-19
Onset:2016-01-21
   Days after vaccination:2
Submitted: 2016-02-09
   Days after onset:19
Entered: 2016-02-16
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L036245 / 1 LA / UN

Administered by: Private       Purchased by: Private
Symptoms: Migraine, New daily persistent headache
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: None
Current Illness: None
Preexisting Conditions: None
Allergies:
Diagnostic Lab Data: Clinical
CDC Split Type:

Write-up: Chronic daily next onset migrainous headache beginning 2 days after HPV #1. No PMhx of recurrent headaches.


VAERS ID: 622962 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Male  
Location: Vermont  
Vaccinated:2016-02-10
Onset:2016-02-12
   Days after vaccination:2
Submitted: 2016-02-17
   Days after onset:5
Entered: 2016-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUZONE) / SANOFI PASTEUR U5304AB / 7+ LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L019297 / 3 LA / IM

Administered by: Private       Purchased by: Public
Symptoms: Aggression, Headache, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Dementia (broad), Hostility/aggression (narrow), Glaucoma (broad), Lens disorders (broad), Retinal disorders (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: Concerta 36mg; Ventolin HFA
Current Illness:
Preexisting Conditions: ADHD; Cough Variant Asthma; Migraine
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Blurry vision, headache, combative.


VAERS ID: 625244 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: Unknown  
Vaccinated:2016-02-12
Onset:2016-02-14
   Days after vaccination:2
Submitted: 2016-02-17
   Days after onset:3
Entered: 2016-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 3 UN / UN

Administered by: Other       Purchased by: Other
Symptoms: Rash generalised
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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications
Current Illness: Unknown
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1602USA007731

Write-up: Information has been received from a company representative''s friend referring to his or her approximately 15 year old daughter. The patient was not pregnant. There was no pertinent medical history and drug reactions or allergies. On unknown dates, the patient was vaccinated with first and second doses of GARDASIL or GARDASIL 9 (the vaccine was not confirmed by the reporter) (both lot number, expiration date and route were unknown, 0.5 ml). There was no adverse events with the first or second shot of the vaccine. On 12-FEB-2016 the patient was vaccinated with the third dose of GARDASIL or GARDASIL 9 (lot number, expiration date and route were unknown, 0.5 ml). Concomitant medications were unspecified. Later on 12-FEB-2016, the patient broke out in a rash. On 13-FEB-2016 (the following day), the rash was gone. But on 14-FEB-2016, the patient broke out in rash again from head to toe. The patient was planning on going to visit the doctor on 15-FEB-2015. No treatment was given for the event. The outcome of the event "rash from head to toe" was unknown. The causality between the event and suspect therapy was unspecified. Additional information is not expected because there was no contact details.


VAERS ID: 625300 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: New York  
Vaccinated:2016-02-08
Onset:2016-02-08
   Days after vaccination:0
Submitted: 2016-02-10
   Days after onset:2
Entered: 2016-02-17
   Days after submission:7
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
PPV: PNEUMO (PNEUMOVAX) / MERCK & CO. INC. L029073 / UNK LA / IM

Administered by: Private       Purchased by: Private
Symptoms: Erythema, Pain, Pain in extremity, Swelling
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Hypersensitivity (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Omeprazole; cefuroxime
Current Illness: Sinus infection
Preexisting Conditions: Chronic sinusitis/rhinitis; headaches; cough
Allergies:
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Within a few hours of receiving the vaccine she began to have severe pain in that arm. 48 hours later she still cannot move her arm without pain. Even the weight of a t-shirt or coat hurts. Acetaminophen doesn''t help. Minimal redness. Some swelling.


VAERS ID: 625413 (history)  
Form: Version 1.0  
Age: 15.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2016-02-12
Onset:2016-02-12
   Days after vaccination:0
Submitted: 2016-02-17
   Days after onset:5
Entered: 2016-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. - / 3 UN / SYR

Administered by: Other       Purchased by: Other
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: No other medications
Current Illness: Prophylaxis
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: WAES1602USA007720

Write-up: Information has been received from a consumer referring to her daughter, a 15 year old female patient with none drug reactions/allergies and none pertinent medical history. On unknown dates, the patient was vaccinated with her first and second injections of GARDASIL series. On 12-FEB-2016, unidentified Merck HPV vaccine was administered (name and lot number not provided) to the patient (injection, the third dose, route and dose were unknown). There was none concomitant medication. About 5 hours after receiving the third dose, the patient experienced hives from the neck. The patient called to pediatrician for medical attention. Unspecified BENADRYL was given to treat the event. None lab diagnostics studies were performed. The patient''s hives was recovered in February 2016. On 14-FEB-2016 (also reported as on Sunday), the patient''s hives recurred and again early on the morning of 15-FEB-2016. The patient had not had any reaction to the first two injections in the GARDASIL series. She was watched for several days. The outcome of hives was reported as not recovered/not resolved. The causality was not reported. Additional information has been requested.


VAERS ID: 623022 (history)  
Form: Version 1.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2016-01-12
Onset:2016-01-12
   Days after vaccination:0
Submitted: 2016-02-18
   Days after onset:37
Entered: 2016-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUN4: INFLUENZA (SEASONAL) (FLUMIST QUADRIVALENT) / MEDIMMUNE VACCINES, INC. FK2035 / 1 NS / IN
HEP: HEP B (ENGERIX-B) / GLAXOSMITHKLINE BIOLOGICALS 475PE / UNK RA / IM
IPV: POLIO VIRUS, INACT. (IPOL) / SANOFI PASTEUR K16941 / UNK RA / IM
MMR: MEASLES + MUMPS + RUBELLA (MMR II) / MERCK & CO. INC. K022284 / UNK RA / SC
TDAP: TDAP (ADACEL) / SANOFI PASTEUR C4697AA / UNK LA / IM
VARCEL: VARICELLA (VARIVAX) / MERCK & CO. INC. L016125 / UNK LA / SC

Administered by: Public       Purchased by: Public
Symptoms: Injection site reaction, Keloid scar
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: No meds, no allergies
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Small raised "keloid like" scar to lower portion of deltoid on right arm within hours of administration. No other symptoms.


VAERS ID: 625305 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Minnesota  
Vaccinated:2016-02-15
Onset:2016-02-16
   Days after vaccination:1
Submitted: 2016-02-17
   Days after onset:1
Entered: 2016-02-18
   Days after submission:1
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L045711 / 3 LA / IM

Administered by: Private       Purchased by: Unknown
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: None
CDC Split Type:

Write-up: Dad reports swollen (L) deltoid, raised and red. They applied ice and ibu. Today area viewed, area red/pink. Measured 130mm x 100mm. Pt stated it felt like it was getting better. Area raised and slightly warm to the touch.


VAERS ID: 623147 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2016-01-13
Onset:2016-02-05
   Days after vaccination:23
Submitted: 2016-02-19
   Days after onset:14
Entered: 2016-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU4: INFLUENZA (SEASONAL) (FLUZONE QUADRIVALENT) / SANOFI PASTEUR UI443AC / 7+ LA / IM
HPV9: HPV (GARDASIL 9) / MERCK & CO. INC. L017407 / 1 LA / IM

Administered by: Unknown       Purchased by: Private
Symptoms: Antinuclear antibody negative, Borrelia test negative, C-reactive protein normal, Differential white blood cell count normal, Electroencephalogram normal, Full blood count normal, Metabolic function test normal, Muscle twitching, Nuclear magnetic resonance imaging brain normal, Streptococcus test negative, Thyroxine free normal, Tremor
SMQs:, Neuroleptic malignant syndrome (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None Of note got 2 prior HPV vaccines but were HPV 4 not 9
Current Illness: NO
Preexisting Conditions: NO
Allergies:
Diagnostic Lab Data: Lab work - Metabolic panel, Lyme disease antibody, CBC with diff, ASO titer, ANA titer, CRP, TSH, Free T4--all normal; EEG- normal; Brain MRI-normal
CDC Split Type:

Write-up: Uncontrollable shaking of right hand/ arm- tremors that progressed to leg and shoulder twitching.


VAERS ID: 623149 (history)  
Form: Version 1.0  
Age: 12.0  
Sex: Female  
Location: Maryland  
Vaccinated:2016-02-15
Onset:2016-02-17
   Days after vaccination:2
Submitted: 2016-02-19
   Days after onset:2
Entered: 2016-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPVX: HPV (NO BRAND NAME) / UNKNOWN MANUFACTURER - / 1 RA / IM

Administered by: Unknown       Purchased by: Other
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: No
Preexisting Conditions: NKA
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Broke out in rash on low-mid back and right leg.


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